Illustration of deep brain stimulation electrodes in the brain for tremor control.

Deep Brain Stimulation: A Ray of Hope for Holmes' Tremor

Kai Mendoza in Health & Wellness December 2025 • 4 min read.

"Discover how a cutting-edge approach combining thalamic and subthalamic stimulation offers new possibilities for those battling this rare and debilitating movement disorder."

Holmes' tremor (HT), first identified in 1904, stands as a particularly challenging movement disorder, characterized by a combination of resting, action, and intention tremors. Unlike more common tremors, Holmes' tremor is often resistant to traditional drug therapies, leaving those affected searching for effective solutions to regain control of their movements and improve their daily lives.

Traditional treatments for tremor, including medications like levodopa, often prove ineffective in managing Holmes' tremor. As a result, surgical interventions, such as stereotactic thalamotomy or deep brain stimulation (DBS), are frequently considered to alleviate symptoms when medication fails. These surgical options aim to disrupt the neural pathways responsible for the tremor, providing much-needed relief.

This article explores a recent case where deep brain stimulation (DBS) targeting the ventralis intermedius nucleus of the thalamus (VIM) and the posterior subthalamic area (PSA) successfully improved the condition of a patient with Holmes' tremor resulting from a brainstem hemorrhage. This approach offers a promising avenue for individuals seeking relief from this debilitating condition, highlighting the potential of targeted neurostimulation.

The Dual-Target DBS Approach: How It Works

Illustration of deep brain stimulation electrodes in the brain for tremor control.

The technique involves implanting electrodes in two key brain regions: the ventralis intermedius nucleus of the thalamus (VIM) and the posterior subthalamic area (PSA). The VIM is traditionally targeted for tremor control, while the PSA is believed to modulate motor circuits involved in various types of tremor. Stimulating both areas simultaneously may offer a more comprehensive approach to managing the complex symptoms of Holmes' tremor.

The surgery is performed using stereotactic techniques, ensuring precise placement of the electrodes. Real-time monitoring and adjustments are made during the procedure to optimize electrode positioning and stimulation parameters. Post-operative imaging confirms the accurate placement of the electrodes, which are then connected to a pulse generator implanted under the skin.

Ventralis Intermedius Nucleus (VIM): A primary target for tremor suppression, disrupting the abnormal neural activity that causes tremors.
Posterior Subthalamic Area (PSA): Modulates motor circuits and potentially impacts different types of tremor, offering a broader therapeutic effect.
Stereotactic Techniques: Precise surgical methods that ensure accurate electrode placement within the brain.
Intraoperative Adjustments: Real-time monitoring and adjustments during surgery to optimize electrode position and stimulation settings.

Following the procedure, stimulation parameters are carefully adjusted to maximize tremor control while minimizing side effects. Regular follow-up appointments are necessary to fine-tune the settings and ensure the patient continues to experience optimal relief. The ultimate goal is to significantly reduce tremor and improve motor function, allowing individuals to regain independence and enhance their overall quality of life.

Looking Ahead: DBS and the Future of Tremor Treatment

This case report offers valuable insights into the potential of dual-target DBS for managing Holmes' tremor, a condition notoriously difficult to treat. While further research is needed to confirm these findings and optimize treatment protocols, the results are encouraging and suggest a promising avenue for future investigation.

Future research should focus on larger studies to assess the long-term efficacy and safety of this approach. Additionally, investigations into the specific mechanisms by which VIM and PSA stimulation interact to alleviate tremor symptoms could lead to even more targeted and effective therapies.

By continuing to explore innovative approaches like dual-target DBS, the medical community can offer new hope to individuals battling Holmes' tremor and other challenging movement disorders, improving their quality of life and helping them regain control over their bodies.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1016/j.jocn.2018.10.041, Alternate LINK

Title: Deep Brain Stimulation Of The Ventralis Intermedius Nucleus Of The Thalamus And Posterior Subthalamic Area For Holmes’ Tremor Secondary To Brainstem Hemorrhage: A Case Report

Subject: Physiology (medical)

Journal: Journal of Clinical Neuroscience

Publisher: Elsevier BV

Authors: Chang Duk Yuk, Jun Hyong Ahn, Jae Keun Oh, In Bok Chang, Joon Ho Song, Ji Hee Kim

Published: 2019-02-01

Everything You Need To Know

What exactly is Holmes' tremor, and how does it differ from other types of tremors?

Holmes' tremor is a movement disorder characterized by a combination of resting, action, and intention tremors. It's different from other tremors because it often doesn't respond to traditional drug therapies like levodopa. This resistance to medication makes finding effective treatments more challenging, and often leads to considering surgical options to provide relief.

How does deep brain stimulation (DBS) specifically target Holmes' tremor, and what are the key brain regions involved?

Deep brain stimulation (DBS) for Holmes' tremor involves implanting electrodes in specific brain regions. The ventralis intermedius nucleus of the thalamus (VIM) is targeted for tremor control, while the posterior subthalamic area (PSA) is believed to modulate motor circuits involved in various types of tremor. By stimulating both the VIM and the PSA, the approach aims to provide a more comprehensive way to manage the complex symptoms.

What surgical techniques are used to ensure accurate placement of electrodes during deep brain stimulation (DBS) for Holmes' tremor?

Stereotactic techniques ensure precise placement of electrodes in the brain during deep brain stimulation (DBS) surgery. During the procedure, real-time monitoring and intraoperative adjustments are made to optimize electrode positioning and stimulation parameters. Post-operative imaging confirms accurate electrode placement, which are then connected to a pulse generator implanted under the skin. These steps are essential for maximizing the effectiveness of the stimulation while minimizing potential side effects.

What happens after the deep brain stimulation (DBS) procedure, and how are the stimulation parameters adjusted for optimal results?

Following deep brain stimulation (DBS) surgery for Holmes' tremor, stimulation parameters are carefully adjusted to maximize tremor control and minimize side effects. Regular follow-up appointments are crucial to fine-tune these settings and ensure the patient continues to experience optimal relief. The ultimate goal is to significantly reduce tremor and improve motor function, allowing individuals to regain independence and enhance their overall quality of life. This process of adjustment and monitoring is key to the long-term success of DBS.

What are the next steps in research and development for deep brain stimulation (DBS) as a treatment for Holmes' tremor?

While deep brain stimulation (DBS) targeting the ventralis intermedius nucleus of the thalamus (VIM) and the posterior subthalamic area (PSA) shows promise for Holmes' tremor, it's important to acknowledge that further research is needed. This includes larger studies to confirm these findings, optimize treatment protocols, and understand the long-term effects of dual-target DBS. Future research could also explore other potential brain targets and stimulation parameters to refine the approach and improve outcomes for individuals with Holmes' tremor. Investigating the specific mechanisms by which VIM and PSA stimulation alleviate tremor symptoms will also be important.