Cerebellum theta-burst stimulation as a supplementary treatment for tremor induced by bilateral hypertrophic olivary degeneration: a case report

作者：Yinglun Chen, Yiqian Hu, Jian Zhang · 发表于：Physiotherapy Theory and Practice · 年份：2025 · DOI：10.1080/09593985.2025.2532571 · 研究领域：Neurological disorders and treatments、Glycogen Storage Diseases and Myoclonus、Botulinum Toxin and Related Neurological Disorders

BACKGROUND: Hemorrhage can result in bilateral hypertrophic olivary degeneration (HOD) by damaging the dentato-rubral-olivary pathway, which may lead to tremor that is resistant to pharmacological management. In recent years, the cerebellum has emerged as a promising target for noninvasive brain stimulation in the treatment of post-stroke motor dysfunction. However, the effects of noninvasive brain stimulation on post-stroke tremor remain uncertain. PURPOSE: To describe and evaluate the effects of theta-burst stimulation (TBS) on tremor induced by bilateral HOD. CASE DESCRIPTION: A 50-year-old man with pontine hemorrhage was admitted to hospital because of unilateral tremor, dizziness, and ataxia. The intention tremor on the right side at a frequency of 2-3 Hz was pronounced. The Fahn-Tolosa-Marin tremor rating scale and Scale for Assessment and Rating of Ataxia were 61 and 25 points. Magnetic resonance imaging (MRI) performed 8 months after symptom onset revealed bilaterally enlarged inferior olivary nuclei. The patient underwent physical therapy for 4 months and pharmacological treatment for 2 months, but his right-sided tremor persisted. Consequently, in addition to personalized physiotherapy and medications, continuous TBS (cTBS) was applied to the right cerebellum, using 60% of the right hemisphere resting motor threshold (RMT) as the stimulation intensity. OUTCOMES: After a two-week intervention, cTBS protocol led to worsened dizziness without any alleviation of the tre...