The dentato-rubro-thalamic tract as the potential common deep brain stimulation target for tremor of various origin: an observational case series

• DOI: 10.1007/s00701-020-04248-2
• Publication Date: 2020-01-29T23:01:32Z
• Authors: Volker Arnd Coenen; Bastian Sajonz; Thomas Prokop; Marco Reisert; Tobias Piroth; Horst Urbach; Carolin Jenkner; Peter Christoph R...
• Keywords: Thalamic stimulator; Transcranial Direct Current Stimulation; Subthalamic Nucleus

Abstract Introduction Deep brain stimulation alleviates tremor of various origins. The dentato-rubro-thalamic tract (DRT) has been suspected as a common tremor-reducing structure. Statistical evidence not obtained. We here report the results an uncontrolled case series patients with refractory who underwent deep under tractographic assistance. Methods A total 36 were enrolled (essential (17), Parkinson’s (8), multiple sclerosis (7), dystonic head (3), tardive dystonia (1)) and received 62 DBS electrodes (26 bilateral; 10 unilateral). Preoperatively, diffusion tensor magnetic resonance imaging sequences acquired together high-resolution anatomical T1W T2W sequences. DRT was individually tracked used direct thalamic or subthalamic target. Intraoperative reduction graded on 4-point scale (0 = no to 3 full control) recorded current amplitude, respectively. Stimulation point coordinates compared DRT. relation amplitude needed reduce expressed TiCR (tremor improvement per ratio). Results points 241 available for analysis. 68 trajectories tested (62 dB leads, 1.1 implanted lead). Tremor significantly decreasing ( p < 0.01) if distance both border center increasing. On initial trajectory, 56 leads (90.3%) finally placed. Long-term outcomes part this Discussion origins acutely alleviated at different along fiber (above below MCP plane) despite diseases. is potentially Individual targeting helps penetrating tracts. characterizes efficacy might help identify optimal point.