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Journal of Neurology

Thalamic ventral-Oralis complex/rostral zona incerta deep brain stimulation for midline tremor

  • Open Access
  • 10-08-2024
  • Tremor
  • Original Communication
Published in:
Authors
Alba Scerrati
Andrea Gozzi
Michele Alessandro Cavallo
Giorgio Mantovani
Pietro Antenucci
Chiara Angelini
Jay Guido Capone
Pasquale De Bonis
Francesca Morgante
Vittorio Rispoli
Mariachiara Sensi
Published in
Journal of Neurology | Issue 10/2024

Abstract

Background

Midline Tremor is defined as an isolated or combined tremor that affects the neck, trunk, jaw, tongue, and/or voice and could be part of Essential Tremor (ET), or dystonic tremor. The clinical efficacy of deep brain stimulation for Midline Tremor has been rarely reported. The Ventral Intermediate Nucleus and Globus Pallidus Internus are the preferred targets, but with variable outcomes. Thalamic Ventral-Oralis (VO) complex and Zona Incerta (ZI) are emerging targets for tremor control in various etiologies.

Objective

To report on neuroradiological, neurophysiological targeting and long-term efficacy of thalamic Ventral-Oralis complex and Zona Incerta deep brain stimulation in Midline Tremor.

Methods

Three patients (two males and one female) with Midline Tremor in dystonic syndromes were recruited for this open-label study. Clinical, surgical, neurophysiological intraoperative testing and long-term follow-up data are reported.

Results

Intraoperative testing and reconstruction of volume of tissue activated confirmed the position of the electrodes in the area stimulated between the thalamic Ventral-Oralis complex and Zona Incerta in all patients.
All three patients showed optimal control of both tremor and dystonic features at short-term (6 months) and long-term follow-up (up to 6 years). No adverse events occurred.

Conclusion

In the syndromes of Midline Tremor of various origins, the best target for DBS might be difficult to identify. Our results showed that thalamic Ventral-Oralis complex/Zona Incerta may be a viable and safe option even in specific forms of tremor with axial distribution.
Title
Thalamic ventral-Oralis complex/rostral zona incerta deep brain stimulation for midline tremor
Authors
Alba Scerrati
Andrea Gozzi
Michele Alessandro Cavallo
Giorgio Mantovani
Pietro Antenucci
Chiara Angelini
Jay Guido Capone
Pasquale De Bonis
Francesca Morgante
Vittorio Rispoli
Mariachiara Sensi
Publication date
10-08-2024
Publisher
Springer Berlin Heidelberg
Published in
Journal of Neurology / Issue 10/2024
Print ISSN: 0340-5354
Electronic ISSN: 1432-1459
DOI
https://doi.org/10.1007/s00415-024-12619-3
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Human brain illustration/© (M) CHRISTOPH BURGSTEDT / SCIENCE PHOTO LIBRARY / Getty Images, Navigating neuroimaging in Alzheimer’s care: Practical applications and strategies for integration/© Springer Health+ IME