One-pass Deep Brain Stimulation of Dentato-rubro-thalamic Tract and Subthalamic Nucleus for Tremor-dominant or Equivalent Type Parkinson's Disease

Overview

Journal Acta Neurochir (Wien)

Specialty Neurosurgery

Date 2016 Feb 16

PMID 26876564

Citations 18

Authors

Volker Arnd Coenen

Michel Rijntjes

Thomas Prokop

Tobias Piroth

Florian Amtage

Horst Urbach

Peter Christoph Reinacher

Affiliations

Soon will be listed here.

Abstract

Background: Refractory tremor in tremor-dominant (TD) or equivalent-type (EQT) idiopathic Parkinson's syndrome (IPS) poses the challenge of choosing the best target region to for deep brain stimulation (DBS). While the subthalamic nucleus is typically chosen in younger patients as the target for dopamine-responsive motor symptoms, it is more complicated if tremor does not (fully) respond under trial conditions. In this report, we present the first results from simultaneous bilateral DBS of the DRT (dentato-rubro-thalamic tract) and the subthalamic nucleus (STN) in two elderly patients with EQT and TD IPS and dopamine-refractory tremor.

Methods: Two patients received bilateral octopolar DBS electrodes in the STN additionally traversing the DRT region. Achieved electrode positions were determined with helical CT, overlaid onto DTI tractography data, and compared with clinical data of stimulation response.

Results: Both patients showed immediate and sustained improvement of their tremor, bilaterally.

Conclusions: The proposed approach appears to be safe and feasible and a combined stimulation of the two target regions was performed tailored to the patients' symptoms. Clinically, no neuropsychiatric effects were seen. Our pilot data suggest a viable therapeutic option to treat the subgroup of TD and EQT IPS and with tremor as the predominant symptom. A clinical study to further investigate this approach (

Opinion: www.clinicaltrials.gov ; NCT02288468) is the focus of our ongoing research.

Citing Articles

Deep brain stimulation for Parkinson's disease: bibliometric analysis of the top 100 cited literature.

Zhao W, Shao X, Wang Z, Mi C, Wang Y, Qi X Front Aging Neurosci. 2024; 16:1413074.

PMID: 39478694 PMC: 11521828. DOI: 10.3389/fnagi.2024.1413074.

One-pass deep brain stimulation of subthalamic nucleus and ventral intermediate nucleus for levodopa-resistant tremor-dominant Parkinson's disease.

Liu B, Xu J, Feng Z, Hui R, Zhang Y, Liu D Front Aging Neurosci. 2024; 15:1289183.

PMID: 38187361 PMC: 10768017. DOI: 10.3389/fnagi.2023.1289183.

Radiofrequency ablation of the pallidothalamic tract and ventral intermediate nucleus for dystonic tremor through the parietal approach.

Horisawa S, Kim K, Sakaguchi M, Kawamata T, Taira T Surg Neurol Int. 2023; 14:390.

PMID: 38053713 PMC: 10695449. DOI: 10.25259/SNI_311_2023.

A case report: Dual-lead deep brain stimulation of the posterior subthalamic area and the thalamus was effective for Holmes tremor after unsuccessful focused ultrasound thalamotomy.

Maesawa S, Torii J, Nakatsubo D, Noda H, Mutoh M, Ito Y Front Hum Neurosci. 2023; 16:1065459.

PMID: 36590066 PMC: 9798537. DOI: 10.3389/fnhum.2022.1065459.

Directed stimulation of the dentato-rubro-thalamic tract for deep brain stimulation in essential tremor: a blinded clinical trial.

Middlebrooks E, Okromelidze L, Carter R, Jain A, Lin C, Westerhold E Neuroradiol J. 2021; 35(2):203-212.

PMID: 34340623 PMC: 9130622. DOI: 10.1177/19714009211036689.

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