Distance to white matter tracts is associated with deep brain stimulation motor outcome in Parkinson’s disease

2020 ◽  
Vol 133 (2) ◽  
pp. 433-442 ◽  
Author(s):  
Naomi Prent ◽  
Wouter V. Potters ◽  
Lennard I. Boon ◽  
Matthan W. A. Caan ◽  
Rob M. A. de Bie ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
White Matter ◽  
Side Effects ◽  
Clinical Outcome ◽  
Outcome Measures ◽  
Brain Stimulation ◽  
White Matter Tracts ◽  
Electrode Contact ◽  
Deep Brain ◽  
Stimulation Of

OBJECTIVEDeep brain stimulation (DBS) of the subthalamic nucleus (STN) alleviates motor symptoms in patients with Parkinson’s disease (PD). However, the underlying mechanism of tremor suppression is not well understood. Stimulation of white matter tracts, such as the dentatorubrothalamic tract (DRT), might be involved. Also, side effects, including dysarthria, might result from (unwanted) stimulation of white matter tracts in proximity to the STN. The aim of this study was to establish an association between stimulation effect on tremor and dysarthria and stimulation location relative to relevant white matter tracts.METHODSIn 35 PD patients in whom a bilateral STN DBS system was implanted, the authors established clinical outcome measures per electrode contact. The distance from each stimulation location to the center of the DRT, corticopontocerebellar tract, pyramidal tract (PT), and medial lemniscus was determined using diffusion-weighted MRI data. Clinical outcome measures were subsequently related to the distances to the white matter tracts.RESULTSPatients with activated contacts closer to the DRT showed increased tremor improvement. Proximity of activated contacts to the PT was associated with dysarthria.CONCLUSIONSProximity to specific white matter tracts is associated with tremor outcome and side effects in DBS. This knowledge can help to optimize both electrode placement and postsurgical electrode contact selection. Presurgical white matter tract visualization may improve targeting and DBS outcome. These findings are of interest not only for treatment in PD, but potentially also for other (movement) disorders.

scholarly journals Stimulation-Induced Side Effects of Deep Brain Stimulation in the Ventralis Intermedius and Posterior Subthalamic Area for Essential Tremor

2021 ◽  
Vol 12 ◽  
Author(s):  
Myung Ji Kim ◽  
Kyung Won Chang ◽  
So Hee Park ◽  
Won Seok Chang ◽  
Hyun Ho Jung ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Side Effects ◽  
Essential Tremor ◽  
Brain Stimulation ◽  
Rating Scale ◽  
Gait Disturbance ◽  
Electrode Implantation ◽  
Electrode Contact ◽  
Deep Brain ◽  
Stimulation Of

Deep brain stimulation (DBS) targeting the ventralis intermedius (VIM) nucleus of the thalamus and the posterior subthalamic area (PSA) has been shown to be an effective treatment for essential tremor (ET). The aim of this study was to compare the stimulation-induced side effects of DBS targeting the VIM and PSA using a single electrode. Patients with medication-refractory ET who underwent DBS electrode implantation between July 2011 and October 2020 using a surgical technique that simultaneously targets the VIM and PSA with a single electrode were enrolled in this study. A total of 93 patients with ET who had 115 implanted DBS electrodes (71 unilateral and 22 bilateral) were enrolled. The Clinical Rating Scale for Tremor (CRST) subscores improved from 20.0 preoperatively to 4.3 (78.5% reduction) at 6 months, 6.3 (68.5% reduction) at 1 year, and 6.5 (67.5% reduction) at 2 years postoperation. The best clinical effect was achieved in the PSA at significantly lower stimulation amplitudes. Gait disturbance and clumsiness in the leg was found in 13 patients (14.0%) upon stimulation of the PSA and in significantly few patients upon stimulation of the VIM (p = 0.0002). Fourteen patients (15.1%) experienced dysarthria when the VIM was stimulated; this number was significantly more than that with PSA stimulation (p = 0.0233). Transient paresthesia occurred in 13 patients (14.0%) after PSA stimulation and in six patients (6.5%) after VIM stimulation. Gait disturbance and dysarthria were significantly more prevalent in patients undergoing bilateral DBS than in those undergoing unilateral DBS (p = 0.00112 and p = 0.0011, respectively). Paresthesia resolved either after reducing the amplitude or switching to bipolar stimulation. However, to control gait disturbance and dysarthria, some loss of optimal tremor control was necessary at that particular electrode contact. In the present study, the most common stimulation-induced side effect associated with VIM DBS was dysarthria, while that associated with PSA DBS was gait disturbance. Significantly, more side effects were associated with bilateral DBS than with unilateral DBS. Therefore, changing active DBS contacts to simultaneous targeting of the VIM and PSA may be especially helpful for ameliorating stimulation-induced side effects.

Deep Brain Stimulation of the Pallidofugal Pathways to Rescue Severe Life-Threatening Dyskinesias after STN-DBS Lead Implantation

2021 ◽  
pp. 1-4
Author(s):  
Josue M. Avecillas-Chasin ◽  
Joohi Jimenez-Shahed ◽  
Joan Miravite ◽  
Susan Bressman ◽  
Brian H Kopell
Keyword(s):  
Deep Brain Stimulation ◽  
White Matter ◽  
Brain Stimulation ◽  
Complete Resolution ◽  
Patient Specific ◽  
Electrode Implantation ◽  
Life Threatening ◽  
Stn Dbs ◽  
Deep Brain ◽  
Stimulation Of

We present a patient with severe life-threatening dyskinesias due to a persistent microlesion effect after STN-DBS electrode implantation. The pallidofugal pathways were identified using patient-specific tractography, and steering the current toward this white matter structure resulted in complete resolution of the severe dyskinesias.

scholarly journals White matter tracts lesions and decline of verbal fluency after deep brain stimulation in Parkinson's disease

2019 ◽  
Vol 40 (9) ◽  
pp. 2561-2570 ◽  
Author(s):  
Guillaume Costentin ◽  
Stéphane Derrey ◽  
Emmanuel Gérardin ◽  
Yohann Cruypeninck ◽  
Thibaut Pressat‐Laffouilhere ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Deep Brain Stimulation ◽  
White Matter ◽  
Brain Stimulation ◽  
Verbal Fluency ◽  
White Matter Tracts ◽  
Deep Brain

Pyramidal tract side effects induced by deep brain stimulation of the subthalamic nucleus

2008 ◽  
Vol 79 (7) ◽  
pp. 813-819 ◽  
Author(s):  
G Tommasi ◽  
P Krack ◽  
V Fraix ◽  
J-F Le Bas ◽  
S Chabardes ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Side Effects ◽  
Subthalamic Nucleus ◽  
Brain Stimulation ◽  
Pyramidal Tract ◽  
Deep Brain ◽  
Stimulation Of

scholarly journals MRI and tractography techniques to localize the ventral intermediate nucleus and dentatorubrothalamic tract for deep brain stimulation and MR-guided focused ultrasound: a narrative review and update

2020 ◽  
Vol 49 (1) ◽  
pp. E8
Author(s):  
Vance T. Lehman ◽  
Kendall H. Lee ◽  
Bryan T. Klassen ◽  
Daniel J. Blezek ◽  
Abhinav Goyal ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
White Matter ◽  
Brain Stimulation ◽  
Focused Ultrasound ◽  
Imaging Features ◽  
White Matter Tracts ◽  
Case Examples ◽  
Intermediate Nucleus ◽  
Ventral Intermediate Nucleus ◽  
Deep Brain

The thalamic ventral intermediate nucleus (VIM) can be targeted for treatment of tremor by several procedures, including deep brain stimulation (DBS) and, more recently, MR-guided focused ultrasound (MRgFUS). To date, such targeting has relied predominantly on coordinate-based or atlas-based techniques rather than directly targeting the VIM based on imaging features. While general regional differences of features within the thalamus and some related white matter tracts can be distinguished with conventional imaging techniques, internal nuclei such as the VIM are not discretely visualized. Advanced imaging methods such as quantitative susceptibility mapping (QSM) and fast gray matter acquisition T1 inversion recovery (FGATIR) MRI and high-field MRI pulse sequences that improve the ability to image the VIM region are emerging but have not yet been shown to have reliability and accuracy to serve as the primary method of VIM targeting. Currently, the most promising imaging approach to directly identify the VIM region for clinical purposes is MR diffusion tractography.In this review and update, the capabilities and limitations of conventional and emerging advanced methods for evaluation of internal thalamic anatomy are briefly reviewed. The basic principles of tractography most relevant to VIM targeting are provided for familiarization. Next, the key literature to date addressing applications of DTI and tractography for DBS and MRgFUS is summarized, emphasizing use of direct targeting. This literature includes 1-tract (dentatorubrothalamic tract [DRT]), 2-tract (pyramidal and somatosensory), and 3-tract (DRT, pyramidal, and somatosensory) approaches to VIM region localization through tractography.The authors introduce a 3-tract technique used at their institution, illustrating the oblique curved course of the DRT within the inferior thalamus as well as the orientation and relationship of the white matter tracts in the axial plane. The utility of this 3-tract tractography approach to facilitate VIM localization is illustrated with case examples of variable VIM location, targeting superior to the anterior commissure–posterior commissure plane, and treatment in the setting of pathologic derangement of thalamic anatomy. Finally, concepts demonstrated with these case examples and from the prior literature are synthesized to highlight several potential advantages of tractography for VIM region targeting.

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