Correlation between MRI-Based Stereotactic Thalamic Deep Brain Stimulation Electrode Placement, Macroelectrode Stimulation and Clinical Response to Tremor Control

Mobin, Fardad; Salles, Antonio A. F. De; Behnke, Eric; Frysinger, Robert C.

doi:10.1159/000029730

Cited by 49 publications

(26 citation statements)

References 22 publications

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“…Correct targeting of the ventro-lateral thalamus has been reported to result in insufficient intraoperative tremor control [6,29,36,37,64], and superior effects on severe intention tremor in ET and MS have been ascribed to DBS in the posterior subthalamic white matter [3,36,45,48,53]. In one of our patients we did not achieve sufficient tremor control until the left electrode which had been inserted properly into the ventro-lateral thalamus was repositioned to be finally placed into the subthalamic area [21].…”

Section: Discussionmentioning

confidence: 98%

Deep brain stimulation in the subthalamic area is more effective than nucleus ventralis intermedius stimulation for bilateral intention tremor

Hamel

Herzog

Kopper

et al. 2007

Acta Neurochir (Wien)

138

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SummaryBackground. The ventro-lateral thalamus is the stereotactic target of choice for severe intention tremor. Nevertheless, the optimal target area has remained controversial, and targeting of the subthalamic area has been suggested to be superior.Patients and methods. Eleven patients with disabling intention tremor of different etiology (essential tremor (n ¼ 8), multiple sclerosis (n ¼ 2) and one with, spinocerebellar ataxia) were implanted bilaterally with DBS electrodes targeted to the ventro-lateral thalamus using micro-recording and micro-stimulation. Among five tracks explored in parallel optimal tracks were chosen for permanent electrode implantation. Postoperative tremor suppression elicited by individual electrode contacts was quantified using a lateralised tremor rating scale at least 3 months (in most patients >1 year) after implantation. The position of electrode contacts was determined retrospectively from stereotactic X-ray exams and by correlation of pre-and postoperative MRI.Results. In all patients, DBS suppressed intention tremor markedly. On average, tremor on the left and right side of the body was improved by 68% (AE19; standard deviation) and 73% (AE21), respectively. In most patients, distal electrode contacts located in the subthalamic area proved to be more effective than proximal contacts in the ventro-lateral thalamus. In stereotactic coordinates, the optimal site was located 12.7 mm (AE1.4; mean AE standard deviation) lateral, 7.0 (AE 1.6) mm posterior, and 1.5 (AE 2.0) mm ventral to the mid-commissural point. In general, the best contacts could be selected for permanent stimulation. Nevertheless, in some instances, more proximal contacts had to be chosen because of adverse effects (paraesthesiae, dysarthria, gait ataxia) which were more pronounced with bilateral stimulation resulting in slightly less tremor suppression on the left and right side of body (63 AE 18 and 68 AE 19%, respectively).Conclusion. Direct comparison of different stimulation sites in individual patients revealed that DBS in the subthalamic area is more effective in suppressing pharmacoresistant intention tremor than the ventro-lateral thalamus proper. Anatomical structures possibly involved in tremor suppression include cerebello-thalamic projections, the prelemniscal radiation, and the zona incerta.

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Section: Discussionmentioning

confidence: 98%

Deep brain stimulation in the subthalamic area is more effective than nucleus ventralis intermedius stimulation for bilateral intention tremor

Hamel

Herzog

Kopper

et al. 2007

Acta Neurochir (Wien)

138

View full text Add to dashboard Cite

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“…MER was considered mandatory for target verification in the early days [18,74,75]. Nowadays, image-guided operation without MER is being increasingly practiced, and its targeting accuracy and clinical efficacy are comparable to those with MER [15,32,33,35,41,53].…”

Section: Discussionmentioning

confidence: 99%

Review on Factors Affecting Targeting Accuracy of Deep Brain Stimulation Electrode Implantation between 2001 and 2015

Li¹,

Zhang

Yan

et al. 2016

Stereotact Funct Neurosurg

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Background: Accurate implantation of a depth electrode into the brain is of the greatest importance in deep brain stimulation (DBS), and various stereotactic systems have been developed for electrode implantation. However, an updated analysis of depth electrode implantation in the modern era of DBS is lacking. Objective: This study aims at providing an updated review on targeting accuracy of DBS electrode implantation by analyzing contemporary DBS electrode implantation operations from the perspective of precision engineering. Methods: Eligible articles with information on targeting accuracy of DBS electrode implantation were searched in the PubMed database. Results: An average targeting error of DBS electrode implantation is reported to decrease toward 1 mm; the standard deviation of targeting error is decreasing toward 0.5 mm. Targeting accuracy is not only found to be affected by individual surgical steps, but also systematically affected by the architecture of the implantation operation. Conclusion: A systematic strategy should be adopted to further improve the targeting accuracy of depth electrode implantation. Attention should be paid to optimizing the whole electrode implantation operation, which can help minimize error accumulation or amplification throughout the serially connected procedures for DBS electrode implantation.

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“…The most ventral electrode, contact 0, of a Medtronic DBS lead (Model 3387, Minneapolis, MN) was positioned in the center of Vim thalamus and oriented 30° anterior to the coronal plane [Mobin et al, 1999], although the optimal location for tremor control is at the ventral border of Vim thalamus, near cerebellar fibers [Klein et al, 2012]. The conductivities of the metal electrodes and insulating material between electrodes were 1e7 and 1e-10 S/m, respectively [Wei and Grill, 2005].…”

Section: Methodsmentioning

confidence: 99%

Short pauses in thalamic deep brain stimulation promote tremor and neuronal bursting

Swan

Brocker

Hilliard

et al. 2016

Clinical Neurophysiology

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Objective We conducted intraoperative measurements of tremor during DBS containing short pauses (≤50 ms) to determine if there is a minimum pause duration that preserves tremor suppression. Methods Nine subjects with ET and thalamic DBS participated during IPG replacement surgery. Patterns of DBS included regular 130 Hz stimulation interrupted by 0, 15, 25 or 50 ms pauses. The same patterns were applied to a model of the thalamic network to quantify effects of pauses on activity of model neurons. Results All patterns of DBS decreased tremor relative to ‘off’. Patterns with pauses generated less tremor reduction than regular high frequency DBS. The model revealed that rhythmic burst-driver inputs to thalamus were masked during DBS, but pauses in stimulation allowed propagation of bursting activity. The mean firing rate of bursting-type model neurons as well as the firing pattern entropy of model neurons were both strongly correlated with tremor power across stimulation conditions. Conclusion The temporal pattern of stimulation influences the efficacy of thalamic DBS. Pauses in stimulation resulted in decreased tremor suppression indicating that masking of pathological bursting is a mechanism of thalamic DBS for tremor. Significance Pauses in stimulation decreased the efficacy of open-loop DBS for suppression of tremor.

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Correlation between MRI-Based Stereotactic Thalamic Deep Brain Stimulation Electrode Placement, Macroelectrode Stimulation and Clinical Response to Tremor Control

Cited by 49 publications

References 22 publications

Deep brain stimulation in the subthalamic area is more effective than nucleus ventralis intermedius stimulation for bilateral intention tremor

Deep brain stimulation in the subthalamic area is more effective than nucleus ventralis intermedius stimulation for bilateral intention tremor

Review on Factors Affecting Targeting Accuracy of Deep Brain Stimulation Electrode Implantation between 2001 and 2015

Short pauses in thalamic deep brain stimulation promote tremor and neuronal bursting

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