Comparison of posterior subthalamic area deep brain stimulation for tremor using conventional landmarks versus directly targeting the dentatorubrothalamic tract with tractography

Low, Hu Liang; Ismail, Mohd. Nasir bin Mohd.; Taqvi, A; Deeb, Janina Golob; Fuller, Charlotte; Misbahuddin, Anjum

doi:10.1016/j.clineuro.2019.105466

Cited by 29 publications

(32 citation statements)

References 33 publications

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“…The DRTT, which originates from the dentate nucleus in the cerebellum and terminates in the contralateral ventrolateral (VL) nucleus of the thalamus, is involved in movement control [2]. Therefore, abnormal movement such as ataxia can occur when the DRTT is injured [3][4][5][6][7][8][9][10][11][12]. In this case study, this patient showed severe dysmetria in his right hand and moderate ataxic gait.…”

Section: Lettermentioning

confidence: 75%

Injury of the Dentato-Rubro-Thalamic Tract in a Patient with Thalamic Infarct

Jang¹,

Seo²

2020

JSR

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Section: Lettermentioning

confidence: 75%

Injury of the Dentato-Rubro-Thalamic Tract in a Patient with Thalamic Infarct

Jang¹,

Seo²

2020

JSR

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“…Moreover, a double-blinded, randomized study involving 34 patients with either tremor-dominant Parkinson's disease or essential tremor demonstrated the clinical utility of tractography. The results demonstrated that the tractography-guided lead placement produced a more enduring tremor control and fewer adverse effects compared with lead placement using conventional landmarks [105]. It also seems that tractography is feasible and effective in identifying the optimal DBS trajectory [106].…”

Section: Structural Connectivity Profilesmentioning

confidence: 88%

Deep brain stimulation for Tourette’s syndrome

Zhang

Deeb

et al. 2020

Transl Neurodegener

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Tourette syndrome (TS) is a childhood-onset neuropsychiatric disorder characterized by the presence of multiple motor and vocal tics. TS usually co-occurs with one or multiple psychiatric disorders. Although behavioral and pharmacological treatments for TS are available, some patients do not respond to the available treatments. For these patients, TS is a severe, chronic, and disabling disorder. In recent years, deep brain stimulation (DBS) of basal ganglia-thalamocortical networks has emerged as a promising intervention for refractory TS with or without psychiatric comorbidities. Three major challenges need to be addressed to move the field of DBS treatment for TS forward: (1) patient and DBS target selection, (2) ethical concerns with treating pediatric patients, and (3) DBS treatment optimization and improvement of individual patient outcomes (motor and phonic tics, as well as functioning and quality of life). The Tourette Association of America and the American Academy of Neurology have recently released their recommendations regarding surgical treatment for refractory TS. Here, we describe the challenges, advancements, and promises of the use of DBS in the treatment of TS. We summarize the results of clinical studies and discuss the ethical issues involved in treating pediatric patients. Our aim is to provide a better understanding of the feasibility, safety, selection process, and clinical effectiveness of DBS treatment for select cases of severe and medically intractable TS.

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“…Much recent work has investigated personalized Vim targeting through the use of connectivity‐derived definitions of the Vim, primarily based on DTI. These DTI‐based approaches include identifying the Vim based on its known connection with the dentato‐rubro‐thalamic tract (Chazen et al, 2018; Coenen et al, 2017; Fenoy & Schiess, 2017, 2018; King et al, 2017; Low et al, 2019; Miller et al, 2019; Morishita et al, 2019; Sammartino et al, 2016; Sasada et al, 2017) or bounding fiber bundles (Krishna et al, 2019; Ranjan et al, 2019) or by segmenting the thalamus based on connectivity with the cerebral cortex (Akram et al, 2018; Middlebrooks et al, 2018; Pouratian et al, 2011; Tian et al, 2018; Tsolaki, Downes, Speier, Elias, & Pouratian, 2018). There is accumulating evidence that this connectivity‐based targeting provides an individualized initial targeting method associated with good clinical outcome.…”

Section: Discussionmentioning

confidence: 99%

“…However, there has also been debate as to which seed regions of interest to use for DTI, technical difficulties associated with DTI for the thalamus, and differences across studies on the precise “sweet spot” within the Vim to target, making the optimal connectivity‐based targeting method still an open question (Akram et al, 2019; Middlebrooks et al, 2019). Thus far, the leading definition of the sweet spot is the thalamic region intersecting with the dentato‐rubro‐thalamic tract (Calabrese et al, 2015; Akram et al, 2018; Chazen et al, 2018; Fenoy & Schiess, 2017, 2018; Weidman, Kaplitt, Strybing, & Chazen, 2019; Morishita et al, 2019; Low et al, 2019; Miller et al, 2019; but see Schlaier et al, 2015). Additional reported sweet spots across the literature include thalamic regions connected with M1, SMA, or premotor cortex (Akram et al, 2018; Middlebrooks et al, 2018; Pouratian et al, 2011; Tsolaki et al, 2018), and near the inferior and posterior boundary of the Vim (Al‐Fatly et al, 2019; Atkinson et al, 2002; Boutet et al, 2018).…”

Section: Discussionmentioning

confidence: 99%

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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Comparison of posterior subthalamic area deep brain stimulation for tremor using conventional landmarks versus directly targeting the dentatorubrothalamic tract with tractography

Cited by 29 publications

References 33 publications

Injury of the Dentato-Rubro-Thalamic Tract in a Patient with Thalamic Infarct

Injury of the Dentato-Rubro-Thalamic Tract in a Patient with Thalamic Infarct

Deep brain stimulation for Tourette’s syndrome

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

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