Thalamic Deep Brain Stimulation for Essential Tremor: Relation of the Dentatorubrothalamic Tract with Stimulation Parameters

Authors

Andrew I. Yang, Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.Follow
Vivek P. Buch, Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Sabrina M. Heman-Ackah, Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Ashwin G. Ramayya, Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Frederick L. Hitti, Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Nathan Beatson, Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Hanane Chaibainou, Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Melissa Yates, Medtronic Neuromodulation, Fridley, Minnesota, USA.
Sumei Wang, Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Ragini Verma, Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Ronald L. Wolf, Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Gordon H. Baltuch, Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Electronic address: gordon.baltuch@uphs.upenn.edu.

Document Type

Article

Abstract

BACKGROUND: In deep brain stimulation (DBS) for essential tremor, the primary target ventrointermedius (VIM) nucleus cannot be clearly visualized with structural imaging. As such, there has been much interest in the dentatorubrothalamic tract (DRTT) for target localization, but evidence for the DRTT as a putative stimulation target in tremor suppression is lacking. We evaluated proximity of the DRTT in relation to DBS stimulation parameters. METHODS: This is a retrospective analysis of 26 consecutive patients who underwent DBS with microelectrode recordings (46 leads). Fiber tracking was performed with a published deterministic technique. Clinically optimized stimulation parameters were obtained in all patients at the time of most recent follow-up (6.2 months). Volume of tissue activated (VTA) around contacts was calculated from a published model. RESULTS: Tremor severity was reduced in all treated hemispheres, with 70% improvement in the treated hand score of the Clinical Rating Scale for Tremor. At the level of the active contact (2.9 ± 2.0 mm superior to the commissural plane), the center of the DRTT was lateral to the contacts (5.1 ± 2.1 mm). The nearest fibers of the DRTT were 2.4 ± 1.7 mm from the contacts, whereas the radius of the VTA was 2.9 ± 0.7 mm. The VTA overlapped with the DRTT in 77% of active contacts. The distance from active contact to the DRTT was positively correlated with stimulation voltage requirements (Kendall τ = 0.33, P = 0.006), whereas distance to the atlas-based VIM coordinates was not. CONCLUSIONS: Active contacts in proximity to the DRTT had lower voltage requirements. Data from a large cohort provide support for the DRTT as an effective stimulation target for tremor control.

Medical Subject Headings

Adult; Aged; Aged, 80 and over; Deep Brain Stimulation (methods); Essential Tremor (diagnosis, physiopathology, therapy); Female; Humans; Male; Middle Aged; Neural Pathways (physiopathology); Retrospective Studies; Severity of Illness Index; Thalamus (physiopathology)

Publication Date

5-1-2020

Publication Title

World neurosurgery

E-ISSN

1878-8769

Volume

137

First Page

e89

Last Page

e97

PubMed ID

31954907

Digital Object Identifier (DOI)

10.1016/j.wneu.2020.01.039

Recommended Citation

Yang, Andrew I.; Buch, Vivek P.; Heman-Ackah, Sabrina M.; Ramayya, Ashwin G.; Hitti, Frederick L.; Beatson, Nathan; Chaibainou, Hanane; Yates, Melissa; Wang, Sumei; Verma, Ragini; Wolf, Ronald L.; and Baltuch, Gordon H., "Thalamic Deep Brain Stimulation for Essential Tremor: Relation of the Dentatorubrothalamic Tract with Stimulation Parameters" (2020). Neurosurgery. 1887.
https://scholar.barrowneuro.org/neurosurgery/1887