Stereotaxic Interventions on the Zona Incerta Area for Treatment of Extrapyramidal Motor Disturbances and their Results

Mundinger, F.

doi:10.1159/000104030

Cited by 95 publications

(59 citation statements)

References 9 publications

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“…Thus, our data corroborate the concept that the subthalamic area is superior to the ventralis intermedius nucleus in suppressing severe 754 intention tremor. This has been proposed almost since ablative procedures in the ventro-lateral thalamus had become an established treatment, and this is supported by the fact that the electrical energy required to excite myelinated fibre tracts is lower than that required for somata [3,5,10,30,46,47,57,58,61,62].…”

Section: Discussionmentioning

confidence: 99%

“…Efficient suppression of intention tremor may be mediated by different structures contained in the subthalamic area, e.g. the zona incerta known to harbour tremor cells, the fields of Forel H 2 , the prelemniscal radiation, and, possibly, dorsal parts of the subthalamic nucleus [5,10,30,36,38,46,47,57,58,61,62]. Notably, with DBS in the subthalamic area efferents from deep cerebellar nuclei will be modulated along their course through the prerubral field and along the zona incerta [24,44,54].…”

Section: Discussionmentioning

confidence: 99%

“…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%

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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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

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

View full text Add to dashboard Cite

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“…The fact that Cooper published a guide to lesioning the GP in order to treat MDs refutes claims that MPTP monkeys were responsible for linking the GP to MDs. Story et al [116], Mundinger [117], and Fager [118] also successfully lesioned the STN in a large number of patients with PD. Clearly by the 1960s operations on very specific components of the basal ganglia were being performed for PD patients and the STN had been linked to movement disorders.…”

Section: Pereira and Aziz Statementioning

confidence: 97%

The Development of Deep Brain Stimulation for Movement Disorders

Greek¹

2012

J Clinic Res Bioeth

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The development of deep brain stimulation has revolutionized care for patients with movement disorders like Parkinson's disease. Many areas of science contributed to this technology but one area, the use of animal models, has been cited as vital. We review these claims as well as the history of the discoveries that eventually led to deep brain stimulation in an attempt to ascertain: 1) the contributions of animal models; 2) the contributions from humanbased research and observation; and the role of advances in the engineering, physics, and computer science. We distinguish between advances and discoveries that were, or at least appear to be, dependent on animal models and those where animals were involved but that could have occurred, and/or were occurring simultaneously, with humanbased research. We conclude that animal-based research played a role in defining gross anatomy in the 19 th and early 20 th centuries, but that essentially all subsequent advances were human-based or secondary to advances in the physical and applied sciences. This has historical, funding, and ethical implications as the development of deep brain stimulation is cited as an example of the importance of animal-based research and a reason for continued social and financial support of animal models in general as opposed to clinical research, other human-based research modalities, and the various disciplines of the physical and applied sciences.

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“…One of them is the work of Mundinger et al (1965), also referred to greater improvement in this sign of 85% vs. 75% of the tremor when the Raprl-Zi damaged. Ito (1975) …”

Section: Rigiditymentioning

confidence: 99%