Deep Brain Stimulation of the Dentato-Rubro-Thalamic Tract: Outcomes of Direct Targeting for Tremor

Fenoy, Albert J.; Schiess, Mya C.

doi:10.1111/ner.12585

Cited by 89 publications

(85 citation statements)

References 28 publications

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“…Coenen and colleagues first reported excellent tremor reduction utilizing a DBS electrode contact located within the DRTt, which was defined by deterministic fiber tracking. Based on these and other cases as well as a post‐hoc tractographic analysis, we have adopted a protocol of diffusion MRI acquisition and fiber tracking, which has shown similar excellent tremor control in a prospective study …”

Section: Discussionmentioning

confidence: 99%

“…Such different locations may all be indirectly targeted in proximity to this pathway, and if the volume of tissue activation is large enough, the fibers will be intercepted to produce tremor control. Importantly, by directly targeting a fiber tract, one can accommodate anatomical variation, such as larger third ventricular widths and longer ACPC lengths, which otherwise can create ambiguity in choosing an effective target using formula‐based coordinates . By visualizing these fibers through the use of deterministic tractography, we have shown that we can more precisely target the DRTt for tremor control and thus likely improve the efficiency of a given DBS electrode, which decreases the size of a required VTA, minimizes side effects, uses smaller parameters, and may lead to lower energy expenditure.…”

Section: Discussionmentioning

confidence: 99%

“…The earlier cohort enrollment occurred from 2011 through 2014, where the target was the Vim thalamus acquired indirectly through standardized stereotactic atlas based coordinates. Enrollment in the later cohort occurred from 2014 through 2016, where the target was the DRTt as it enters the Vim thalamus acquired directly through deterministic tractography . This study (HSC‐MS‐16‐0066) was approved by our local institutional review board.…”

Section: Methodsmentioning

confidence: 99%

“…Each patient underwent staged DBS surgery targeting the DRTt or Vim as described above using a standard previously described stereotactic protocol . Briefly, the chosen trajectory was based on avoidance of vessels, sulci, and, whenever possible, ventricles, and typically adopted a precoronal entrance point.…”

Section: Methodsmentioning

confidence: 99%

“…We recently showed, in a prospective study, that direct targeting of the DRTt using deterministic tractography provided excellent tremor control, which had before been described in case reports . However, it is unclear whether targeting an electrode in very close proximity to a depicted tract yields superior results to indirect targeting of the Vim thalamus.…”

mentioning

confidence: 92%

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Comparison of tractography‐assisted to atlas‐based targeting for deep brain stimulation in essential tremor

Fenoy

Schiess

2018

Movement Disorders

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Direct targeting of the dentato-rubro-thalamic tract provides excellent tremor control, comparable to indirectly targeting the ventral intermediate nucleus of the thalamus. Use of lower stimulation parameters, especially frequency, to control tremor in the directly targeted group suggests that it is a more efficient targeting methodology, which may minimize battery depletion. © 2018 International Parkinson and Movement Disorder Society.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 92%

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Comparison of tractography‐assisted to atlas‐based targeting for deep brain stimulation in essential tremor

Fenoy

Schiess

2018

Movement Disorders

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Direct visualization and characterization of the human zona incerta and surrounding structures

Lau

Xiao

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et al. 2020

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The zona incerta (ZI) is a small gray matter region of the deep brain first identified in the 19th century, yet direct in vivo visualization and characterization has remained elusive. Noninvasive detection of the ZI and surrounding region could be critical to further our understanding of this widely connected but poorly understood deep brain region and could contribute to the development and optimization of neuromodulatory therapies. We demonstrate that high resolution (submillimetric) longitudinal (T1) relaxometry measurements at high magnetic field strength (7 T) can be used to delineate the ZI from surrounding white matter structures, specifically the fasciculus cerebellothalamicus, fields of Forel (fasciculus lenticularis, fasciculus thalamicus, and field H), and medial lemniscus. Using this approach, we successfully derived in vivo estimates of the size, shape, location, and tissue characteristics of substructures in the ZI region, confirming observations only previously possible through histological evaluation that this region is not just a space between structures but contains distinct morphological entities that should be considered separately. Our findings pave the way for increasingly detailed in vivo study and provide a structural foundation for precise functional and neuromodulatory investigation.

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Improved Vim targeting for focused ultrasound ablation treatment of essential tremor: A probabilistic and patient‐specific approach

Choi

Tourdias

et al. 2020

Human Brain Mapping

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Magnetic resonance‐guided focused ultrasound (MRgFUS) ablation of the ventral intermediate (Vim) thalamic nucleus is an incisionless treatment for essential tremor (ET). The standard initial targeting method uses an approximate, atlas‐based stereotactic approach. We developed a new patient‐specific targeting method to identify an individual's Vim and the optimal MRgFUS target region therein for suppression of tremor. In this retrospective study of 14 ET patients treated with MRgFUS, we investigated the ability of WMnMPRAGE, a highly sensitive and robust sequence for imaging gray matter‐white matter contrast, to identify the Vim, FUS ablation, and a clinically efficacious region within the Vim in individual patients. We found that WMnMPRAGE can directly visualize the Vim in ET patients, segmenting this nucleus using manual or automated segmentation capabilities developed by our group. WMnMPRAGE also delineated the ablation's core and penumbra, and showed that all patients' ablation cores lay primarily within their Vim segmentations. We found no significant correlations between standard ablation features (e.g., ablation volume, Vim‐ablation overlap) and 1‐month post‐treatment clinical outcome. We then defined a group‐based probabilistic target, which was nonlinearly warped to individual brains; this target was located within the Vim for all patients. The overlaps between this target and patient ablation cores correlated significantly with 1‐month clinical outcome (r = −.57, p = .03), in contrast to the standard target (r = −.23, p = .44). We conclude that WMnMPRAGE is a highly sensitive sequence for segmenting Vim and ablation boundaries in individual patients, allowing us to find a novel tremor‐associated center within Vim and potentially improving MRgFUS treatment for ET.

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Deep Brain Stimulation of the Dentato-Rubro-Thalamic Tract: Outcomes of Direct Targeting for Tremor

Cited by 89 publications

References 28 publications

Comparison of tractography‐assisted to atlas‐based targeting for deep brain stimulation in essential tremor

Comparison of tractography‐assisted to atlas‐based targeting for deep brain stimulation in essential tremor

Direct visualization and characterization of the human zona incerta and surrounding structures

Improved Vim targeting for focused ultrasound ablation treatment of essential tremor: A probabilistic and patient‐specific approach

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