Modulation of the Cerebello-Thalamo-Cortical Network in Thalamic Deep Brain Stimulation for Tremor
| Autor: | Volker A. Coenen, Niels Allert, Horst Urbach, Martin Kronenbürger, Burkhard Mädler, Sebastian Paus |
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| Rok vydání: | 2014 |
| Předmět: |
Male
Deep brain stimulation Deep Brain Stimulation medicine.medical_treatment Thalamus Caudal Zona Incerta Cerebellum Neural Pathways Tremor medicine Humans Prospective Studies Diffusion Tractography Aged business.industry Middle Aged Diffusion Tensor Imaging medicine.anatomical_structure Thalamo cortical Modulation Subthalamus Surgery Neurology (clinical) business Nucleus Neuroscience Diffusion MRI |
| Zdroj: | Neurosurgery. 75:657-670 |
| ISSN: | 0148-396X |
| DOI: | 10.1227/neu.0000000000000540 |
| Popis: | Deep brain stimulation alleviates tremor of various origins. Several regions like the ventralis intermediate nucleus of thalamus, the caudal zona incerta, and the posterior subthalamic region are generally targeted. Previous work with fiber tractography has shown the involvement of the cerebello-thalamo-cortical network in tremor control.To report the results of a prospective trial in a group of patients with tremor who underwent post hoc tractographic analysis after treatment with traditional thalamic deep brain stimulation.A total of 11 patients (aged 64 ± 17 years, 6 male) were enrolled (essential tremor [6], Parkinson tremor [3], and myoclonic tremor in myoclonus dystonia [2]). Patients received 1 (3 patients), 2 (7 patients), or 3 (1 patient) quadripolar electrodes. A 32-direction diffusion tensor magnetic resonance imaging sequence was acquired preoperatively. Tractography was processed postoperatively for evaluation and the dentato-rubro-thalamic tract (DRT) was individually tracked. Electrode positions were determined with helical computed tomography. Electric fields (EFs) were simulated according to individual stimulation parameters in a standardized atlas brain space (ICBM-MNI 152).Tremor was reduced in all patients (69.4% mean) on the global (bilateral) tremor score. Effective contacts were located inside or in proximity to the DRT. In moderate tremor reduction (2 patients), the EFs were centered on its anterior border. In good and excellent tremor reduction (9 patients), EFs focused on its center.Deep brain stimulation of the cerebello-thalamo-cortical network reduces tremor. The DRT connects 3 traditional target regions for deep brain stimulation in tremor disease. Tractography techniques can be used to directly visualize the DRT and, therefore, optimize target definition in individual patients. |
| Databáze: | OpenAIRE |
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