Bilateral stimulation of the caudal zona incerta nucleus for tremor control

Plaha, Puneet; Khan, Sadaquate; Gill, Steven

doi:10.1136/jnnp.2006.112334

Cited by 242 publications

(207 citation statements)

References 101 publications

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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: 97%

“…Each is thought to have several physiological functions: The rostral component (rZI), attributed to the visceral control [17] , extends over the dorsal and medial surface of the STN separated by the pallidofugal fibres (PFF) and crossing the internal capsule (Ci). The caudal part (cZI) or the motor component is located posteriomedial to the STN and extends behind the prelemniscal radiation [18] . Ventrocaudally to the ZI lies the substantia nigra [19,20] , laterally the Ci, and dorsomedially the red nucleus [21,22] .…”

Section: Deep Brain Stimulation (Dbs)mentioning

confidence: 99%

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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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Section: Deep Brain Stimulation (Dbs)mentioning

confidence: 97%

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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“…A small fascicle of fibers leaves the field of Forel and passes laterally into this nucleus and the zona incerta [page 299 and ff in Chan-Palay (1977)]. In addition, the interposite nucleus (Plaha et al 2008) and the basal ganglia (Chivileva and Gorbachevskaya 2008) project to the zona incerta making a subcortical communication between the cerebellum and the basal ganglia highly probable. For the dentate nucleus, a direct communication between this nucleus and the pallidum has been described (Hoshi et al 2005).…”

Section: Extrathalamic Cerebello-bg Communicationmentioning

confidence: 99%

Thalamic interactions of cerebellum and basal ganglia

2017

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Cerebellum and basal ganglia are reciprocally interconnected with the neocortex via oligosynaptic loops. The signal pathways of these loops predominantly converge in motor areas of the frontal cortex and are mainly segregated on subcortical level. Recent evidence, however, indicates subcortical interaction of these systems. We have reviewed literature that addresses the question whether, and to what extent, projections of main output nuclei of basal ganglia (reticular part of the substantia nigra, internal segment of the globus pallidus) and cerebellum (deep cerebellar nuclei) interact with each other in the thalamus. To this end, we compiled data from electrophysiological and anatomical studies in rats, cats, dogs, and non-human primates. Evidence suggests the existence of convergence of thalamic projections originating in basal ganglia and cerebellum, albeit sparse and restricted to certain regions. Four regions come into question to contain converging inputs: (1) lateral parts of medial dorsal nucleus (MD); (2) parts of anterior intralaminar nuclei and centromedian and parafascicular nuclei (CM/Pf); (3) ventromedial nucleus (VM); and (4) border regions of cerebellar and ganglia terminal territories in ventral anterior and ventral lateral nuclei (VA-VL). The amount of convergences was found to exhibit marked interspecies differences. To explain the rather sparse convergences of projection territories and to estimate their physiological relevance, we present two conceivable principles of anatomical organization: (1) a "core-and-shell" organization, in which a central core is exclusive to one projection system, while peripheral shell regions intermingle and occasionally converge with other projection systems and (2) convergences that are characteristic to distinct functional networks. The physiological relevance of these convergences is not yet clear. An oculomotor network proposed in this work is an interesting candidate to examine potential ganglia and cerebellar subcortical interactions.

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“…Thalamic and dorsal or posterior STN DBS has been described in multiple case reports in patients with HT secondary to pontomesencephalic lesions with variable short-term results. 4,[9][10][11]25,27,29,30,33,34,[37][38][39][40]43,49,50 Recently Kobayashi et al reported 2-year outcome with dual thalamic and subthalamic area stimulation in 4 patients with HT, with significant benefit.…”

Section: Prior Surgical Approaches To Htmentioning

confidence: 99%

Pallidal stimulation for Holmes tremor: clinical outcomes and single-unit recordings in 4 cases

Kilbane

Ramirez‐Zamora

Ryapolova-Webb

et al. 2015

JNS

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OBJECT Holmes tremor (HT) is characterized by irregular, low-frequency (< 4.5 Hz) tremor occurring at rest, with posture, and with certain actions, often affecting proximal muscles. Previous reports have tended to highlight the use of thalamic deep brain stimulation (DBS) in cases of medication-refractory HT. In this study, the authors report the clinical outcome and analysis of single-unit recordings in patients with medication-refractory HT treated with globus pallidus internus (GPi) DBS. METHODS The authors retrospectively reviewed the medical charts of 4 patients treated with pallidal DBS for medication-refractory HT at the University of California, San Francisco, and San Francisco Veterans Affairs Medical Center. Clinical outcomes were measured at baseline and after surgery using an abbreviated motor-severity Fahn-Tolosa-Marin (FTM) tremor rating scale. Intraoperative microelectrode recordings were performed with patients in the awake state. The neurophysiological characteristics identified in HT were then also compared with characteristics previously described in Parkinson's disease (PD) studied at the authors' institution. RESULTS The mean percentage improvement in tremor motor severity was 78.87% (range 59.9%–94.4%) as measured using the FTM tremor rating scale, with an average length of follow-up of 33.75 months (range 18–52 months). Twenty-eight GPi neurons were recorded intraoperatively in the resting state and 13 of these were also recorded during contralateral voluntary arm movement. The mean firing rate at rest in HT was 56.2 ± 28.5 Hz, and 63.5 ± 19.4 Hz with action, much lower than the GPi recordings in PD. GPi unit oscillations of 2–8 Hz were prominent in both patients with HT and those with PD, but in HT, unlike PD, these oscillations were not suppressed by voluntary movement. CONCLUSIONS The efficacy of GPi DBS exceeded that reported in prior studies of ventrolateral thalamus DBS and suggest GPi may be a better target for treating HT. These clinical and neurophysiological findings help illuminate evolving models of HT and highlight the importance of cerebellar–basal ganglia interactions.

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Bilateral stimulation of the caudal zona incerta nucleus for tremor control

Abstract: This prospective study shows that the cZI may be an alternative target for the treatment of tremor with DBS. In contrast to bilateral DBS of the VL nucleus, it improves all components of tremor affecting both the distal and proximal limbs as well as the axial musculature.

Cited by 242 publications

References 101 publications

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

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

Thalamic interactions of cerebellum and basal ganglia

Pallidal stimulation for Holmes tremor: clinical outcomes and single-unit recordings in 4 cases

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