Difference in surgical strategies between thalamotomy and thalamic deep brain stimulation for tremor control

Abstract

Stereotactic targeting strategies differ between thalamotomy and thalamic deep brain stimulation (DBS) for tremor control. In thalamotomy, a minimal radiofrequency lesion created within the lateral portion of the nucleus ventralis intermedius (Vim) often affords the best control of parkinsonian tremor, supporting the assumption that there is a concentrated cluster of cells within this area which is responsible for tremor. However, this assumption may not always be true; such neural elements sometimes appear to spread out across wide areas. Cells with tremor-frequency activity are widely distributed over the areas extending from the Vim to the nuclei ventralis oralis posterior and anterior (Vop and Voa). All of these cells appear to be more or less involved in tremor generation, especially in patients with essential tremor and post-stroke tremor. In contrast to radiofrequency lesions for thalamotomy, electrodes for DBS can be arranged in such a way that wide areas can be stimulated, if necessary. For this purpose, it is critically important to determine optimal placement and orientation of DBS leads for arranging the electrodes to yield maximal benefits in patients with tremor.

Thalamic Deep Brain Stimulation for Parkinson’s Disease

“…This may play a role in the better surgical outcomes seen in PD patients (Brodkey et al, 2004). Based on their experiences, Katayama et al (2005) postulated that tremor cells might play a predominant role in the lateral portion of the Vim nucleus, which provides the best control of PD-associated tremor, in accordance with previous reports (Atkinson et al, 2002;Hariz & Hirabayashi., 1997).…”

“…However, recent studies show that tremor cells are widely distributed in the Vim, Vo, and Vc nuclei, and that they show no apparent differences in proportion within each nucleus (Kobayashi et al, 2003;Brodkey et al, 2004). These findings suggest that the ideal surgical target might not be determined by microelectrode recordings of tremor cells alone (Kobayashi et al, 2003;Katayama et al, 2005). The number of tremor cells in PD patients is much higher than that in patients with other movement disorders, such as essential tremor and multiple sclerosis.…”

Issues Related to Deep Brain Stimulation for Treatment-Refractory Tourette’s Syndrome

“…The anterior CM-Pf is able to influence cells involved in tremor generation located in a wide area including the ventral oral anterior and posterior (VoA and VoP) nuclei [Katayama et al, 2005]. The intralaminar nuclei and CM-Pf convey multimodal stimulatory signals to the striatum, and are thus involved in attention and arousal in response to stimulation.…”

An integrated wearable robot for tremor suppression with context aware sensing

“…On the other hand, DBS has shown remarkable successes in removing tremors, and enabled many patients to return to normal healthy life. DBS reduces the tremor by stimulating targeted areas of the brain, such as globus pallidus internus and subthalamic nucleus, depends on the specific symptom [11,12]. Despite the high risk of neurosurgery, DBS is only suitable for a small group of patients and may cause disturbances in behavior and cognition and cerebral hemorrhage [11,12].…”

“…DBS reduces the tremor by stimulating targeted areas of the brain, such as globus pallidus internus and subthalamic nucleus, depends on the specific symptom [11,12]. Despite the high risk of neurosurgery, DBS is only suitable for a small group of patients and may cause disturbances in behavior and cognition and cerebral hemorrhage [11,12]. Less invasive approaches, such as exoskeleton and assistive devices, have been proposed as an alternative approach to attenuate tremor and assist daily living [13,14].…”