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doi: 10.1227/NEU.0000000000000540

Modulation of the Cerebello-thalamo-cortical Network in Thalamic Deep Brain Stimulation for Tremor: A Diffusion Tensor Imaging Study.

Coenen, Volker Arnd M.D.; Allert, Niels M.D.; Paus, Sebastian M.D.; Kronenbürger, Martin M.D.; Urbach, Horst M.D.; Mädler, Burkhard Ph.D.

Published Ahead-of-Print
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Background: 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.

Objective: To report the results of a prospective trial in a group of tremor patients that underwent posthoc tractographic analysis after treatment with traditional thalamic deep brain stimulation.

Methods: A total of 11 patients (aged 64+/-17 years, 6 male) were enrolled (Essential Tremor (6), Parkinson's tremor (3) and myoclonic tremor in myoclonus dystonia (2)). Patients received one (3), two (7), or three (1) 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 CT. Electric fields (EFs) were simulated according to individual stimulation parameters in a standardized atlas brain space (ICBM-MNI152).

Results: 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.

Conclusion: DBS of the cerebello-thalamo-cortical network reduces tremor. The DRT connects three 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.

Copyright (C) by the Congress of Neurological Surgeons


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