Top

Published in:

Open Access 01-04-2016 | Clinical Article - Functional

One-pass deep brain stimulation of dentato-rubro-thalamic tract and subthalamic nucleus for tremor-dominant or equivalent type Parkinson’s disease

Authors: Volker Arnd Coenen, Michel Rijntjes, Thomas Prokop, Tobias Piroth, Florian Amtage, Horst Urbach, Peter Christoph Reinacher

Published in: Acta Neurochirurgica | Issue 4/2016

Abstract

Background

Refractory tremor in tremor-dominant (TD) or equivalent-type (EQT) idiopathic Parkinson’s syndrome (IPS) poses the challenge of choosing the best target region to for deep brain stimulation (DBS). While the subthalamic nucleus is typically chosen in younger patients as the target for dopamine-responsive motor symptoms, it is more complicated if tremor does not (fully) respond under trial conditions. In this report, we present the first results from simultaneous bilateral DBS of the DRT (dentato-rubro-thalamic tract) and the subthalamic nucleus (STN) in two elderly patients with EQT and TD IPS and dopamine-refractory tremor.

Methods

Two patients received bilateral octopolar DBS electrodes in the STN additionally traversing the DRT region. Achieved electrode positions were determined with helical CT, overlaid onto DTI tractography data, and compared with clinical data of stimulation response.

Results

Both patients showed immediate and sustained improvement of their tremor, bilaterally.

Conclusions

The proposed approach appears to be safe and feasible and a combined stimulation of the two target regions was performed tailored to the patients’ symptoms. Clinically, no neuropsychiatric effects were seen. Our pilot data suggest a viable therapeutic option to treat the subgroup of TD and EQT IPS and with tremor as the predominant symptom. A clinical study to further investigate this approach (OPINION: www.clinicaltrials.gov; NCT02288468) is the focus of our ongoing research.

Burgel U, Madler B, Honey CR, Thron A, Gilsbach J, Coenen VA (2009) Fiber tracking with distinct software tools results in a clear diversity in anatomical fiber tract portrayal. Cent Eur Neurosurg 70:27–35CrossRefPubMed

Coenen VA, Allert N, Madler B (2011) A role of diffusion tensor imaging fiber tracking in deep brain stimulation surgery: DBS of the dentato-rubro-thalamic tract (DRT) for the treatment of therapy-refractory tremor. Acta Neurochir 153:1579–1585, discussion 1585CrossRefPubMed

Coenen VA, Allert N, Paus S, Kronenburger M, Urbach H, Madler B (2014) Modulation of the cerebello-thalamo-cortical network in thalamic deep brain stimulation for tremor: a diffusion tensor imaging study. Neurosurgery 75:657–670CrossRefPubMed

Coenen VA, Madler B, Schiffbauer H, Urbach H, Allert N (2011) Individual fiber anatomy of the subthalamic region revealed with diffusion tensor imaging: a concept to identify the deep brain stimulation target for tremor suppression. Neurosurgery 68:1069–1075, discussion 1075-1066PubMed

Coenen VA, McIntyre CC (2015) Letter to the editor: correlation of diffusion tensor imaging and intraoperative macrostimulation. J Neurosurg 123:291–292CrossRefPubMed

Coenen VA, Prescher A, Schmidt T, Picozzi P, Gielen FL (2008) What is dorso-lateral in the subthalamic Nucleus (STN)?--a topographic and anatomical consideration on the ambiguous description of today’s primary target for deep brain stimulation (DBS) surgery. Acta Neurochir 150:1163–1165, discussion 1165CrossRefPubMed

Coenen VA, Schlaepfer TE, Allert N, Madler B (2012) Diffusion tensor imaging and neuromodulation: DTI as key technology for deep brain stimulation. Int Rev Neurobiol 107:207–234CrossRefPubMed

Deuschl G, Bain P, Brin M (1998) Consensus statement of the movement disorder society on tremor. Ad Hoc Sci Comm Mov Disord: Off J Mov Disord Soc 13(Suppl 3):2–23

Deuschl G, Schade-Brittinger C, Krack P, Volkmann J, Schafer H, Botzel K, Daniels C, Deutschlander A, Dillmann U, Eisner W, Gruber D, Hamel W, Herzog J, Hilker R, Klebe S, Kloss M, Koy J, Krause M, Kupsch A, Lorenz D, Lorenzl S, Mehdorn HM, Moringlane JR, Oertel W, Pinsker MO, Reichmann H, Reuss A, Schneider GH, Schnitzler A, Steude U, Sturm V, Timmermann L, Tronnier V, Trottenberg T, Wojtecki L, Wolf E, Poewe W, Voges J, German Parkinson Study Group NS (2006) A randomized trial of deep-brain stimulation for Parkinson’s disease. N Engl J Med 355:896–908CrossRefPubMed

10.

Fisher R, Salanova V, Witt T, Worth R, Henry T, Gross R, Oommen K, Osorio I, Nazzaro J, Labar D, Kaplitt M, Sperling M, Sandok E, Neal J, Handforth A, Stern J, DeSalles A, Chung S, Shetter A, Bergen D, Bakay R, Henderson J, French J, Baltuch G, Rosenfeld W, Youkilis A, Marks W, Garcia P, Barbaro N, Fountain N, Bazil C, Goodman R, McKhann G, Babu Krishnamurthy K, Papavassiliou S, Epstein C, Pollard J, Tonder L, Grebin J, Coffey R, Graves N, SS Group (2010) Electrical stimulation of the anterior nucleus of thalamus for treatment of refractory epilepsy. Epilepsia 51:899–908CrossRefPubMed

11.

Fraix V, Pollak P, Moro E, Chabardes S, Xie J, Ardouin C, Benabid AL (2005) Subthalamic nucleus stimulation in tremor dominant parkinsonian patients with previous thalamic surgery. J Neurol Neurosurg Psychiatry 76:246–248CrossRefPubMedPubMedCentral

12.

Hilker R, Benecke R, Deuschl G, Fogel W, Kupsch A, Schrader C, Sixel-Doring F, Timmermann L, Volkmann J, Lange M, German Deep Brain Stimulation A (2009) Deep brain stimulation for Parkinson’s disease. Consensus recommendations of the German Deep Brain Stimulation Association. Nervenarzt 80:646–655CrossRefPubMed

13.

Kinoshita M, Yamada K, Hashimoto N, Kato A, Izumoto S, Baba T, Maruno M, Nishimura T, Yoshimine T (2005) Fiber-tracking does not accurately estimate size of fiber bundle in pathological condition: initial neurosurgical experience using neuronavigation and subcortical white matter stimulation. NeuroImage 25:424–429CrossRefPubMed

14.

Krack P, Pollak P, Limousin P, Benazzouz A, Benabid AL (1997) Stimulation of subthalamic nucleus alleviates tremor in Parkinson’s disease. Lancet 350:1675CrossRefPubMed

15.

Kramer DR, Halpern CH, Danish SF, Jaggi JL, Baltuch GH (2012) The effect of intraventricular trajectory on brain shift in deep brain stimulation. Stereotact Funct Neurosurg 90:20–24CrossRefPubMed

16.

Lance JW, Schwab RS, Peterson EA (1963) Action tremor and the cogwheel phenomenon in Parkinson’s disease. Brain: J Neurol 86:95–110CrossRef

17.

Limousin P, Speelman JD, Gielen F, Janssens M (1999) Multicentre European study of thalamic stimulation in parkinsonian and essential tremor. J Neurol Neurosurg Psychiatry 66:289–296CrossRefPubMedPubMedCentral

18.

Madler B, Coenen VA (2012) Explaining clinical effects of deep brain stimulation through simplified target-specific modeling of the volume of activated tissue. AJNR Am J Neuroradiol 33:1072–1080CrossRefPubMed

19.

Okun MS, Rodriguez RL, Foote KD, Sudhyadhom A, Bova F, Jacobson C, Bello B, Zeilman P, Fernandez HH (2008) A case-based review of troubleshooting deep brain stimulator issues in movement and neuropsychiatric disorders. Parkinsonism Relat Disord 14:532–538CrossRefPubMed

20.

Rehncrona S, Johnels B, Widner H, Tornqvist AL, Hariz M, Sydow O (2003) Long-term efficacy of thalamic deep brain stimulation for tremor: double-blind assessments. Ad Hoc Sci Comm Mov Disord: Off J Mov Disord Soc 18:163–170

21.

Reich MM, Steigerwald F, Sawalhe AD, Reese R, Gunalan K, Johannes S, Nickl R, Matthies C, McIntyre CC, Volkmann J (2015) Short pulse width widens the therapeutic window of subthalamic neurostimulation. Ann Clin Transl Neurol 2:427–432CrossRefPubMedPubMedCentral

22.

Said N, Elias WJ, Raghavan P, Cupino A, Tustison N, Frysinger R, Patrie J, Xin W, Wintermark M (2014) Correlation of diffusion tensor tractography and intraoperative macrostimulation during deep brain stimulation for Parkinson disease. J Neurosurg 121:929–935CrossRefPubMed

23.

Schuepbach WM, Rau J, Knudsen K, Volkmann J, Krack P, Timmermann L, Halbig TD, Hesekamp H, Navarro SM, Meier N, Falk D, Mehdorn M, Paschen S, Maarouf M, Barbe MT, Fink GR, Kupsch A, Gruber D, Schneider GH, Seigneuret E, Kistner A, Chaynes P, Ory-Magne F, Brefel Courbon C, Vesper J, Schnitzler A, Wojtecki L, Houeto JL, Bataille B, Maltete D, Damier P, Raoul S, Sixel-Doering F, Hellwig D, Gharabaghi A, Kruger R, Pinsker MO, Amtage F, Regis JM, Witjas T, Thobois S, Mertens P, Kloss M, Hartmann A, Oertel WH, Post B, Speelman H, Agid Y, Schade-Brittinger C, Deuschl G, ES Group (2013) Neurostimulation for Parkinson’s disease with early motor complications. N Engl J Med 368:610–622CrossRefPubMed

24.

Tomlinson CL, Stowe R, Patel S, Rick C, Gray R, Clarke CE (2010) Systematic review of levodopa dose equivalency reporting in Parkinson’s disease. Ad Hoc Sci Comm Mov Disord: Off J Mov Disord Soc 25:2649–2653

25.

Volkmann J, Daniels C, Witt K (2010) Neuropsychiatric effects of subthalamic neurostimulation in Parkinson disease. Nat Rev Neurol 6:487–498PubMed

26.

Zaitsev M, Hennig J, Speck O (2004) Point spread function mapping with parallel imaging techniques and high acceleration factors: fast, robust, and flexible method for echo-planar imaging distortion correction. Magn Reson Med 52:1156–1166CrossRefPubMed

27.

Zrinzo L, Holl EM, Petersen EA, Limousin P, Foltynie T, Hariz MI (2011) Skewering the subthalamic nucleus via a parietal approach. Stereotact Funct Neurosurg 89:70–75CrossRefPubMed

Title: One-pass deep brain stimulation of dentato-rubro-thalamic tract and subthalamic nucleus for tremor-dominant or equivalent type Parkinson’s disease
Authors: Volker Arnd Coenen
Michel Rijntjes
Thomas Prokop
Tobias Piroth
Florian Amtage
Horst Urbach
Peter Christoph Reinacher
Publication date: 01-04-2016
Publisher: Springer Vienna
Published in: Acta Neurochirurgica / Issue 4/2016
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI: https://doi.org/10.1007/s00701-016-2725-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

One-pass deep brain stimulation of dentato-rubro-thalamic tract and subthalamic nucleus for tremor-dominant or equivalent type Parkinson’s disease

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 4/2016

Endovascular treatment of ruptured blood blister-like aneurysms with multiple (≥3) overlapping Enterprise stents and coiling

If it can be done, it should be done,…or not?

Transaqueductal trans-Magendie fenestration of arachnoid cyst in the posterior fossa

The current role of Gamma Knife radiosurgery in the management of intracranial haemangiopericytoma

Assessing size of pituitary adenomas: a comparison of qualitative and quantitative methods on MR

Vertebral artery dolicoectasia with brainstem compression: role of microvascular decompression in relieving pyramidal weakness