A 60-year-old male presented to functional neurosurgeon Stephen C. Harward II, MD, PhD, with severe essential tremor (ET), a history of hypertension, and von Willebrand disease (VWD) Type 2B.
The patient reported a more than 20-year history of tremor impacting both hands, with his left, dominant hand most affected. Despite medication trials, the patient’s tremors progressed. Upon neurologic exam, the patient scored a 34 on the Clinical Rating Scale for Tremor (CRST). He reported disability with writing, eating with utensils, and drinking out of a cup.
Harward proposed placing bilateral deep brain stimulating (DBS) electrodes into the ventral intermediate nucleus (VIM)—the current standard of care. However, the patient declined DBS. His father, who also had ET and VWD Type 2B, previously underwent DBS surgery and encountered significant hemorrhagic complications, which terminated the procedure.
Read the full case on Clinical Practice Today.