scholarly journals Dystonic tics induced by deep brain stimulation of the posterior subthalamic area for essential tremor

2017 ◽  
Vol 126 (2) ◽  
pp. 386-390 ◽  
Author(s):  
Arjun S. Chandran ◽  
Stuti Joshi ◽  
Megan Thorburn ◽  
Rick Stell ◽  
Christopher R. P. Lind
Keyword(s):  
Deep Brain Stimulation ◽  
Essential Tremor ◽  
Brain Stimulation ◽  
Case Series ◽  
Brain Regions ◽  
Tic Disorders ◽  
Zona Incerta ◽  
Brain Target ◽  
Deep Brain ◽  
Stimulation Of

OBJECTIVE The posterior subthalamic area (PSA) is a promising target of deep brain stimulation (DBS) for medication-refractory essential tremor (ET). This case series describes a novel adverse effect manifesting as dystonic tics in patients with ET undergoing DBS of the PSA. METHODS Six patients with ET received electrode implants for DBS of the dorsal and caudal zona incerta subregions of the PSA. RESULTS Five of the 6 patients developed dystonic tics soon after clinical programming. These tics were of varying severity and required reduction of the electrical stimulation amplitude. This reduction resolved tic occurrence without significantly affecting ET control. Dystonic tics were not observed in 39 additional patients who underwent DBS of the same brain regions for controlling non-ET movement disorders. CONCLUSIONS The pathophysiology of tic disorders is poorly understood and may involve the basal ganglia and related cortico-striato-thalamo-cortical circuits. This series is the first report of DBS-induced tics after stimulation of any brain target. Although the PSA has not previously been implicated in tic pathophysiology, it may be a candidate region for future studies.

Voice Tremor in Patients With Essential Tremor: Effects of Deep Brain Stimulation of Caudal Zona Incerta

2016 ◽  
Vol 30 (2) ◽  
pp. 228-233 ◽  
Author(s):  
Patricia Hägglund ◽  
Linda Sandström ◽  
Patric Blomstedt ◽  
Fredrik Karlsson
Keyword(s):  
Deep Brain Stimulation ◽  
Essential Tremor ◽  
Brain Stimulation ◽  
Zona Incerta ◽  
Deep Brain ◽  
Stimulation Of

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

2011 ◽  
Vol 153 (12) ◽  
pp. 2329-2335 ◽  
Author(s):  
Patric Blomstedt ◽  
Ulrika Sandvik ◽  
Jan Linder ◽  
Anna Fredricks ◽  
Lars Forsgren ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Essential Tremor ◽  
Subthalamic Nucleus ◽  
Brain Stimulation ◽  
Zona Incerta ◽  
Deep Brain ◽  
Stimulation Of

scholarly journals Deep brain stimulation in the caudal zona incerta in patients with essential tremor: effects on cognition 1 year after surgery

2021 ◽  
Vol 134 (1) ◽  
pp. 208-215 ◽  
Author(s):  
Johanna Philipson ◽  
Patric Blomstedt ◽  
Marwan Hariz ◽  
Marjan Jahanshahi
Keyword(s):  
Deep Brain Stimulation ◽  
Essential Tremor ◽  
Brain Stimulation ◽  
Neuropsychological Test ◽  
Zona Incerta ◽  
Cognitive Domains ◽  
Show Evidence ◽  
Ventral Intermediate Nucleus ◽  
Brain Target ◽  
Deep Brain

OBJECTIVEThe ventral intermediate nucleus (VIM) of the thalamus is currently the established target in the use of deep brain stimulation (DBS) to treat essential tremor (ET). In recent years, the caudal zona incerta (cZi), a brain target commonly used during the lesional era, has been revived as the primary target in a number of DBS studies that show evidence of the efficacy of cZi targeting in DBS treatment for controlling the symptoms of ET. The authors sought to obtain comprehensive neuropsychological data and thoroughly investigate the cognitive effects of cZi targeting in patients with ET treated with DBS.METHODSTwenty-six consecutive patients with ET who received DBS with cZi as the target at our department from December 2012 to February 2017 were included in this study. All patients were assessed using a comprehensive neuropsychological test battery covering the major cognitive domains both preoperatively and 12 months postoperatively.RESULTSThe results show no major adverse effects on patient performance on the tests of cognitive function other than a slight decline of semantic verbal fluency.CONCLUSIONSThis study indicates that the cZi is a safe target from a cognitive perspective in the treatment of ET with DBS.

Long term follow-up of deep brain stimulation of the caudal zona incerta for essential tremor

2011 ◽  
Vol 83 (3) ◽  
pp. 258-262 ◽  
Author(s):  
Anders Fytagoridis ◽  
Ulrika Sandvik ◽  
Mattias Åström ◽  
Tommy Bergenheim ◽  
Patric Blomstedt
Keyword(s):  
Deep Brain Stimulation ◽  
Essential Tremor ◽  
Brain Stimulation ◽  
Zona Incerta ◽  
Long Term Follow Up ◽  
Deep Brain ◽  
Stimulation Of

scholarly journals Speech Function Following Deep Brain Stimulation of the Caudal Zona Incerta: Effects of Habitual and High-Amplitude Stimulation

2021 ◽  
pp. 1-13
Author(s):  
Linda Sandström ◽  
Ellika Schalling ◽  
Fredrik Karlsson ◽  
Patric Blomstedt ◽  
Lena Hartelius
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
High Amplitude ◽  
Nonparametric Tests ◽  
Zona Incerta ◽  
Maximal Amplitude ◽  
Significant Group ◽  
Preliminary Study ◽  
Deep Brain ◽  
Stimulation Of

Purpose Deep brain stimulation (DBS) is often successful in alleviating motor symptoms of essential tremor (ET); however, DBS may also induce adverse speech effects. The caudal zona incerta (cZi) is a promising DBS target for tremor, but less is known about the consequences of cZi DBS for speech. This preliminary study examined how habitual cZi DBS and cZi stimulation at high amplitudes may affect speech function in persons with ET. Method Fourteen participants with ET were evaluated: off stimulation, on habitual cZi DBS, and with unilateral cZi stimulation at increasing stimulation amplitudes. At each stimulation condition, the participants read three 16-word sentences. Two speech-language pathologists made audio-perceptual consensus ratings of overall speech function, articulation, and voice using a visual sort and rate method. Rated functions when off stimulation, on habitual cZi DBS, and at maximal-amplitude stimulation were compared using Friedman nonparametric tests. For participants with bilateral habitual DBS ( n = 5), the effects of bilateral and unilateral stimulation were described in qualitative terms. Results Habitual cZi DBS had no significant group-level effect on any of the investigated speech parameters. Maximal-amplitude stimulation had a small but significant negative effect on articulation. Participants with reduced articulatory precision ( n = 9) had more medially placed electrodes than the nonaffected group ( n = 5). Bilateral and unilateral left stimulation had comparable effects on speech. Conclusions Findings from this preliminary study of cZi DBS indicate that speech is generally not affected by stimulation at habitual levels. High-amplitude cZi stimulation may, however, induce adverse effects, particularly on articulation. Instances of decreased articulatory function were associated with stimulation of more medial electrode contacts, which could suggest cerebello-rubrospinal involvement.

Evaluating and Optimizing Dentato-Rubro-Thalamic-Tract Deterministic Tractography in Deep Brain Stimulation for Essential Tremor

2021 ◽  
Author(s):  
Maarten Bot ◽  
Anne-Fleur van Rootselaari ◽  
Vincent Odekerken ◽  
Joke Dijk ◽  
Rob M A de Bie ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Essential Tremor ◽  
Brain Stimulation ◽  
Red Nucleus ◽  
Brain Regions ◽  
Superior Cerebellar Peduncle ◽  
Beneficial Effects ◽  
Ventral Intermediate Nucleus ◽  
Cerebellar Peduncle ◽  
Deep Brain

Abstract BACKGROUND Dentato-rubro-thalamic tract (DRT) deep brain stimulation (DBS) suppresses tremor in essential tremor (ET) patients. However, DRT depiction through tractography can vary depending on the included brain regions. Moreover, it is unclear which section of the DRT is optimal for DBS. OBJECTIVE To evaluate deterministic DRT tractography and tremor control in DBS for ET. METHODS After DBS surgery, DRT tractography was conducted in 37 trajectories (20 ET patients). Per trajectory, 5 different DRT depictions with various regions of interest (ROI) were constructed. Comparison resulted in a DRT depiction with highest correspondence to intraoperative tremor control. This DRT depiction was subsequently used for evaluation of short-term postoperative adverse and beneficial effects. RESULTS Postoperative optimized DRT tractography employing the ROI motor cortex, posterior subthalamic area (PSA), and ipsilateral superior cerebellar peduncle and dentate nucleus best corresponded with intraoperative trajectories (92%) and active DBS contacts (93%) showing optimal tremor control. DRT tractography employing a red nucleus or ventral intermediate nucleus of the thalamus (VIM) ROI often resulted in a more medial course. Optimal stimulation was located in the section between VIM and PSA. CONCLUSION This optimized deterministic DRT tractography strongly correlates with optimal tremor control. This technique is readily implementable for prospective evaluation in DBS target planning for ET.

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