Thalamic Ventral-Oralis Complex/rostral Zona Incerta Deep Brain Stimulation for Midline Tremor

Overview

Journal J Neurol

Specialty Neurology

Date 2024 Aug 10

PMID 39126514

Authors

Alba Scerrati

Andrea Gozzi

Michele Alessandro Cavallo

Giorgio Mantovani

Pietro Antenucci

Chiara Angelini

Jay Guido Capone

Pasquale De Bonis

Francesca Morgante

Vittorio Rispoli

Mariachiara Sensi

Affiliations

Soon will be listed here.

Abstract

Background: Midline Tremor is defined as an isolated or combined tremor that affects the neck, trunk, jaw, tongue, and/or voice and could be part of Essential Tremor (ET), or dystonic tremor. The clinical efficacy of deep brain stimulation for Midline Tremor has been rarely reported. The Ventral Intermediate Nucleus and Globus Pallidus Internus are the preferred targets, but with variable outcomes. Thalamic Ventral-Oralis (VO) complex and Zona Incerta (ZI) are emerging targets for tremor control in various etiologies.

Objective: To report on neuroradiological, neurophysiological targeting and long-term efficacy of thalamic Ventral-Oralis complex and Zona Incerta deep brain stimulation in Midline Tremor.

Methods: Three patients (two males and one female) with Midline Tremor in dystonic syndromes were recruited for this open-label study. Clinical, surgical, neurophysiological intraoperative testing and long-term follow-up data are reported.

Results: Intraoperative testing and reconstruction of volume of tissue activated confirmed the position of the electrodes in the area stimulated between the thalamic Ventral-Oralis complex and Zona Incerta in all patients. All three patients showed optimal control of both tremor and dystonic features at short-term (6 months) and long-term follow-up (up to 6 years). No adverse events occurred.

Conclusion: In the syndromes of Midline Tremor of various origins, the best target for DBS might be difficult to identify. Our results showed that thalamic Ventral-Oralis complex/Zona Incerta may be a viable and safe option even in specific forms of tremor with axial distribution.

Citing Articles

Engaging dystonia networks with subthalamic stimulation.

Butenko K, Neudorfer C, Dembek T, Hollunder B, Meyer G, Li N Proc Natl Acad Sci U S A. 2025; 122(2):e2417617122.

PMID: 39773021 PMC: 11745339. DOI: 10.1073/pnas.2417617122.

References

Rekik A, Nasri A, Mrabet S, Gharbi A, Souissi A, Gargouri A . Non-motor features of essential tremor with midline distribution. Neurol Sci. 2022; 43(10):5917-5925. DOI: 10.1007/s10072-022-06262-x. View

Bhatia K, Bain P, Bajaj N, Elble R, Hallett M, Louis E . Consensus Statement on the classification of tremors. from the task force on tremor of the International Parkinson and Movement Disorder Society. Mov Disord. 2017; 33(1):75-87. PMC: 6530552. DOI: 10.1002/mds.27121. View

Pandey S, Sarma N . Tremor in dystonia. Parkinsonism Relat Disord. 2016; 29:3-9. DOI: 10.1016/j.parkreldis.2016.03.024. View

Tsuboi T, Au K, Deeb W, Almeida L, Foote K, Okun M . Motor outcomes and adverse effects of deep brain stimulation for dystonic tremor: A systematic review. Parkinsonism Relat Disord. 2020; 76:32-41. DOI: 10.1016/j.parkreldis.2020.06.008. View

Obwegeser A, Uitti R, Turk M, Strongosky A, Wharen R . Thalamic stimulation for the treatment of midline tremors in essential tremor patients. Neurology. 2000; 54(12):2342-4. DOI: 10.1212/wnl.54.12.2342. View

Krause M, Fogel W, Kloss M, Rasche D, Volkmann J, Tronnier V . Pallidal stimulation for dystonia. Neurosurgery. 2004; 55(6):1361-8. DOI: 10.1227/01.neu.0000143331.86101.5e. View

Morishita T, Foote K, Haq I, Zeilman P, Jacobson C, Okun M . Should we consider Vim thalamic deep brain stimulation for select cases of severe refractory dystonic tremor. Stereotact Funct Neurosurg. 2010; 88(2):98-104. DOI: 10.1159/000289354. View

Paschen S, Becktepe J, Hobert M, Zeuner K, Helmers A, Berg D . The Challenge of Choosing the Right Stimulation Target for Dystonic Tremor-A Series of Instructive Cases. Mov Disord Clin Pract. 2023; 10(10):1478-1484. PMC: 10585974. DOI: 10.1002/mdc3.13846. View

Picillo M, Paramanandam V, Morgante F, Algarni M, Olszewska D, Munhoz R . Dystonia as complication of thalamic neurosurgery. Parkinsonism Relat Disord. 2019; 66:232-236. DOI: 10.1016/j.parkreldis.2019.08.008. View

10.

Paoli D, Mills R, Brechany U, Pavese N, Nicholson C . DBS in tremor with dystonia: VIM, GPi or both? A review of the literature and considerations from a single-center experience. J Neurol. 2023; 270(4):2217-2229. PMC: 10025201. DOI: 10.1007/s00415-023-11569-6. View

11.

Mongardi L, Rispoli V, Scerrati A, Giordano F, Capone J, Vaudano A . Deep brain stimulation of the ventralis oralis anterior thalamic nucleus is effective for dystonic tremor. Parkinsonism Relat Disord. 2020; 81:8-11. DOI: 10.1016/j.parkreldis.2020.09.040. View

12.

Neudorfer C, Kultas-Ilinsky K, Ilinsky I, Paschen S, Helmers A, Cosgrove G . The role of the motor thalamus in deep brain stimulation for essential tremor. Neurotherapeutics. 2024; 21(3):e00313. PMC: 11103222. DOI: 10.1016/j.neurot.2023.e00313. View

13.

Baumgartner A, Thompson J, Kern D, Ojemann S . Novel targets in deep brain stimulation for movement disorders. Neurosurg Rev. 2022; 45(4):2593-2613. DOI: 10.1007/s10143-022-01770-y. View

14.

Pauls K, Hammesfahr S, Moro E, Moore A, Binder E, El Majdoub F . Deep brain stimulation in the ventrolateral thalamus/subthalamic area in dystonia with head tremor. Mov Disord. 2014; 29(7):953-9. DOI: 10.1002/mds.25884. View

15.

Erro R, Lazzeri G, Terranova C, Paparella G, Gigante A, De Micco R . Comparing Essential Tremor with and without Soft Dystonic Signs and Tremor Combined with Dystonia: The TITAN Study. Mov Disord Clin Pract. 2024; 11(6):645-654. PMC: 11145151. DOI: 10.1002/mdc3.14026. View

16.

Ossowska K . Zona incerta as a therapeutic target in Parkinson's disease. J Neurol. 2019; 267(3):591-606. PMC: 7035310. DOI: 10.1007/s00415-019-09486-8. View

17.

Blomstedt P, Fytagoridis A, Tisch S . Deep brain stimulation of the posterior subthalamic area in the treatment of tremor. Acta Neurochir (Wien). 2008; 151(1):31-6. DOI: 10.1007/s00701-008-0163-7. View

18.

Barbe M, Reker P, Hamacher S, Franklin J, Kraus D, Dembek T . DBS of the PSA and the VIM in essential tremor: A randomized, double-blind, crossover trial. Neurology. 2018; 91(6):e543-e550. DOI: 10.1212/WNL.0000000000005956. View

19.

Bagatti D, DAmmando A, Franzini A, Messina G . Deep Brain Stimulation of the Caudal Zona Incerta and Motor Thalamus for Postischemic Dystonic Tremor of the Left Upper Limb: Case Report and Review of the Literature. World Neurosurg. 2019; 125:191-197. DOI: 10.1016/j.wneu.2019.01.183. View

20.

Sitsapesan H, Holland P, Oliphant Z, de Pennington N, Brittain J, Jenkinson N . Deep brain stimulation for tremor resulting from acquired brain injury. J Neurol Neurosurg Psychiatry. 2013; 85(7):811-5. DOI: 10.1136/jnnp-2013-305340. View