Deep brain stimulation of the subthalamic nucleus versus the zona incerta in the treatment of essential tremor

Blomstedt, Patric; Sandvik, Ulrika; Lindér, Jan; Fredricks, Anna; Forsgren, Lars; Hariz, Marwan

doi:10.1007/s00701-011-1157-4

Cited by 57 publications

(40 citation statements)

References 17 publications

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“…Particularly the stimulation of the caudal component of the Zi [50,51] seems to provide a greater therapeutic benefit compared to the stimulation of the Stn, the currently preferred target structure for PD [21]. Several studies suggested that cZi nucleus is effective in suppressing tremors of various etiologies of both the distal and proximal extremities [52][53][54]. a recent study comparing DBS of the Stn and the Zi found similar results for the motor function but specific improvement in anxiety and Table 3 average signal-to-noise ratios (Snr) and contrast-to-noise ratios (cnr) of the zona incerta for each sequence to balance the differences of the vendor optimised sequences in slice thickness and pixel size the measured Snr and cnr values were adjusted to a voxel of 1 x 1 x 1 mm³ c Sequences with a statistically significant superior SNR and CNR values compared to T2-FLAIR imaging (paired t-test) are denoted (*) self-reported depression for Zi stimulation [55].…”

Section: Discussionmentioning

confidence: 99%

Visualisation of the Zona Incerta for Deep Brain Stimulation at 3.0 Tesla

et al. 2012

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Section: Discussionmentioning

confidence: 99%

Visualisation of the Zona Incerta for Deep Brain Stimulation at 3.0 Tesla

et al. 2012

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“…However, this 3.2% represents only one procedure at one surgical center. There is currently limited evidence supporting the use of STN-targeted DBS for ET [24,25]. …”

Section: Discussionmentioning

confidence: 99%

An International Survey of Deep Brain Stimulation Procedural Steps

Abosch

Timmermann

Bartley

et al. 2012

Stereotact Funct Neurosurg

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104

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Background: Deep brain stimulation (DBS) surgery is standard of care for the treatment of certain movement disorders. Objective: We sought to characterize the spectrum of steps performed in DBS surgery, at centers around the world where this surgery is performed. Methods: We identified the main steps in DBS surgery workflow and grouped these 19 steps into 3 phases (preoperative, operative, and postoperative). A survey tool, informed by a pilot survey, was administered internationally by trained study personnel at high- and low-volume DBS centers. Procedural components, duration, and surgeon motivational factors were assessed. Cluster analysis was used to identify procedural and behavioral clusters. Results: One hundred eighty-five procedure workflow surveys (143 DBS centers) and 65 online surveys of surgeon motivational drivers were completed (45% response rate). Significant heterogeneity in technique, operative time, and surgeon motivational drivers was reported across centers. Conclusions: We provide a description of the procedural steps involved in DBS surgery and the duration of these steps, based on an international survey. These data will enable individual surgeons and centers to examine their own experience relative to colleagues at other centers and in other countries. Such information could also be useful in comparing efficiencies and identifying workflow obstacles between different hospital environments.

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“…The ZI, an embryological derivate of the ventral thalamus, is a small horizontally elongated area of grey matter cells in the subthalamic region of the mesencephalon. The nucleus gains increasing importance as an alternative target for the treatment with DBS of various neurological and psychiatrical disorders including ET and PD [12,13] . It is located at the base of the dorsal thalamus and separates the lenticular fasciculus from the thalamic fasciculus ("field H1 and H2 of Forel") [14,15] .…”

Section: Deep Brain Stimulation (Dbs)mentioning

confidence: 99%

Imaging for deep brain stimulation: The zona incerta at 7 Tesla

Kerl

Gerigk²,

Brockmann³

et al. 2013

WJR

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AIM:To evaluate different promising magnetic resonance imaging (MRI) methods at 7.0 Tesla (T) for the pre-stereotactic visualization of the zona incerta (ZI). METHODS:Two neuroradiologists qualitatively and quantitatively examined T2-turbo spin-echo (T2-TSE), T1-weighted gradient-echo, as well as FLASH2D-T2Star and susceptibility-weighted imaging (SWI) for the visualization of the ZI at 7.0 T MRI. Delineation and image quality for the ZI were independently examined using a 6-scale grading system. Inter-rater reliability using Cohen's kappa coefficient (κ ) were assessed. Contrast-tonoise ratios (CNR), and signal-to-noise ratios (SNR) for the ZI were calculated for all sequences. Differences in delineation, SNR, and CNR between the sequences were statistically assessed using a paired t -test. For the anatomic validation the coronal FLASH2D-T2Star images were co-registered with a stereotactic atlas (Schaltenbrand-Wahren). RESULTS:The rostral part of the ZI (rZI) could easily be identified and was best and reliably visualized in the coronal FLASH2D-T2Star images. The caudal part was not definable in any of the sequences. No major artifacts in the rZI were observed in any of the scans. FLASH2D-T2Star and SWI imaging offered significant higher CNR values for the rZI compared to T2-TSE images (P > 0.05). The co-registration of the coronal FLASH2D-T2Star images with the stereotactic atlas schema (Schaltenbrand-Wahren) confirmed the correct localization of the ZI in all cases.CONCLUSION: FLASH2D-T2Star imaging (particularly coronal view) provides the reliable and currently optimal visualization of the rZI at 7.0 T. These results can facilitate a better and more precise targeting of the caudal part of the ZI than ever before.

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Deep brain stimulation of the subthalamic nucleus versus the zona incerta in the treatment of essential tremor

Abstract: In this limited material, STN DBS was demonstrated to be an efficient treatment for ET, even though cZi DBS was more efficient. The STN may be an alternative target in the treatment of ET, pending further investigations to decide on the relative merits of the different targets.

Cited by 57 publications

References 17 publications

Visualisation of the Zona Incerta for Deep Brain Stimulation at 3.0 Tesla

Visualisation of the Zona Incerta for Deep Brain Stimulation at 3.0 Tesla

An International Survey of Deep Brain Stimulation Procedural Steps

Imaging for deep brain stimulation: The zona incerta at 7 Tesla

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