Bilateral caudal zona incerta nucleus stimulation for essential tremor: outcome and quality of life

Plaha, Puneet; Javed, Shazia; Agombar, David; Farrell, Genevive O'; Khan, Sadaquate; Whone, Alan; Gill, Steven

doi:10.1136/jnnp.2010.222992

Cited by 84 publications

(75 citation statements)

References 35 publications

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“…The clinical outcome is not the focus of this paper, but it is worth noting that the clinical ETRS scores (table 1) are consistent with previous reports of cZi DBS for ET [6,7,9] and compare well with the published experience of VIM DBS [2,6,19,20]. …”

Section: Discussionsupporting

confidence: 76%

“…The posterior subthalamic area (PSA) is situated immediately inferior to the VIM and posteromedial to the subthalamic nucleus (STN). Cerebellothalamic axons are particularly dense within the PSA before dispersing into the VIM, and promising results have been reported regarding DBS in this area [5,6,7,8,9]. One plausible explanation for the effectiveness of PSA DBS is that stimulation of axons instead of nuclei actually affects more neurons and therefore also alters tremor oscillations more efficiently [3,4,10].…”

Section: Introductionmentioning

confidence: 99%

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Deep Brain Stimulation of the Caudal Zona Incerta: Tremor Control in Relation to the Location of Stimulation Fields

Fytagoridis

Åström

Samuelsson

et al. 2016

Stereotact Funct Neurosurg

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Background: The caudal zona incerta (cZi) and posterior subthalamic area (PSA) are an emerging deep brain stimulation (DBS) target for essential tremor (ET). Objectives: To evaluate the efficacy of tremor control in relation to the anatomical locations of stimulation fields in 50 patients with ET and DBS of the cZi. Methods: A total of 240 contacts were evaluated separately with monopolar stimulation, and amplitudes were optimized for improvement of tremor and hand function. Stimulation fields, i.e., volumes of neural activation, were simulated for each optimized setting and assembled into probabilistic stimulation maps (PSMs). Results: There were differences in the anatomical distribution of PSMs associated with good versus poor tremor control. The location of PSMs which achieved good and excellent tremor control corresponded well with the PSM for the clinically used settings, and they were located within the superior part of the PSA. Conclusions: PSMs may serve as a useful tool for defining the most efficacious anatomical location of stimulation. The best tremor control in this series of cZi DBS was achieved with stimulation of the superior part of the PSA, which corresponds to the final part of the cerebellothalamic projections before they reach the ventral lateral thalamus.

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Section: Discussionsupporting

confidence: 76%

Section: Introductionmentioning

confidence: 99%

Deep Brain Stimulation of the Caudal Zona Incerta: Tremor Control in Relation to the Location of Stimulation Fields

Fytagoridis

Åström

Samuelsson

et al. 2016

Stereotact Funct Neurosurg

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“…A recent study by Burrows et al [23] comparing DBS of the STN and the ZI provided similar findings resulting in sustained motor benefit with less limbic side effects, including anxiety and self-reported depression, for ZI stimulation. Furthermore, the stimulation of the cZI [18,24,25] seems to be superior compared to the stimulation of the STN in improving contralateral parkinsonism [26] . Moreover, a prospective study suggested that bilateral stimulation of the cZI nucleus is effective in suppressing tremors of various etiologies of both the distal and proximal extremities [25] .…”

Section: Deep Brain Stimulation (Dbs)mentioning

confidence: 99%

“…Furthermore, the stimulation of the cZI [18,24,25] seems to be superior compared to the stimulation of the STN in improving contralateral parkinsonism [26] . Moreover, a prospective study suggested that bilateral stimulation of the cZI nucleus is effective in suppressing tremors of various etiologies of both the distal and proximal extremities [25] . Previous studies including magnetic resonance imaging (MRI) studies up to 1.5 T showed that the visualization of the ZI is unsatisfactory as the small nucleus is hard to distinguish from the surrounding vital structures in the subthalamic region [27,28] .…”

Section: Deep Brain Stimulation (Dbs)mentioning

confidence: 99%

Imaging for deep brain stimulation: The zona incerta at 7 Tesla

Kerl

Gerigk²,

Brockmann³

et al. 2013

WJR

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AIM:To evaluate different promising magnetic resonance imaging (MRI) methods at 7.0 Tesla (T) for the pre-stereotactic visualization of the zona incerta (ZI). METHODS:Two neuroradiologists qualitatively and quantitatively examined T2-turbo spin-echo (T2-TSE), T1-weighted gradient-echo, as well as FLASH2D-T2Star and susceptibility-weighted imaging (SWI) for the visualization of the ZI at 7.0 T MRI. Delineation and image quality for the ZI were independently examined using a 6-scale grading system. Inter-rater reliability using Cohen's kappa coefficient (κ ) were assessed. Contrast-tonoise ratios (CNR), and signal-to-noise ratios (SNR) for the ZI were calculated for all sequences. Differences in delineation, SNR, and CNR between the sequences were statistically assessed using a paired t -test. For the anatomic validation the coronal FLASH2D-T2Star images were co-registered with a stereotactic atlas (Schaltenbrand-Wahren). RESULTS:The rostral part of the ZI (rZI) could easily be identified and was best and reliably visualized in the coronal FLASH2D-T2Star images. The caudal part was not definable in any of the sequences. No major artifacts in the rZI were observed in any of the scans. FLASH2D-T2Star and SWI imaging offered significant higher CNR values for the rZI compared to T2-TSE images (P > 0.05). The co-registration of the coronal FLASH2D-T2Star images with the stereotactic atlas schema (Schaltenbrand-Wahren) confirmed the correct localization of the ZI in all cases.CONCLUSION: FLASH2D-T2Star imaging (particularly coronal view) provides the reliable and currently optimal visualization of the rZI at 7.0 T. These results can facilitate a better and more precise targeting of the caudal part of the ZI than ever before.

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“…The ventral intermediate nucleus of the thalamus is the most widely agreed target for treating ET with DBS [15,16], with an average tremor control of over 80% in these patients [17,18,19]. Other investigators have suggested that the subthalamic region, posterior subthalamic area and caudal zona incerta nucleus may also be an effective target for ET [20,21,22]. The technique is, however, limited in some ET patients by relevant side effects such as dysarthria, disequilibrium and paresthesia.…”

Section: Clinical Applications Of Deep Brain Stimulationmentioning

confidence: 99%

Deep Brain Stimulation

Chen

Xiong

et al. 2012

Intervent Neurol

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Deep brain stimulation (DBS) has provided remarkable therapeutic benefits for people with a variety of neurological disorders. Despite the uncertainty of the precise mechanisms underlying its efficacy, DBS is clinically effective in improving motor function of essential tremor, Parkinson's disease and primary dystonia and in relieving obsessive-compulsive disorder. Recently, this surgical technique has continued to expand to other numerous neurological diseases with encouraging results. This review highlighted the current and potential future clinical applications of DBS.

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Bilateral caudal zona incerta nucleus stimulation for essential tremor: outcome and quality of life

Cited by 84 publications

References 35 publications

Deep Brain Stimulation of the Caudal Zona Incerta: Tremor Control in Relation to the Location of Stimulation Fields

Deep Brain Stimulation of the Caudal Zona Incerta: Tremor Control in Relation to the Location of Stimulation Fields

Imaging for deep brain stimulation: The zona incerta at 7 Tesla

Deep Brain Stimulation

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