Deep Brain Stimulation for Essential Tremor: Targeting the Dentato-Rubro-Thalamic Tract?

Schlaier, J.; Anthofer, Judith; Steib, Kathrin; Fellner, Claudia; Rothenfusser, Eva; Brawanski, Alexander; Lange, Max

doi:10.1111/ner.12238

Cited by 92 publications

(88 citation statements)

References 41 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…

…”

supporting

confidence: 89%

“…But, as demanded by Avecillas-Chasin, the method needs to be optimised and standardised. Optimal parameters for data acquisition (number of read-out directions, field strengths of MR scanner or voxel size) have to be generated, as well as optimal algorithms such as a mixture of tensors, Q-ball imaging, diffusion spectrum imaging and others [10]. As also mentioned by Avecillas-Chasin, it will be necessary in the future to compare deterministic algorithms with the probabilistic method, especially in tracts such as the dentate-rubro-thalamic tract (DRTT) that intersect regions with multiple fibre orientations.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Letter of response to “Individualization of deep brain stimulation targets for movement disorders”

et al. 2015

Self Cite

View full text Add to dashboard Cite

Dear Editor, We would like to thank Josue M. Avecillas-Chasin for his appreciation of our study BThe variability of atlas-based targets in relation to surrounding major fibre tracts in thalamic deep brain stimulation^[1] and for his valuable comments on the study.We fully agree with the concerns regarding the limitations of tractography, as already discussed in our article [1] and earlier reports by our group [2,6,10]. His own work constitutes a further valuable contribution to the topic [3]. Several studies in the past have used diffusion tensor imaging (DTI) and tractography to visualise fibre tracts in the region of the ventro-lateral thalamus [5,7,8,11]. However the reliability of the depicted connections is yet unclear. First approaches to comparing diffusion tensor imaging-based fibre tracts with clinical effects have been made [3-5, 10] and have shown promising results. But, as demanded by Avecillas-Chasin, the method needs to be optimised and standardised. Optimal parameters for data acquisition (number of read-out directions, field strengths of MR scanner or voxel size) have to be generated, as well as optimal algorithms such as a mixture of tensors, Q-ball imaging, diffusion spectrum imaging and others [10]. As also mentioned by Avecillas-Chasin, it will be necessary in the future to compare deterministic algorithms with the probabilistic method, especially in tracts such as the dentate-rubro-thalamic tract (DRTT) that intersect regions with multiple fibre orientations. Furthermore, different software packages lead to different results in the depiction of chosen fibre tracts [6].We are aware that the used method of DTI with deterministic tractography has its limitations and is not yet elaborate and reliable enough for implementation in routine clinical use as a standard tool. Therefore, today we still depend on neurophysiological and clinical information for targeting by means of micro-electrode recording (MER) and clinical testing in the setting of awake-surgeries [9]. Conflict of interest None. References 1. Anthofer J, Steib K, Fellner C, Lange M, Brawanski A, Schlaier J (2014) The variability of atlas-based targets in relation to surrounding major fibre tracts in thalamic deep brain stimulation. Acta Neurochir 156:1497-1504, discussion 1504 2. Anthofer JM, Steib K, Fellner C, Lange M, Brawanski A, Schlaier J (2015) DTI-based deterministic fibre tracking of the medial forebrain bundle. Acta Neurochir 157:469-477 3. Avecillas-Chasin JM, Alonso-Frech F, Parras O, Del Prado N, Barcia JA (2015) Assessment of a method to determine deep brain stimulation targets using deterministic tractography in a navigation system. Neurosurg Rev.

show abstract

“…

…”

supporting

confidence: 89%

mentioning

confidence: 99%

Letter of response to “Individualization of deep brain stimulation targets for movement disorders”

et al. 2015

Self Cite

View full text Add to dashboard Cite

show abstract

“…We did not correlate the position of the active contact to the position of the DRTT in each patient, as a preoperative DTI sequence was not performed routinely before 2012 in our institution. The accuracy and reliability of DTI to identify the DRTT may also be questioned, as several parameters may have an impact on its exact location, as was mentioned by Schlaier et al [21]. Moreover, the VTA calculation is based on finite element models of electrical propagation around the electrode and provides an approximation of the real VTA in each individual patient [11,12].…”

Section: Discussionmentioning

confidence: 99%

“…Unfortunately, a preoperative DTI sequence was not performed routinely before 2012 in our institution. Moreover, the correlation between the proximity of the DTI-based identification of the DRTT and clinical outcome is also a matter of debate in the literature [21] and is due to some technical limitations of the DTI to accurately show the DRTT (DTI assumptions on diffusion, signal to noise ratio, coregistration accuracy, etc.). For this reason, we found that the projection of our mean stimulation site on the Morel atlas was appropriate as it provides a precise anatomical location of the DRTT.…”

Section: Discussionmentioning

confidence: 99%

“…Both fiber tracts merge into the fasciculus thalamicus (or Forel field H1) dorsally and medially to the STN before entering the thalamus [19]. The cerebellothalamic tract or DRTT forms the main cerebellar efferent by interconnecting cerebellar nuclei (emboliform, globose, and dentate nuclei) and projecting through the superior cerebellar peduncle into the red nucleus and then the ventrolateral thalamus [19,20,21]. From the red nucleus to the thalamus, the DRTT crosses the Zi from posterior to anterior when it goes from medial to lateral and from inferior to superior.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Deep Brain Stimulation for Tremor: Is There a Common Structure?

Fiechter¹,

Nowacki²,

Oertel³

et al. 2017

Stereotact Funct Neurosurg

View full text Add to dashboard Cite

Background: Subthalamic nucleus (STN) stimulation has been recognized to control resting tremor in Parkinson disease. Similarly, thalamic stimulation (ventral intermediate nucleus; VIM) has shown tremor control in Parkinson disease, essential, and intention tremors. Recently, stimulation of the posterior subthalamic area (PSA) has been associated with excellent tremor control. Thus, the optimal site of stimulation may be located in the surrounding white matter. Aims: The objective of this work was to investigate the area of stimulation by determining the contact location correlated with the best tremor control in STN/VIM patients. Methods: The mean stimulation site and related volume of tissue activated (VTA) of 25 tremor patients (STN or VIM) were projected on the Morel atlas and compared to stimulation sites from other tremor studies. Results: All patients showed a VTA that covered ≥50% of the area superior and medial to the STN or inferior to the VIM. Our stimulation areas suggest involvement of the more lateral and superior part of the dentato-rubro-thalamic tract (DRTT), whereas targets described in other studies seem to involve the DRTT in its more medial and inferior part when it crosses the PSA. Conclusions: According to anatomical and diffusion tensor imaging data, the DRTT might be the common structure stimulated at different portions within the PSA/caudal zona incerta.

show abstract

Association of Essential Tremor With Novel Risk Loci

et al. 2022

View full text Add to dashboard Cite

IMPORTANCE Essential tremor (ET) is one of the most common movement disorders, affecting 5% of the general population older than 65 years. Common variants are thought to contribute toward susceptibility to ET, but no variants have been robustly identified. OBJECTIVE To identify common genetic factors associated with risk of ET. DESIGN, SETTING, AND PARTICIPANTS Case-control genome-wide association study. Inverse-variance meta-analysis was used to combine cohorts. Multicenter samples collected from European populations were collected from January 2010 to September 2019 as part of an ongoing study. Included patients were clinically diagnosed with or reported having ET. Control individuals were not diagnosed with or reported to have ET. Of 485 250 individuals, data for 483 054 passed data quality control and were used. MAIN OUTCOMES AND MEASURES Genotypes of common variants associated with risk of ET. RESULTS Of the 483 054 individuals included, there were 7177 with ET (3693 [51.46%] female; mean [SD] age, 62.66 [15.12] years), and 475 877 control individuals (253 785 [53.33%] female; mean [SD] age, 56.40 [17.6] years). Five independent genome-wide significant loci and were identified and were associated with approximately 18% of ET heritability. Functional analyses found significant enrichment in the cerebellar hemisphere, cerebellum, and axonogenesis pathways. Genetic correlation (r), which measures the degree of genetic overlap, revealed significant common variant overlap with Parkinson disease (r, 0.28; P = 2.38 × 10 −8 ) and depression (r, 0.12; P = 9.78 × 10 −4 ). A separate fine-mapping of transcriptome-wide association hits identified genes such as BACE2, LRRN2, DHRS13, and LINC00323 in disease-relevant brain regions, such as the cerebellum. CONCLUSIONS AND RELEVANCEThe results of this genome-wide association study suggest that a portion of ET heritability can be explained by common genetic variation and can help identify new common genetic risk factors for ET.

show abstract

Deep Brain Stimulation for Essential Tremor: Targeting the Dentato-Rubro-Thalamic Tract?

Cited by 92 publications

References 41 publications

Letter of response to “Individualization of deep brain stimulation targets for movement disorders”

Letter of response to “Individualization of deep brain stimulation targets for movement disorders”

Deep Brain Stimulation for Tremor: Is There a Common Structure?

Association of Essential Tremor With Novel Risk Loci

Contact Info

Product

Resources

About