Top

Journal of Neurology

Published in:

01-11-2019 | Tremor | Original Communication

Zona incerta deep-brain stimulation in orthostatic tremor: efficacy and mechanism of improvement

Authors: Greydon Gilmore, Aditya Murgai, Abdulrahman Nazer, Andrew Parrent, Mandar Jog

Published in: Journal of Neurology | Issue 11/2019

Abstract

Background

Orthostatic tremor is a rare hyperkinetic movement disorder that is characterized by a 13–18 Hz tremor in both legs while standing. Deep-brain stimulation of the caudal zona incerta has re-emerged as an alternate target for tremor control in various etiologies.

Object

Explore the clinical efficacy and mechanism of action of caudal zona incerta deep-brain stimulation in orthostatic tremor.

Methods

Four patients (63.1 ± 4.1 years, female = 50%) with orthostatic tremor were recruited for this open label study (63.1 ± 4.1 years, female = 50%). In two patients, the electrodes were externalized to determine the effectiveness of caudal zona incerta as a target. Surface EMG (leg muscles), EEG (leg motor cortex) and caudal zona incerta local field potential recordings were recorded. Data were recorded in sitting and standing positions with stimulation OFF and ON.

Results

EMG frequency analysis showed tremor frequency at 13–17 Hz. EMG–EEG coherence was found in the tremor frequency band and double tremor frequency band. EMG–caudal zona incerta coherence was higher in the tremor frequency band, while EEG coherence was higher in the double tremor frequency band. Upon stimulation, there was a selective reduction in tremor frequency band EEG-EMG coherence in all patients. All the patients had reduction in feeling of unsteadiness and increase in the stance duration.

Conclusions

Bilateral caudal zona incerta deep-brain stimulation is effective in refractory orthostatic tremor. Two independent central oscillations were found at tremor and double tremor frequency. Zona incerta DBS produces improvement in OT patients possibly by modifying the abnormal oscillatory proprioceptive input from leg muscles. Frequent changes in deep-brain stimulation settings were required for maintaining the clinical benefit.

Britton TC, Thompson PD, van der Kamp W et al (1992) Primary orthostatic tremor: further observations in six cases. J Neurol 239:209–217. https://doi.org/10.1007/BF00839142 CrossRefPubMed

Yaltho TC, Ondo WG (2014) Orthostatic tremor: a review of 45 cases. Parkinsonism Relat Disord 20:723–725. https://doi.org/10.1016/j.parkreldis.2014.03.013 CrossRefPubMed

Espay AJ, Duker AP, Chen R et al (2008) Deep brain stimulation of the ventral intermediate nucleus of the thalamus in medically refractory orthostatic tremor: preliminary observations. Mov Disord 23:2357–2362. https://doi.org/10.1002/mds.22271 CrossRefPubMed

Guridi J, Rodriguez-Oroz MC, Arbizu J et al (2008) Successful thalamic deep brain stimulation for orthostatic tremor. Mov Disord 23:1808–1811. https://doi.org/10.1002/mds.22001 CrossRefPubMed

Magariños-Ascone C, Ruiz FM, Millán AS et al (2010) Electrophysiological evaluation of thalamic DBS for orthostatic tremor. Mov Disord 25:2476–2477. https://doi.org/10.1002/mds.23333 CrossRefPubMed

Lyons MK, Behbahani M, Boucher OK et al (2012) Orthostatic tremor responds to bilateral thalamic deep brain stimulation. Tremor Other Hyperkinet Mov (N Y) 2:2–5. https://doi.org/10.7916/D8TQ608K CrossRef

Contarino MF, Bour LJ, Schuurman PR et al (2015) Thalamic deep brain stimulation for orthostatic tremor: clinical and neurophysiological correlates. Parkinsonism Relat Disord 21:1005–1007. https://doi.org/10.1016/j.parkreldis.2015.06.008 CrossRefPubMed

Muthuraman M, Hellriegel H, Paschen S et al (2013) The central oscillatory network of orthostatic tremor. Mov Disord 28:1424–1430. https://doi.org/10.1002/mds.25616 CrossRefPubMed

Gallea C, Popa T, García-Lorenzo D et al (2016) Orthostatic tremor: a cerebellar pathology? Brain 139:2182–2197. https://doi.org/10.1093/brain/aww140 CrossRefPubMedPubMedCentral

10.

Velasco FC, Molina-Negro P, Bertrand C, Hardy J (1972) Further definition of the subthalamic target for arrest of tremor. J Neurosurg 36:184–191. https://doi.org/10.3171/jns.1972.36.2.0184 CrossRefPubMed

11.

Fytagoridis A, Åström M, Samuelsson J, Blomstedt P (2016) Deep Brain stimulation of the caudal zona incerta: tremor control in relation to the location of stimulation fields. Stereotact Funct Neurosurg 94:363–370. https://doi.org/10.1159/000448926 CrossRefPubMed

12.

Shammah-Lagnado SJ, Negrão N, Ricardo JA (1985) Afferent connections of the zona incerta: a horseradish peroxidase study in the rat. Neuroscience 15:109–134. https://doi.org/10.1016/0306-4522(85)90127-7 CrossRefPubMed

13.

Ellenbogen RG, Sekhar LN, Kitchen ND (2018) Principles of neurological surgery

14.

Yen CT, Conley M, Hendry SH, Jones EG (1985) The morphology of physiologically identified GABAergic neurons in the somatic sensory part of the thalamic reticular nucleus in the cat. J Neurosci 5:2254–2268CrossRef

15.

Plaha P, Ben-Shlomo Y, Patel NK, Gill SS (2006) Stimulation of the caudal zona incerta is superior to stimulation of the subthalamic nucleus in improving contralateral parkinsonism. Brain 129:1732–1747. https://doi.org/10.1093/brain/awl127 CrossRefPubMed

16.

Plaha P, Khan S, Gill SS (2008) Bilateral stimulation of the caudal zona incerta nucleus for tremor control. J Neurol Neurosurg Psychiatry 79:504–513. https://doi.org/10.1136/jnnp.2006.112334 CrossRefPubMed

17.

Deuschl G, Bain P, Brin M (1998) Consensus statement of the Movement disorder society on tremor: Ad Hoc Scientific Committee. Mov Disord 13(Suppl 3):2–23. https://doi.org/10.7235/hort.2013.12183 CrossRefPubMed

18.

Blomstedt P, Sandvik U, Tisch S (2010) Deep brain stimulation in the posterior subthalamic area in the treatment of essential tremor. Mov Disord 25:1350–1356. https://doi.org/10.1002/mds.22758 CrossRefPubMed

19.

Li X, Morgan PS, Ashburner J et al (2016) The first step for neuroimaging data analysis: DICOM to NIfTI conversion. J Neurosci Methods 264:47–56. https://doi.org/10.1016/j.jneumeth.2016.03.001 CrossRefPubMed

20.

Modat M, Ridgway GR, Taylor ZA et al (2010) Fast free-form deformation using graphics processing units. Comput Methods Programs Biomed 98:278–284. https://doi.org/10.1016/j.cmpb.2009.09.002 CrossRefPubMed

21.

Fedorov A, Beichel R, Kalpathy-Cramer J et al (2012) 3D Slicer as an image computing platform for the Quantitative Imaging Network. Magn Reson Imaging 30:1323–1341. https://doi.org/10.1016/j.mri.2012.05.001 CrossRefPubMedPubMedCentral

22.

Halliday DM, Rosenberg JR, Amjad a M, et al (1995) A framework for the analysis of mixed time series/point process data—theory and application to the study of physiological tremor, single motor unit discharges and electromyograms. Prog Biophys Mol Biol 64:237–278. https://doi.org/10.1016/S0079-6107(96)00009-0 CrossRefPubMed

23.

Grosse P, Guerrini R, Parmeggiani L et al (2003) Abnormal corticomuscular and intermuscular coupling in high-frequency rhythmic myoclonus. Brain 126:326–342. https://doi.org/10.1093/brain/awg043 CrossRefPubMed

24.

Blomstedt P, Stenmark Persson R, Hariz G-M et al (2018) Deep brain stimulation in the caudal zona incerta versus best medical treatment in patients with Parkinson’s disease: a randomised blinded evaluation. J Neurol Neurosurg Psychiatry 89:710–716. https://doi.org/10.1136/jnnp-2017-317219 CrossRefPubMedPubMedCentral

25.

Krauss JK, Weigel R, Blahak C et al (2006) Chronic spinal cord stimulation in medically intractable orthostatic tremor. J Neurol Neurosurg Psychiatry 77:1013–1016. https://doi.org/10.1136/jnnp.2005.086132 CrossRefPubMedPubMedCentral

26.

Blahak C, Sauer T, Baezner H et al (2016) Long-term follow-up of chronic spinal cord stimulation for medically intractable orthostatic tremor. J Neurol 263:2224–2228. https://doi.org/10.1007/s00415-016-8239-4 CrossRefPubMed

27.

Coleman RR, Starr PA, Katz M et al (2016) Bilateral Ventral intermediate nucleus thalamic deep brain stimulation in orthostatic tremor. Stereotact Funct Neurosurg 94:69–74. https://doi.org/10.1159/000444127 CrossRefPubMed

28.

Fung VS, Sauner D, Day BL (2001) A dissociation between subjective and objective unsteadiness in primary orthostatic tremor. Brain 124:322–330. https://doi.org/10.1103/PhysRevB.51.17618 CrossRefPubMed

29.

Raethjen J, Govindan RB, Muthuraman M et al (2009) Cortical correlates of the basic and first harmonic frequency of Parkinsonian tremor. Clin Neurophysiol 120:1866–1872. https://doi.org/10.1016/j.clinph.2009.06.028 CrossRefPubMed

30.

Merola A, Fasano A, Hassan A et al (2017) Thalamic deep brain stimulation for orthostatic tremor: a multicenter international registry. Mov Disord 32:1240–1244. https://doi.org/10.1002/mds.27082 CrossRefPubMed

31.

Ramirez-Zamora A, Smith H, Kumar V et al (2016) Evolving Concepts in posterior subthalamic area deep brain stimulation for treatment of tremor: surgical neuroanatomy and practical considerations. Stereotact Funct Neurosurg 94:283–297. https://doi.org/10.1159/000449007 CrossRefPubMed

Title: Zona incerta deep-brain stimulation in orthostatic tremor: efficacy and mechanism of improvement
Authors: Greydon Gilmore
Aditya Murgai
Abdulrahman Nazer
Andrew Parrent
Mandar Jog
Publication date: 01-11-2019
Publisher: Springer Berlin Heidelberg
Keywords: Tremor
Deep Brain Stimulation
Parkinson's Disease
Published in: Journal of Neurology / Issue 11/2019
Print ISSN: 0340-5354
Electronic ISSN: 1432-1459
DOI: https://doi.org/10.1007/s00415-019-09505-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Zona incerta deep-brain stimulation in orthostatic tremor: efficacy and mechanism of improvement

Abstract

Background

Object

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Object

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 11/2019

Antibodies against neural antigens in patients with acute stroke: joint results of three independent cohort studies

Development and validation of the Heidelberg Neurological Triage System (HEINTS)

Cluster headache: an overview of established and emerging treatments

Correction to: Switching from natalizumab to fingolimod treatment in multiple sclerosis: real life data from the Austrian MS Treatment Registry

Biological and imaging predictors of cognitive impairment after stroke: a systematic review

Recent advances in traumatic brain injury