Deep Brain Stimulation for Essential Tremor: Aligning Thalamic and Posterior Subthalamic Targets in 1 Surgical Trajectory

Bot, Maarten; Rootselaar, Fleur van; Contarino, Maria Fiorella; Odekerken, Vincent J.J.; Dijk, J. Marc C. van; Bie, Rob M.A. de; Schuurman, Richard; Munckhof, Pepijn van den

doi:10.1093/ons/opx232

Cited by 28 publications

(43 citation statements)

References 28 publications

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“…Beyond these technical differences, tremor benefit is likely multifactorial where variation in surgical technique, stimulation settings, and outcome variables have all contributed to the mixed findings. For instance, it has been suggested that greater tremor control with DRTC stimulation may also be accompanied by an increased incidence of stimulation‐induced ataxia, a common side effect of VIM DBS that is less frequent with caudal zona incerta stimulation—and perhaps more anterior VIM/ventralis oralis stimulation . Additionally, outcome endpoints within studies may be an additional confound given that most connectivity investigations in ET DBS unfortunately have very short follow‐up intervals.…”

Section: Etmentioning

confidence: 99%

A Comprehensive Review of Brain Connectomics and Imaging to Improve Deep Brain Stimulation Outcomes

et al. 2020

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A BS TRACT: DBS is an effective neuromodulatory therapy that has been applied in various conditions, including PD, essential tremor, dystonia, Tourette syndrome, and other movement disorders. There have also been recent examples of applications in epilepsy, chronic pain, and neuropsychiatric conditions. Innovations in neuroimaging technology have been driving connectomics, an emerging whole-brain network approach to neuroscience. Two rising techniques are functional connectivity profiling and structural connectivity profiling. Functional connectivity profiling explores the operational relationships between multiple regions of the brain with respect to time and stimuli. Structural connectivity profiling approximates physical connections between different brain regions through reconstruction of axonal fibers. Through these techniques, complex relationships can be described in various disease states, such as PD, as well as in response to therapy, such as DBS. These advances have expanded our understanding of human brain function and have provided a partial in vivo glimpse into the underlying brain circuits underpinning movement and other disorders. This comprehensive review will highlight the contemporary concepts in brain connectivity as applied to DBS, as well as introduce emerging considerations in movement disorders.

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Section: Etmentioning

confidence: 99%

A Comprehensive Review of Brain Connectomics and Imaging to Improve Deep Brain Stimulation Outcomes

et al. 2020

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“…Because all discussed tremor targets (Vim, Vo, caudal Zi, Raprl, STN) are located in the same area, many authors have suggested lead trajectories engaging multiple targets through different contacts (Figure 3). on the same trajectory ( Figure 3C), the entry point must be moved laterally [56,57]. This approach has been used successfully in many cases of ET [56,57] and Holmes tremor [58], although no large trial has confirmed its formal utility.…”

Section: Combined Targetsmentioning

confidence: 99%

“…on the same trajectory ( Figure 3C), the entry point must be moved laterally [56,57]. This approach has been used successfully in many cases of ET [56,57] and Holmes tremor [58], although no large trial has confirmed its formal utility. For patients with tremor predominant PD, a posterior trajectory targeting both the DRTT and STN [59] or Vim and STN [60] have also been suggested ( Figure 3D).…”

Section: Combined Targetsmentioning

confidence: 99%

Deep Brain Stimulation for Essential Tremor and Other Tremor Syndromes: A Narrative Review of Current Targets and Clinical Outcomes

Iorio-Morin

Fomenko

Kalia

2020

Preprint

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Tremor is a prevalent symptom associated with multiple conditions, including Essential Tremor (ET), Parkinson’s disease (PD), multiple sclerosis (MS), stroke, and trauma. The surgical management of tremor evolved from stereotactic lesions to deep-brain stimulation (DBS), which allowed safe and reversible interference with specific neural networks. This paper reviews the current literature on DBS for tremor, starting with a detailed discussion of current tremor targets (Vim, Raprl, caudal Zi, Vo and STN) and continuing with a discussion of results obtained when performing DBS in the various aforementioned tremor syndromes. Future directions for DBS research are then briefly discussed.

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“…In four patients, both the VIM and PSA were targeted. In the other three patients, both regions were not simultaneously targeted because we were unable to align them in one trajectory (Bot et al, 2017).…”

Section: Surgical Proceduresmentioning

confidence: 99%

Bilateral Posterior Subthalamic Area Deep Brain Stimulation for Essential Tremor: A Case Series

Sun

Huang

Pan

et al. 2020

Front. Hum. Neurosci.

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Background: Deep brain stimulation (DBS) of the posterior subthalamic area (PSA) provides a potentially effective treatment for medication-refractory essential tremor (ET). Objective: To study the clinical benefits and adverse-event profile of bilateral PSA-DBS for refractory ET. Methods: Seven patients with refractory ET underwent bilateral PSA-DBS surgery under general anesthesia between September 2017 and May 2018. Clinical outcome assessments, using the Essential Tremor Rating Scale, were performed at 1-, 6-, and 12-month follow-up, except for the last assessment of one patient who was followed up to 9 months. Analysis was focused on changes in patients' motor symptoms and quality of life following surgery as well as documenting the adverse-event profile associated with the surgical PSA-DBS treatment. Results: After surgery, patients' motor symptoms, including upper limb tremor and head tremor, were improved by 84.2% and their quality of life by 81.25% at 1-month follow-up. The clinical benefits to patients were maintained at 6-month and last follow-up. Adverse side effects included dysarthria (n = 4), balance disorder (n = 2), and paresthesia of the right limb (n = 1). No habituation effects were observed throughout the follow-up. Conclusion: Bilateral PSA-DBS seems to offer an effective and safe alternative treatment for medically intractable ET, warranting further research into its clinical utility, adverse-event profile, and comparative effectiveness.

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Deep Brain Stimulation for Essential Tremor: Aligning Thalamic and Posterior Subthalamic Targets in 1 Surgical Trajectory

Cited by 28 publications

References 28 publications

A Comprehensive Review of Brain Connectomics and Imaging to Improve Deep Brain Stimulation Outcomes

A Comprehensive Review of Brain Connectomics and Imaging to Improve Deep Brain Stimulation Outcomes

Deep Brain Stimulation for Essential Tremor and Other Tremor Syndromes: A Narrative Review of Current Targets and Clinical Outcomes

Bilateral Posterior Subthalamic Area Deep Brain Stimulation for Essential Tremor: A Case Series

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