The tremor network targeted by successful VIM deep brain stimulation in humans

Klein, Johannes; Barbe, Michael T.; Seifried, Carola; Baudrexel, Simon; Runge, Matthias; Maarouf, Mohammad; Gasser, Thomas; Hattingen, Elke; Liebig, Thomas; Deichmann, R.; Timmermann, Lars; Weise, Lutz; Hilker, Rüdiger

doi:10.1212/wnl.0b013e318249f702

Cited by 118 publications

(118 citation statements)

References 39 publications

Supporting

Mentioning

113

Contrasting

Order By: Relevance

“…Finally, the cerebellar outflow pathways also seem to be involved in aspects of the pathophysiology of PD, specifically tremor [95,175,176], as suggested by imaging studies [177], and by the finding that, unlike other signs of the disease, parkinsonian tremor is effectively treated with surgical interventions targeting the cerebellar-receiving portions of the thalamus [178,179]. While dopamine loss is, in some way, related to the expression of tremor, this parkinsonian sign is often less sensitive to dopamine replacement therapy than the other parkinsonian signs, and not strongly related to beta-band power in LFP signals recorded in the basal ganglia [163].…”

Section: Pathophysiology Of Parkinsonism and Dystoniamentioning

confidence: 99%

Deep Brain Stimulation for Movement Disorders of Basal Ganglia Origin: Restoring Function or Functionality?

2016

View full text Add to dashboard Cite

Deep brain stimulation (DBS) is highly effective for both hypo-and hyperkinetic movement disorders of basal ganglia origin. The clinical use of DBS is, in part, empiric, based on the experience with prior surgical ablative therapies for these disorders, and, in part, driven by scientific discoveries made decades ago. In this review, we consider anatomical and functional concepts of the basal ganglia relevant to our understanding of DBS mechanisms, as well as our current understanding of the pathophysiology of two of the most commonly DBS-treated conditions, Parkinson's disease and dystonia. Finally, we discuss the proposed mechanism(s) of action of DBS in restoring function in patients with movement disorders. The signs and symptoms of the various disorders appear to result from signature disordered activity in the basal ganglia output, which disrupts the activity in thalamocortical and brainstem networks. The available evidence suggests that the effects of DBS are strongly dependent on targeting sensorimotor portions of specific nodes of the basal gangliathalamocortical motor circuit, that is, the subthalamic nucleus and the internal segment of the globus pallidus. There is little evidence to suggest that DBS in patients with movement disorders restores normal basal ganglia functions (e.g., their role in movement or reinforcement learning). Instead, it appears that high-frequency DBS replaces the abnormal basal ganglia output with a more tolerable pattern, which helps to restore the functionality of downstream networks.

show abstract

Section: Pathophysiology Of Parkinsonism and Dystoniamentioning

confidence: 99%

Deep Brain Stimulation for Movement Disorders of Basal Ganglia Origin: Restoring Function or Functionality?

2016

View full text Add to dashboard Cite

show abstract

“…157 The circuit targeted by effective DBS in ET has been probed with diffusion tensor imaging; effective contacts had robust connectivity to a circuit comprising the superior cerebellar peduncle (and presumably the dentate) as well as the primary motor cortex, supplementary motor area, lateral premotor cortex, and pallidum. 91 Source analysis of electroencephalography-electromyography coherence has supported a similar circuit. 143 …”

Section: Mechanistic Understandingmentioning

confidence: 95%

Deep brain stimulation: a mechanistic and clinical update

Karas

Mikell

Christian

et al. 2013

FOC

View full text Add to dashboard Cite

Deep brain stimulation (DBS), the practice of placing electrodes deep into the brain to stimulate subcortical structures with electrical current, has been increasing as a neurosurgical procedure over the past 15 years. Originally a treatment for essential tremor, DBS is now used and under investigation across a wide spectrum of neurological and psychiatric disorders. In addition to applying electrical stimulation for clinical symptomatic relief, the electrodes implanted can also be used to record local electrical activity in the brain, making DBS a useful research tool. Human single-neuron recordings and local field potentials are now often recorded intraoperatively as electrodes are implanted. Thus, the increasing scope of DBS clinical applications is being matched by an increase in investigational use, leading to a rapidly evolving understanding of cortical and subcortical neurocircuitry. In this review, the authors discuss recent innovations in the clinical use of DBS, both in approved indications as well as in indications under investigation. Deep brain stimulation as an investigational tool is also reviewed, paying special attention to evolving models of basal ganglia and cortical function in health and disease. Finally, the authors look to the future across several indications, highlighting gaps in knowledge and possible future directions of DBS treatment.

show abstract

“…2 Second, the authors equate age at motor onset to rate of disease progression, 1 and do not formally assess serial clinical measurements on the same individuals as we previously reported. 2 However, the observation that, despite a similar age at onset, homozygote patients display a faster rate of clinical deterioration suggests that mechanisms contributing to age at onset and disease progression might not entirely overlap.…”

mentioning

confidence: 97%

“…Ahmad Aziz, Raymund A.C. Roos, Leiden, the Netherlands: We read with interest the article by Lee et al 1 concerning the potential effect of the CAG repeat size in the normal HTT allele on age at motor onset in Huntington disease (HD). Although the authors have done an excellent job in analyzing data on an impressively large number of patients with HD, we feel that the following points should be considered before dismissing a potential disease-modifying role of the normal HTT allele.…”

mentioning

confidence: 99%

“…3 Third, although excluding outliers generally yields more robust statistical models, this comes at the cost of missing potentially interesting genetic modifiers at the allelic extremes. 4 Author Response: James F. Gusella, Jong-Min Lee, Marcy E. MacDonald, Boston: We thank Aziz et al for their interest in our study 1 but feel that some clarification is required. They are correct that our study was aimed exclusively at determining whether the shorter CAG repeat allele in HD has a significant impact, either alone or in interaction with the longer, expanded allele, on the age at which motor disturbance-the phenotype considered diagnostic of the disorder-is manifest.…”

mentioning

confidence: 99%

See 1 more Smart Citation