Mediation of Tremor Control by the Decussating and Nondecussating Part of the Dentato-Rubro-Thalamic Tract in Deep Brain Stimulation in Essential Tremor: Which Part Should Be Stimulated?

Deuter, Daniel; Torka, Elisabeth; Kohl, Zacharias; Schmidt, Nils-Ole; Schlaier, J.

doi:10.1016/j.neurom.2022.04.040

Cited by 4 publications

(7 citation statements)

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“…More recently, diffusion weighted imaging (DWI) tractography has emerged as a useful technique in defining the connectivity of the thalamus to aid in target selection. Many of the findings from studies of DBS have demonstrated proximity to the DWI tractography generated DRTT and the correlation with tremor suppression (14)(15)(16)(17)(18), knowledge which has been translated to treatment with MRgFUS. In MRgFUS studies, the strongest evidence to date of DRTT involvement comes from several studies examining the microstructural changes along the DRTT and the relationship with clinical outcomes.…”

Section: Introductionmentioning

confidence: 99%

Tremor suppression following treatment with MRgFUS: skull density ratio consistency and degree of posterior dentatorubrothalamic tract lesioning predicts long-term clinical outcomes in essential tremor

Kyle

Maller²,

Barnett

et al. 2023

Front. Neurol.

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ObjectivesMagnetic resonance-guided focussed ultrasound (MRgFUS) is an incisionless ablative procedure, widely used for treatment of Parkinsonian and Essential Tremor (ET). Enhanced understanding of the patient- and treatment-specific factors that influence sustained long-term tremor suppression could help clinicians achieve superior outcomes via improved patient screening and treatment strategy.MethodsWe retrospectively analysed data from 31 subjects with ET, treated with MRgFUS at a single centre. Tremor severity was assessed with parts A, B and C of the Clinical Rating Scale for Tremor (CRST) as well as the combined CRST. Tremor in the dominant and non-dominant hand was assessed with Hand Tremor Scores (HTS), derived from the CRST. Pre- and post-treatment imaging data were analysed to determine ablation volume overlap with automated thalamic segmentations, and the dentatorubrothalamic tract (DRTT) and compared with percentage change in CRST and HTS following treatment.ResultsTremor symptoms were significantly reduced following treatment. Combined pre-treatment CRST (mean: 60.7 ± 17.3) and HTS (mean: 19.2 ± 5.7) improved by an average of 45.5 and 62.6%, respectively. Percentage change in CRST was found to be significantly negatively associated with age (β = −0.375, p = 0.015), and SDR standard deviation (SDRSD; β = −0.324, p = 0.006), and positively associated with ablation overlap with the posterior DRTT (β = 0.535, p < 0.001). Percentage HTS improvement in the dominant hand decreased significantly with older age (β = −0.576, p < 0.01).ConclusionOur results suggest that increased lesioning of the posterior region of the DRTT could result in greater improvements in combined CRST and non-dominant hand HTS, and that subjects with lower SDR standard deviation tended to experience greater improvement in combined CRST.

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Section: Introductionmentioning

confidence: 99%

Tremor suppression following treatment with MRgFUS: skull density ratio consistency and degree of posterior dentatorubrothalamic tract lesioning predicts long-term clinical outcomes in essential tremor

Kyle

Maller²,

Barnett

et al. 2023

Front. Neurol.

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“…Subsequently, tracts were binarized based on the probability maps. Several methods how to choose the threshold for the final definition of fiber tracts exist as previously described [ 20 ]. As thresholds based on 200%, 400%, 600%, 800%, and 1000% of the robust range ignoring extreme spikes within the histogram (“-thrp”) showed best results in previous tests, tracts were calculated based on these values and were compared in direct overly on the T2-weighted images in parallel.…”

Section: Methodsmentioning

confidence: 99%

“…Subcortical fibers are thought to be electrically influenced by the DBS signal inside a volume of tissue electrically activated (VTA) [ 11 , 12 ]. As these fiber tracts are probably mediating DBS effects inside the brain, special interest has been paid to subcortical fiber tracts with regard to DBS [ 13 – 20 ].…”

Section: Introductionmentioning

confidence: 99%

“…The dentato-rubro-thalamic tract (DRTT), connecting the cerebellum with the thalamus, consists of crossing and non-decussating fibers (c-DRTT and nd-DRTT) and has been shown to mediate tremor-reducing DBS effects in essential tremor (ET) [ 18 – 20 , 28 ]. Some authors even proposed the DRTT, representing the main cerebellar efferent pathway [ 29 , 30 ], as a common structure mediating tremor-reducing DBS effects irrespective of the underlying pathology.…”

Section: Introductionmentioning

confidence: 99%

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Amelioration of Parkinsonian tremor evoked by DBS: which role play cerebello-(sub)thalamic fiber tracts?

Deuter,

Mederer,

Kohl

et al. 2023

J Neurol

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Background Current pathophysiological models of Parkinson’s disease (PD) assume a malfunctioning network being adjusted by the DBS signal. As various authors showed a main involvement of the cerebellum within this network, cerebello-cerebral fiber tracts are gaining special interest regarding the mediation of DBS effects. Objectives The crossing and non-decussating fibers of the dentato-rubro-thalamic tract (c-DRTT/nd-DRTT) and the subthalamo-ponto-cerebellar tract (SPCT) are thought to build up an integrated network enabling a bidimensional communication between the cerebellum and the basal ganglia. The aim of this study was to investigate the influence of these tracts on clinical control of Parkinsonian tremor evoked by DBS. Methods We analyzed 120 electrode contacts from a cohort of 14 patients with tremor-dominant or equivalence-type PD having received bilateral STN-DBS. Probabilistic tractography was performed to depict the c-DRTT, nd-DRTT, and SPCT. Distance maps were calculated for the tracts and correlated to clinical tremor control for each electrode pole. Results A significant difference between “effective” and “less-effective” contacts was only found for the c-DRTT (p = 0.039), but not for the SPCT, nor the nd-DRTT. In logistic and linear regressions, significant results were also found for the c-DRTT only (pmodel logistic = 0.035, ptract logistic = 0,044; plinear = 0.027). Conclusions We found a significant correlation between the distance of the DBS electrode pole to the c-DRTT and the clinical efficacy regarding tremor reduction. The c-DRTT might therefore play a major role in the mechanisms of alleviation of Parkinsonian tremor and could eventually serve as a possible DBS target for tremor-dominant PD in future.

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“…1 https://fsl.fmrib.ox.ac.uk/fsl/fslwiki/FSL model was rendered via the MRIcroGL software 2 (Figure 1A). Considering that the decussating DRTT was more related to DBS outcomes (Deuter et al, 2022), we only tracked the decussating part of the DRTT. Besides, since the DRTT travels along the angle between the pyramidal tract and the somatosensory tract, to lower the incidence of adverse effects, the final target of VIM was identified to be at least 3 mm away from these two tracts.…”

Section: Vim Positioning and Surgery Planningmentioning

confidence: 99%

One-pass deep brain stimulation of subthalamic nucleus and ventral intermediate nucleus for levodopa-resistant tremor-dominant Parkinson’s disease

Liu,

Xu,

Feng

et al. 2023

Front. Aging Neurosci.

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ObjectiveTremor-dominant Parkinson’s disease (TD-PD) can be further separated into levodopa-responsive and levodopa-resistant types, the latter being considered to have a different pathogenesis. Previous studies indicated that deep brain stimulation (DBS) of the subthalamic nucleus (STN) or the globus pallidus internus (GPi) individually was not sufficient for tremor control, especially for the levodopa-resistant TD-PD (LRTD-PD). The thalamic ventral intermediate nucleus (VIM) has been regarded as a potent DBS target for different kinds of tremors. Therefore, we focused on the LRTD-PD subgroup and performed one-pass combined DBSs of STN and VIM to treat refractory tremors, aiming to investigate the safety and effectiveness of this one-trajectory dual-target DBS scheme.MethodsWe retrospectively collected five LRTD-PD patients who underwent a one-pass combined DBS of STN and VIM via a trans-frontal approach. The targeting of VIM was achieved by probabilistic tractography. Changes in severity of symptoms (measured by the Unified Parkinson Disease Rating Scale part III, UPDRS-III), levodopa equivalent daily doses (LEDD), and disease-specific quality of life (measured by the 39-item Parkinson’s Disease Questionnaire, PDQ-39) were evaluated.ResultsThree-dimensional reconstruction of electrodes illustrated that all leads were successfully implanted into predefined positions. The mean improvement rates (%) were 53 ± 6.2 (UPDRS-III), 82.6 ± 11.4 (tremor-related items of UPDRS), and 52.1 ± 11.4 (PDQ-39), respectively, with a mean follow-up of 11.4 months.ConclusionOne-pass combined DBS of STN and VIM via the trans-frontal approach is an effective and safe strategy to alleviate symptoms for LRTD-PD patients.

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Mediation of Tremor Control by the Decussating and Nondecussating Part of the Dentato-Rubro-Thalamic Tract in Deep Brain Stimulation in Essential Tremor: Which Part Should Be Stimulated?

Cited by 4 publications

References 46 publications

Tremor suppression following treatment with MRgFUS: skull density ratio consistency and degree of posterior dentatorubrothalamic tract lesioning predicts long-term clinical outcomes in essential tremor

Tremor suppression following treatment with MRgFUS: skull density ratio consistency and degree of posterior dentatorubrothalamic tract lesioning predicts long-term clinical outcomes in essential tremor

Amelioration of Parkinsonian tremor evoked by DBS: which role play cerebello-(sub)thalamic fiber tracts?

One-pass deep brain stimulation of subthalamic nucleus and ventral intermediate nucleus for levodopa-resistant tremor-dominant Parkinson’s disease

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