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J Neurol Surg A Cent Eur Neurosurg 2017; 78(04): 350-357
DOI: 10.1055/s-0036-1597894
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Distance between Active Electrode Contacts and Dentatorubrothalamic Tract in Patients with Habituation of Stimulation Effect of Deep Brain Stimulation in Essential Tremor

Judith Maria Anthofer
1   Department of Neurosurgery, Universitatsklinikum Regensburg Klinik und Poliklinik fur Neurochirurgie Ringgold Standard Institution, Regensburg, Germany
,
Kathrin Steib
1   Department of Neurosurgery, Universitatsklinikum Regensburg Klinik und Poliklinik fur Neurochirurgie Ringgold Standard Institution, Regensburg, Germany
,
Max Lange
2   Department of Neurosurgery, University Medical Center Regensburg, Regensburg, Germany
,
Eva Rothenfusser
3   Department of Neurology, Universitatsklinikum Regensburg Klinik und Poliklinik fur Neurologie Ringgold Standard Institution, Regensburg, Bayern, Germany
,
Claudia Fellner
4   Department of Radiology, University Hospital Regensburg, Regensburg, Germany
,
Alexander Brawanski
2   Department of Neurosurgery, University Medical Center Regensburg, Regensburg, Germany
,
Juergen Schlaier
1   Department of Neurosurgery, Universitatsklinikum Regensburg Klinik und Poliklinik fur Neurochirurgie Ringgold Standard Institution, Regensburg, Germany
› Author Affiliations
Further Information

Publication History

24 January 2016

17 October 2016

Publication Date:
20 March 2017 (online)

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Abstract

Background Some patients under thalamic deep brain stimulation (DBS) for essential tremor (ET) experience habituation of tremor reduction. The nucleus ventralis intermedius (Vim) is the current main target side for ET in DBS. However, the dentatorubrothalamic tract (DRTT) is considered the relevant structure to stimulate. We investigated the distance between the active contact of the DBS electrode and the DRTT and compared this distance in patients with habituation of tremor reduction and good responders.

Material and Methods In this retrospective study, we performed deterministic fiber tracking of the DRTT in 6 patients (12 hemispheres) with ET who underwent DBS in the Vim. We subsequently measured the distance between the active contact of the electrode and the ipsilateral DRTT in both hemispheres. The clinical tremor response of those 6 patients was analyzed accordingly.

Results The distance between the active contact and the DRTT in patients with better and constant clinical tremor reduction was shorter (mean distance: 2.9 ± 2.2 mm standard deviation [SD]) than in patients who showed habituation of their response (mean distance: 6.1 ± 3.9 mm SD). After re-placement of a thalamic electrode inside the DRTT in one patient who experienced unsatisfying tremor reduction due to habituation of stimulation, the tremor alleviation was significant and persistent at a 13-month follow-up.

Conclusion This retrospective analysis suggests that recurrence of ET tremor under chronic DBS might be associated with a larger distance between the DRTT and the active lead contact, in comparison with the smaller distances in patients with persistently good tremor control.

Keywords

essential tremor - dentatorubrothalamic tract - diffusion tensor imaging - deterministic fiber tracking - deep brain stimulation
 

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