Structure-function relationship of the posterior subthalamic area with directional deep brain stimulation for essential tremor
| Autor: | Michael Schüpbach, Gerd Tinkhauser, Alba Segura Amil, Jean-Philippe Lévy, Lenard Lachenmayer, Andreas Nowacki, Katrin Petermann, Claudio Pollo, Joan P. Michelis, T A Khoa Nguyen, Ines Debove |
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| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
endocrine system
Deep brain stimulation Cognitive Neuroscience medicine.medical_treatment 610 Medicine & health Stimulation lcsh:Computer applications to medicine. Medical informatics 050105 experimental psychology lcsh:RC346-429 Structure-Activity Relationship 03 medical and health sciences 0302 clinical medicine Thalamus Subthalamic Nucleus medicine Humans 0501 psychology and cognitive sciences Radiology Nuclear Medicine and imaging lcsh:Neurology. Diseases of the nervous system Essential tremor business.industry 05 social sciences Structure function Significant difference Medial lemniscus Regular Article medicine.disease Posterior subthalamic area nervous system diseases medicine.anatomical_structure Neurology Corticospinal tract 570 Life sciences biology Zona incerta lcsh:R858-859.7 Neurology (clinical) business Neuroscience Dentato-rubro-thalamic tract 030217 neurology & neurosurgery |
| Zdroj: | NeuroImage: Clinical, Vol 28, Iss, Pp 102486-(2020) NeuroImage : Clinical Lévy, Jean-Philippe; Nguyen, T. A. Khoa; Lachenmayer, Lenard; Debove, Ines; Tinkhauser, Gerd; Petermann, Katrin; Segura Amil, Alba; Michelis, Joan; Schüpbach, Michael; Nowacki, Andreas; Pollo, Claudio (2020). Structure-function relationship of the posterior subthalamic area with directional deep brain stimulation for essential tremor. NeuroImage: Clinical, 28, p. 102486. Elsevier 10.1016/j.nicl.2020.102486 |
| ISSN: | 2213-1582 |
| DOI: | 10.1016/j.nicl.2020.102486 |
| Popis: | Highlights • Directional DBS of the DRTT and the zona incerta is correlated with tremor suppression. • Activation patterns for tremor suppression and side effects involve mostly the dentato-rubro-thalamic tract and the zona incerta. • Concomitant side effects often limit the therapeutic window of directional deep brain stimulation. Deep Brain Stimulation of the posterior subthalamic area is an emergent target for the treatment of Essential Tremor. Due to the heterogeneous and complex anatomy of the posterior subthalamic area, it remains unclear which specific structures mediate tremor suppression and different side effects. The objective of the current work was to yield a better understanding of what anatomical structures mediate the different clinical effects observed during directional deep brain stimulation of that area. We analysed a consecutive series of 12 essential tremor patients. Imaging analysis and systematic clinical testing performed 4–6 months postoperatively yielded location, clinical efficacy and corresponding therapeutic windows for 160 directional contacts. Overlap ratios between individual activation volumes and neighbouring thalamic and subthalamic nuclei as well as individual fiber tracts were calculated. Further, we generated stimulation heatmaps to assess the area of activity and structures stimulated during tremor suppression and occurrence of side effects. Stimulation of the dentato-rubro-thalamic tract and the zona incerta was most consistently correlated with tremor suppression. Both individual and group analysis demonstrated a similar pattern of activation for tremor suppression and different sorts of side-effects. Unlike current clinical concepts, induction of spasms and paresthesia were not correlated with stimulation of the corticospinal tract and the medial lemniscus. Furthermore, we noticed a significant difference in the therapeutic window between the best and worst directional contacts. The best directional contacts did not provide significantly larger therapeutic windows than omnidirectional stimulation at the same level. Deep brain stimulation of the posterior subthalamic area effectively suppresses all aspects of ET but can be associated with concomitant side effects limiting the therapeutic window. Activation patterns for tremor suppression and side effects were similar and predominantly involved the dentato-rubro-thalamic tract and the zona incerta. We found no different activation patterns between different types of side effects and no clear correlation between structure and function. Future studies with use of more sophisticated modelling of activation volumes taking into account fiber heterogeneity and orientation may eventually better delineate these different clusters, which may allow for a refined targeting and programming within this area. |
| Databáze: | OpenAIRE |
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