Limbic and Motor Function Comparison of Deep Brain Stimulation of the Zona Incerta and Subthalamic Nucleus

Burrows, Anthony M.; Ravin, Paula D.; Novák, Péter; Peters, Mary Linton B.; Dessureau, Brian; Swearer, Joan M.; Pilitsis, Julie G.

doi:10.1227/neu.0b013e318232fdac

Cited by 39 publications

(43 citation statements)

References 25 publications

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“…An advantage of ILS stimulation is that 2 regions (e.g., STN and rZI) can be costimulated. With the exception of case reports, there are no large case series of ILS for the treatment of dyskinesias [20, 27-30]. The antidyskinetic effects of rZI stimulation evident in our study and reported in the literature may involve stimulation of the rZI and/or the surrounding pallidothalamic fibers.…”

Section: Discussionmentioning

confidence: 48%

“…Retrospective studies on stimulation of sites immediately dorsal to the STN for the treatment of PD have reported clinical benefits, i.e., reduced tremor, bradykinesia, and rigidity [17, 20-25]. In the only prospective studies evaluating ZI stimulation in PD, Plaha et al [26] determined that patients with cZI or stimulation dorsomedial to the STN compared to patients with STN stimulation had greater improvement in parkinsonism.…”

Section: Discussionmentioning

confidence: 99%

“…Most studies were performed retrospectively and in a small number of patients. In addition, inconsistencies in the efficacy and adverse effects of ZI stimulation exist and likely reflect the inability to directly target the ZI resulting in variability of contact placement [20-23, 31, 32]. Methods for visualization of the rZI allowing direct stereotactic targeting have recently been reported [33, 34].…”

Section: Discussionmentioning

confidence: 99%

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Interleaving Stimulation in Parkinson’s Disease, Tremor, and Dystonia

Kern

Picillo

Thompson

et al. 2018

Stereotact Funct Neurosurg

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Background/Aims: Interleaving stimulation (ILS) in deep brain stimulation (DBS) provides individualized stimulation of 2 contacts delivered in alternating order. Currently, limited information on the utility of ILS exists. The aims of this study were to determine the practical applications and outcomes of ILS DBS in Parkinson’s disease (PD), tremor, and dystonia. Methods: We performed a single-center, unblinded, retrospective chart review of all patients with DBS attempted on ILS at our referral center assessing for rationale and outcomes. Results: Fifty patients (PD, n = 27; tremor, n = 7; dystonia, n = 16 patients) tried ILS for 2 rationales: management of adverse effects (n = 29) and to improve clinical efficacy (n = 21). A total of 19 patients demonstrated improvement with ILS for adverse effect management predominately for the treatment of dyskinesias (n = 12). In the vast majority of dyskinetic patients, a contact added into the rostral zona incerta with ILS was performed. Nine out of 21 patients demonstrated improved clinical efficacy with ILS with all 6 PD patients who tried ILS for this rationale demonstrating benefit. Conclusions: In PD, ILS provided benefits for dyskinesias and parkinsonism, with minimal improvement of other adverse effects. In tremor and dystonia, marginal effects in terms of mitigation of adverse effects and improvement of clinical outcomes were evident.

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Section: Discussionmentioning

confidence: 48%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Interleaving Stimulation in Parkinson’s Disease, Tremor, and Dystonia

Kern

Picillo

Thompson

et al. 2018

Stereotact Funct Neurosurg

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“…Ventrocaudally to the ZI lies the substantia nigra [19,20] , laterally the Ci, and dorsomedially the red nucleus [21,22] . A recent study by Burrows et al [23] comparing DBS of the STN and the ZI provided similar findings resulting in sustained motor benefit with less limbic side effects, including anxiety and self-reported depression, for ZI stimulation. Furthermore, the stimulation of the cZI [18,24,25] seems to be superior compared to the stimulation of the STN in improving contralateral parkinsonism [26] .…”

Section: Deep Brain Stimulation (Dbs)mentioning

confidence: 69%

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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“…However, active electrode contacts often lie in white matter regions, including the zona incerta (ZI) and fields of Forel (FF) 7. Stimulation of the caudal ZI has been reported to be superior to stimulation of STN 8 9. To complicate the issue, the optimal stimulation site may vary by motor symptom—for example, dorsal STN for tremor, central STN for bradykinesia, and ventral STN for gait disturbance 10…”

Section: Introductionmentioning

confidence: 99%