Deep brain stimulation in the caudal zona incerta in patients with essential tremor: effects on cognition 1 year after surgery

Philipson, Johanna; Blomstedt, Patric; Hariz, Marwan; Jahanshahi, Marjan

doi:10.3171/2019.9.jns191646

Cited by 11 publications

(20 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…We next investigated the predictive power of the hypointensity with respect to clinical improvement and compared the model's performance to correlations with hotspot, coldspot, VIM, DRT, and other structures that have been implicated in tremor suppression, namely pallidothalamic tract 31 and caudal ZI (cZI). 32,33 To this end, simple linear models were generated investigating the relationship between percent volume overlap and clinical improvement scores obtained at 12 months compared to preoperative baseline (see Fig 3). Overlap between each patient's stimulation volume and the hypointensity template significantly correlated with clinical improvement (R 2 = 0.16, p = 0.017).…”

Section: Validation Of Probabilistic Mappingmentioning

confidence: 99%

Personalizing Deep Brain Stimulation Using Advanced Imaging Sequences

Neudorfer

Kroneberg

Al‐Fatly

et al. 2022

Annals of Neurology

View full text Add to dashboard Cite

Objective: With a growing appreciation for interindividual anatomical variability and patient-specific brain connectivity, advanced imaging sequences offer the opportunity to directly visualize anatomical targets for deep brain stimulation (DBS). The lack of quantitative evidence demonstrating their clinical utility, however, has hindered their broad implementation in clinical practice. Methods: Using fast gray matter acquisition T1 inversion recovery (FGATIR) sequences, the present study identified a thalamic hypointensity that holds promise as a visual marker in DBS. To validate the clinical utility of the identified hypointensity, we retrospectively analyzed 65 patients (26 female, mean age = 69.1 AE 12.7 years) who underwent DBS in the treatment of essential tremor. We characterized its neuroanatomical substrates and evaluated the hypointensity's ability to predict clinical outcome using stimulation volume modeling and voxelwise mapping. Finally, we determined whether the hypointensity marker could predict symptom improvement on a patient-specific level. Results: Anatomical characterization suggested that the identified hypointensity constituted the terminal part of the dentatorubrothalamic tract. Overlap between DBS stimulation volumes and the hypointensity in standard space significantly correlated with tremor improvement (R 2 = 0.16, p = 0.017) and distance to hotspots previously reported in the literature (R 2 = 0.49, p = 7.9e-4). In contrast, the amount of variance explained by other anatomical atlas structures was reduced. When accounting for interindividual neuroanatomical variability, the predictive power of the hypointensity increased further (R 2 = 0.37, p = 0.002). Interpretation: Our findings introduce and validate a novel imaging-based marker attainable from FGATIR sequences that has the potential to personalize and inform targeting and programming in DBS for essential tremor.

show abstract

Section: Validation Of Probabilistic Mappingmentioning

confidence: 99%

Personalizing Deep Brain Stimulation Using Advanced Imaging Sequences

Neudorfer

Kroneberg

Al‐Fatly

et al. 2022

Annals of Neurology

View full text Add to dashboard Cite

show abstract

“…Fytagoridis et al (2013) found while DBS adversely influenced the verbal fluency immediately after surgery when compared against a baseline, this effect dissipated at 1 year both on and off stimulation suggesting the deterioration likely reflected a micro-lesion effect. In a study involving caudal zona incerta stimulation, although the overall cognitive functioning was stable, there was a slight but statistically significant decline in semantic fluency at a 1-year follow-up (Philipson et al, 2019). A few studies have also shown improvement of cognitive functioning for ET with DBS besides the earlier work by Tröster et al (1999).…”

Section: Discussionmentioning

confidence: 94%

Cognitive Outcomes for Essential Tremor Patients Selected for Thalamic Deep Brain Stimulation Surgery Through Interdisciplinary Evaluations

Jones

Orozco

Bowers

et al. 2020

Front. Hum. Neurosci.

View full text Add to dashboard Cite

Objective: Deep brain stimulation (DBS) targeted to the ventral intermediate (VIM) nucleus of the thalamus is effective for motor symptoms in essential tremor (ET), but there is limited data on cognitive outcomes. We examined cognitive outcomes in a large cohort of ET DBS patients (pre-DBS and 1+ year after DBS).Methods: In a retrospective analysis, we used repeated-measures ANOVA testing to examine whether the age of tremor onset, age at DBS surgery, hemisphere side implanted with lead, unilateral vs. bilateral implantations, and presence of surgical complications influenced the cognitive outcomes. Neuropsychological outcomes of interest were verbal memory, executive functioning, working memory, language functioning, visuospatial functioning, and general cognitive function.Results: We identified 50 ET DBS patients; 29 (58%) males; the mean age of tremor onset was 35.84 (±21.50) years with a median age of 38 years. The mean age at DBS was 68.18 (±10.07) years. There were 37 unilateral 30 left, seven right, and 13 bilateral brain implantations. In the subgroup analysis, there was a significant interaction between assessment (pre vs. post) and age of tremor onset (<38 vs. >38 years); F(1,30) = 4.47; p = 0.043 for working memory. The post hoc testing found improvements for younger onset ET. Similarly, there was a significant interaction between assessment (pre vs. post) and complications vs. no complications subgroups; F(1,45) = 4.34; p = 0.043 for verbal memory with worsening scores seen for ET patients with complications. The remaining tests were not significant.Conclusion: In this large cohort of ET patients with (>30% improvements), DBS was not accompanied by a significant decline in many cognitive domains. These outcomes were possibly related to the selection of patients with normal cognitive functioning before surgery, unilateral DBS implantations for the majority, and selection of patients with optimal response to DBS.

show abstract

“…The detailed characteristics of included studies are shown in Table 1 . For sensitivity analysis, eight studies were included in the PSA‐DBS group 13 , 22 , 23 , 24 , 25 , 26 , 27 , 28 and fourteen studies were included in the VIM‐DBS group. 5 , 6 , 13 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 Due to the short term of follow‐up, three studies in the VIM‐DBS group were excluded from the main analysis.…”

Section: Resultsmentioning

confidence: 99%

“…According to multiple reports, VIM‐DBS improves the QoL in ET patients. However, only five studies reported the QoL of PSA‐DBS using three different types of assessment scales, including SF‐36, ADL, and QUEST 13,22,24,27,28 . It is of limited value to use such diverse data to make a comparison with VIM‐DBS.…”

Section: Discussionmentioning

confidence: 99%