Electrical Stimulation of the Thalamic and Subthalamic Area in Parkinson’s Disease

Johansson, Gunnar; Laitinen, L.

doi:10.1159/000104064

Cited by 14 publications

(4 citation statements)

References 7 publications

(7 reference statements)

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“…Since the electrode tip was located in the right zona incerta, the stimulation may have influenced symptoms via the zona incerta and H2 fields of Forel. Neurosurgical studies of these regions in PD patients in the 1960s reported amelioration of rigidity and tremor with stimulation and subsequent lesioning 35, 36. It has recently been proposed that activation of fibres in the zona incerta and fields of Forel may have tremorlytic effects 25…”

Section: Discussionmentioning

confidence: 99%

Postmortem analysis of bilateral subthalamic electrode implants in Parkinson's disease

et al. 2002

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This is the second neuropathological report detailing bilateral electrodes targeting the subthalamic nucleus (STN) in idiopathic Parkinson's disease (PD). The patient presented with unilateral tremor-dominant parkinsonism. Bilateral STN stimulation was carried out 7 years later due to significant disease progression and severe motor fluctuations. The patient exhibited bilateral improvements in rigidity and bradykinesia both intraoperatively and postoperatively. The patient died 2 months later from aspiration pneumonia. Neuropathological examination confirmed both the diagnosis of PD and the electrode placements. The tip of the left electrode was located medially and posteriorly in the left STN and the tip of the right electrode entered the base of the thalamus/zona incerta immediately above the right STN. Tissue changes associated with the subthalamic electrode tracts included mild cell loss, astrogliosis, and some tissue vacuolation. Our postmortem analysis indicates little tissue damage associated with STN stimulation for PD.

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Section: Discussionmentioning

confidence: 99%

Postmortem analysis of bilateral subthalamic electrode implants in Parkinson's disease

et al. 2002

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“…These favourable effects have been ascribed to the zona incerta, prelemniscal radiation (RAPRL), fields of Forel, but also the subthalamic nucleus [3,5,10,28,30,33,38,40,46,47,57,58,61,62]. Thus, clearly distinct stereotactic targets located several millimeters apart have been suggested to result in best tremor suppression.…”

Section: Introductionmentioning

confidence: 99%

Deep brain stimulation in the subthalamic area is more effective than nucleus ventralis intermedius stimulation for bilateral intention tremor

Hamel

Herzog

Kopper

et al. 2007

Acta Neurochir (Wien)

138

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SummaryBackground. The ventro-lateral thalamus is the stereotactic target of choice for severe intention tremor. Nevertheless, the optimal target area has remained controversial, and targeting of the subthalamic area has been suggested to be superior.Patients and methods. Eleven patients with disabling intention tremor of different etiology (essential tremor (n ¼ 8), multiple sclerosis (n ¼ 2) and one with, spinocerebellar ataxia) were implanted bilaterally with DBS electrodes targeted to the ventro-lateral thalamus using micro-recording and micro-stimulation. Among five tracks explored in parallel optimal tracks were chosen for permanent electrode implantation. Postoperative tremor suppression elicited by individual electrode contacts was quantified using a lateralised tremor rating scale at least 3 months (in most patients >1 year) after implantation. The position of electrode contacts was determined retrospectively from stereotactic X-ray exams and by correlation of pre-and postoperative MRI.Results. In all patients, DBS suppressed intention tremor markedly. On average, tremor on the left and right side of the body was improved by 68% (AE19; standard deviation) and 73% (AE21), respectively. In most patients, distal electrode contacts located in the subthalamic area proved to be more effective than proximal contacts in the ventro-lateral thalamus. In stereotactic coordinates, the optimal site was located 12.7 mm (AE1.4; mean AE standard deviation) lateral, 7.0 (AE 1.6) mm posterior, and 1.5 (AE 2.0) mm ventral to the mid-commissural point. In general, the best contacts could be selected for permanent stimulation. Nevertheless, in some instances, more proximal contacts had to be chosen because of adverse effects (paraesthesiae, dysarthria, gait ataxia) which were more pronounced with bilateral stimulation resulting in slightly less tremor suppression on the left and right side of body (63 AE 18 and 68 AE 19%, respectively).Conclusion. Direct comparison of different stimulation sites in individual patients revealed that DBS in the subthalamic area is more effective in suppressing pharmacoresistant intention tremor than the ventro-lateral thalamus proper. Anatomical structures possibly involved in tremor suppression include cerebello-thalamic projections, the prelemniscal radiation, and the zona incerta.

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“…In 1965, both the effects of intraoperative stimulation [61] and the benefi cial effects of lesions [62,63] of the subthalamic nuclei were reported. However, there was concern that lesions in the subthalamic nucleus might produce the complication of hemiballism, so it was never a popular target.…”

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confidence: 99%

Evolution of Neuromodulation

Gildenberg¹

2005

Stereotact Funct Neurosurg

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Electrical Stimulation of the Thalamic and Subthalamic Area in Parkinson’s Disease

Cited by 14 publications

References 7 publications

Postmortem analysis of bilateral subthalamic electrode implants in Parkinson's disease

Postmortem analysis of bilateral subthalamic electrode implants in Parkinson's disease

Deep brain stimulation in the subthalamic area is more effective than nucleus ventralis intermedius stimulation for bilateral intention tremor

Evolution of Neuromodulation

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