High Frequency Deep Brain Stimulation of Superior Cerebellar Peduncles in a Patient with Cerebral Palsy

Lin, Song-Sun; Zhang, Chencheng; Li, Hongxia; Wang, Yuhan; Wu, Yunhao; Wang, Tao; Pan, Yixin; Sun, Bomin; Wu, Yiwen; Li, Dianyou

doi:10.5334/tohm.551

Cited by 14 publications

(17 citation statements)

References 21 publications

(38 reference statements)

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“…31 Because the DRTT is a critical relay connecting these nodes of the sensorimotor network, abnormalities indicative of degraded axonal integrity suggest a microstructural correlate of the network dysfunction. The potential therapeutic relevance of this path is highlighted by cases demonstrating the efficacy of deep brain stimulation of cerebellar outflow regions in patients with secondary dystonias, [32][33][34][35] with whom a dysfunctional network involving cerebellar outflow pathways is shared by patients with CD. 31 Similar DTI abnormalities (decrease of FA and AD) are also found in conditions characterized by disrupted brain maturation, [36][37][38][39][40] which is supported by the association of the idiopathic dystonia spectrum with neurodevelopmental disorders, such as major depressive disorder, schizophrenia, and obsessivecompulsive disorder.…”

Section: Discussionmentioning

confidence: 99%

Microstructural Abnormalities of the Dentatorubrothalamic Tract in Cervical Dystonia

et al. 2021

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Background The dentatorubrothalamic tract (DRTT) remains understudied in idiopathic cervical dystonia (CD), despite evidence that the pathway is relevant in the pathophysiology of the disorder. Objective The aim of this study was to examine the DRTT in patients with CD using diffusion tensor imaging (DTI)–based tractography. Methods Magnetic resonance imaging scans from 67 participants were collected to calculate diffusion tractography metrics using a binary tractography‐based DRTT template. Fractional anisotropy and diffusivity measures of left and right DRTT were computed and compared between 32 subjects with CD and 35 age‐matched healthy volunteers. Results Fractional anisotropy of right DRTT and mean and axial diffusivity of left DRTT were significantly reduced in patients with CD. Similar abnormalities were observed in patients with focal CD and patients with CD without tremor. DTI metrics did not correlate with disease duration or severity. Conclusions Significant reductions in DTI measures suggest microstructural abnormalities within the DRTT in CD, characterized by a tractography pattern consistent with decreased axonal integrity. © 2021 International Parkinson and Movement Disorder Society

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Section: Discussionmentioning

confidence: 99%

Microstructural Abnormalities of the Dentatorubrothalamic Tract in Cervical Dystonia

et al. 2021

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“…Cerebellar stimulation-induced complications including ipsilateral leaning, dizziness, appendicular ataxia, gaze deviation, nausea, decreased verbal fluency, and forced laughing have been reported ( 9 , 10 , 26 ). Interestingly, the present patient showed hypersalivation and hyperhidrosis after the surgery, which have not been reported.…”

Section: Discussionmentioning

confidence: 99%

Case Report: Deep Cerebellar Stimulation for Tremor and Dystonia

et al. 2021

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Background: The cerebellum plays an important role in the pathogenesis and pathophysiology of movement disorders, including tremor and dystonia. To date, there have been few reports on deep cerebellar stimulation.Case Report: The patient was a 35-year-old previously healthy man with no history of movement disorders. He developed a tremor and stiffness in his left hand at the age of 27 years, which was diagnosed as a dystonic tremor. We performed right thalamotomy, which resulted in a complete resolution of the tremor; however, the dystonia persisted. Subsequently, the patient developed left foot dystonia with inversion and a newly developed tremor in the right hand and foot. The patient underwent left ventralis intermedius (VIM) deep brain stimulation (VIM-DBS) and left pallidothalamic tract DBS (PTT-DBS). Left VIM-DBS completely resolved the right hand and foot tremor, and PTT-DBS significantly improved the left hand and foot dystonia. Three months postoperatively, the patient developed an infection and wound disruption at the surgical site. We performed palliative surgery for deep cerebellar stimulation via the posterior cranial region, which was not infected. The surgery was performed under general anesthesia with the patient lying in the prone position. Eight contact DBS electrodes were used. The placement of electrodes extended from the superior cerebellar peduncle to the dentate nucleus. Both the right hand and foot tremor improved with right cerebellar stimulation. Further, both the left hand and foot dystonia improved with left cerebellar stimulation. Right and left cerebellar stimulation led to no improvement in the left hand and foot dystonia and right hand and foot tremor, respectively. Stimulation-induced complications observed in the patient included dizziness, dysphagia, and dysarthria. After the surgery, the patient developed hypersalivation and hyperhidrosis in the left side of the body, both of which did not improve with adjustments of stimulation parameters. At the 6-month follow-up, the tremor and dystonia had almost completely resolved.Conclusion: Deep cerebellar stimulation deserves consideration as a potential treatment for tremor and dystonia.

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“…Although pallidal deep brain stimulation is still the gold standard for medically intractable generalized and cervical dystonia [ 156 , 157 , 158 , 159 ], Vo thalamic nucleus surgeries, which is innervated by both the pallidum and cerebellum, are effective for some forms of dystonia [ 160 , 161 , 162 , 163 , 164 , 165 , 166 , 167 , 168 , 169 , 170 , 171 ]. Recently, evidence from basic and clinical research has facilitated the revival of cerebellar surgery for dystonia [ 172 , 173 , 174 , 175 , 176 , 177 , 178 ], which mainly targets the deep cerebellar nuclei and superior cerebellar peduncles. The primary target nucleus in the cerebellum is the motor (dorsal) part of the dentate nucleus [ 173 ].…”

Section: Research Regarding the Role Of The Cerebellum In Dystonia Genesismentioning

confidence: 99%

“…The primary target nucleus in the cerebellum is the motor (dorsal) part of the dentate nucleus [ 173 ]. In addition, deep brain stimulation (DBS) of the superior cerebellar peduncle is preferred to avoid accompanying side effects, including dizziness, nystagmus, and ipsilateral leaning, as observed in studies of the dentate nucleus [ 172 , 175 ]. Recent studies have used high-frequency stimulations (104–300 Hz), pulse width (50–180 μs), 1.2–2.8V for stimulation of the dentate nucleus [ 174 , 178 ], and 130–200 Hz, 50–180 μs, 1.4–8.0 V for stimulation of the superior cerebellar peduncle [ 172 , 175 , 176 ].…”

Section: Research Regarding the Role Of The Cerebellum In Dystonia Genesismentioning

confidence: 99%

“…In addition, deep brain stimulation (DBS) of the superior cerebellar peduncle is preferred to avoid accompanying side effects, including dizziness, nystagmus, and ipsilateral leaning, as observed in studies of the dentate nucleus [ 172 , 175 ]. Recent studies have used high-frequency stimulations (104–300 Hz), pulse width (50–180 μs), 1.2–2.8V for stimulation of the dentate nucleus [ 174 , 178 ], and 130–200 Hz, 50–180 μs, 1.4–8.0 V for stimulation of the superior cerebellar peduncle [ 172 , 175 , 176 ]. Evidence also suggests the effectiveness of cerebellar modulation in dystonia treatment; however, the efficacy of GPi or Vo thalamic DBS, not the Vim nucleus, where more abundant cerebellar inputs come, implies the importance of the cortico-basal ganglia-thalamo-cortical circuitry in its pathogenesis [ 6 ].…”

Section: Research Regarding the Role Of The Cerebellum In Dystonia Genesismentioning

confidence: 99%

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Dystonia and Cerebellum: From Bench to Bedside

Morigaki

Miyamoto

Matsuda

et al. 2021

Life

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Dystonia pathogenesis remains unclear; however, findings from basic and clinical research suggest the importance of the interaction between the basal ganglia and cerebellum. After the discovery of disynaptic pathways between the two, much attention has been paid to the cerebellum. Basic research using various dystonia rodent models and clinical studies in dystonia patients continues to provide new pieces of knowledge regarding the role of the cerebellum in dystonia genesis. Herein, we review basic and clinical articles related to dystonia focusing on the cerebellum, and clarify the current understanding of the role of the cerebellum in dystonia pathogenesis. Given the recent evidence providing new hypotheses regarding dystonia pathogenesis, we discuss how the current evidence answers the unsolved clinical questions.

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High Frequency Deep Brain Stimulation of Superior Cerebellar Peduncles in a Patient with Cerebral Palsy

Cited by 14 publications

References 21 publications

Microstructural Abnormalities of the Dentatorubrothalamic Tract in Cervical Dystonia

Microstructural Abnormalities of the Dentatorubrothalamic Tract in Cervical Dystonia

Case Report: Deep Cerebellar Stimulation for Tremor and Dystonia

Dystonia and Cerebellum: From Bench to Bedside

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