Ventral intermediate nucleus of the thalamus, dentatorubrothalamic tract, and caudal zona incerta: stimulation of which structure provides ongoing tremor control in patients with essential tremor?

Autor:	Remore LG; 1Department of Neurosurgery, University of California, Los Angeles, California.; 2University of Milan 'LA STATALE,' Milan, Italy.; 3Department of Neurosurgery, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy., Rifi Z; 1Department of Neurosurgery, University of California, Los Angeles, California., Tsolaki E; 1Department of Neurosurgery, University of California, Los Angeles, California., Ward MJ; 1Department of Neurosurgery, University of California, Los Angeles, California., Wei W; 1Department of Neurosurgery, University of California, Los Angeles, California., Tolossa M; 1Department of Neurosurgery, University of California, Los Angeles, California., Locatelli M; 2University of Milan 'LA STATALE,' Milan, Italy.; 3Department of Neurosurgery, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy.; 4Department of Pathophysiology and Transplantation, University of Milan, Italy.; 5'Aldo Ravelli' Research Center for Neurotechnology and Experimental Brain Therapeutics, University of Milan, Italy., Bari AA; 1Department of Neurosurgery, University of California, Los Angeles, California.; 6David Geffen School of Medicine, University of California, Los Angeles, California.
Jazyk:	angličtina
Zdroj:	Neurosurgical focus [Neurosurg Focus] 2024 Jun; Vol. 56 (6), pp. E15.
DOI:	10.3171/2024.3.FOCUS2425
Abstrakt:	Objective: Essential tremor (ET) is the most common movement disorder. Deep brain stimulation (DBS) targeting the ventral intermediate nucleus (VIM) is known to improve symptoms in patients with medication-resistant ET. However, the clinical effectiveness of VIM-DBS may vary, and other targets have been proposed. The authors aimed to investigate whether the same anatomical structure is responsible for tremor control both immediately after VIM-DBS and at later follow-up evaluations. Methods: Of 68 electrodes from 41 patients with ET, the authors mapped the distances of the active contact from the VIM, the dentatorubrothalamic tract (DRTT), and the caudal zona incerta (cZI) and compared them using Friedman's ANOVA and the Wilcoxon signed-rank follow-up test. The same distances were also compared between the initially planned target and the final implantation site after intraoperative macrostimulation. Finally, the comparison among the three structures was repeated for 16 electrodes whose active contact was changed after a mean 37.5 months follow-up to improve tremor control. Results: After lead implantation, the VIM was statistically significantly closer to the active contact than both the DRTT (p = 0.008) and cZI (p < 0.001). This result did not change if the target was moved based on intraoperative macrostimulation. At the last follow-up, the active contact distance from the VIM was always significantly less than that of the cZI (p < 0.001), but the distance from the DRTT was reduced and even less than the distance from the VIM. Conclusions: In patients receiving VIM-DBS, the VIM itself is the structure driving the anti-tremor effect and remains more effective than the cZI, even years after implantation. Nevertheless, the role of the DRTT may become more important over time and may help sustain the clinical efficacy when the habituation from the VIM stimulation ensues.
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu