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Directed stimulation of the dentato-rubro-thalamic tract for deep brain stimulation in essential tremor: a blinded clinical trial.
Middlebrooks, Erik H; Okromelidze, Lela; Carter, Rickey E; Jain, Ayushi; Lin, Chen; Westerhold, Erin; Peña, Ashley B; Quiñones-Hinojosa, Alfredo; Uitti, Ryan J; Grewal, Sanjeet S.
  • Middlebrooks EH; Department of Radiology, Mayo Clinic, USA.
  • Okromelidze L; Department of Neurosurgery, Mayo Clinic, USA.
  • Carter RE; Department of Radiology, Mayo Clinic, USA.
  • Jain A; Department of Health Sciences Research, Mayo Clinic, USA.
  • Lin C; Department of Radiology, Mayo Clinic, USA.
  • Westerhold E; Department of Radiology, Mayo Clinic, USA.
  • Peña AB; Department of Radiology, Mayo Clinic, USA.
  • Quiñones-Hinojosa A; Department of Neurology, Mayo Clinic, USA.
  • Uitti RJ; Department of Neurosurgery, Mayo Clinic, USA.
  • Grewal SS; Department of Neurology, Mayo Clinic, USA.
Neuroradiol J ; 35(2): 203-212, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1817078
ABSTRACT

OBJECTIVE:

Observational studies utilising diffusion tractography have suggested a common mechanism for tremor alleviation in deep brain stimulation for essential tremor the decussating portion of the dentato-rubro-thalamic tract. We hypothesised that directional stimulation of the dentato-rubro-thalamic tract would result in greater tremor improvement compared to sham programming, as well as comparable improvement as more tedious standard-of-care programming.

METHODS:

A prospective, blinded crossover trial was performed to assess the feasibility, safety and outcomes of programming based solely on dentato-rubro-thalamic tract anatomy. Using magnetic resonance imaging diffusion-tractography, the dentato-rubro-thalamic tract was identified and a connectivity-based treatment setting was derived by modelling a volume of tissue activated using directional current steering oriented towards the dentato-rubro-thalamic tract centre. A sham setting was created at approximately 180° opposite the connectivity-based treatment. Standard-of-care programming at 3 months was compared to connectivity-based treatment and sham settings that were blinded to the programmer. The primary outcome measure was percentage improvement in the Fahn-Tolosa-Marín tremor rating score compared to the preoperative baseline.

RESULTS:

Among the six patients, tremor rating scores differed significantly among the three experimental conditions (P=0.030). The mean tremor rating score improvement was greater with the connectivity-based treatment settings (64.6% ± 14.3%) than with sham (44.8% ± 18.6%; P=0.031) and standard-of-care programming (50.7% ± 19.2%; P=0.062). The distance between the centre of the dentato-rubro-thalamic tract and the volume of tissue activated inversely correlated with the percentage improvement in the tremor rating score (R2=0.24; P=0.04). No significant adverse events were encountered.

CONCLUSIONS:

Using a blinded, crossover trial design, we have shown the technical feasibility, safety and potential efficacy of connectivity-based stimulation settings in deep brain stimulation for treatment of essential tremor.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Essential Tremor / Deep Brain Stimulation Type of study: Cohort study / Observational study / Prognostic study / Randomized controlled trials Limits: Humans Language: English Journal: Neuroradiol J Year: 2022 Document Type: Article Affiliation country: 19714009211036689

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Essential Tremor / Deep Brain Stimulation Type of study: Cohort study / Observational study / Prognostic study / Randomized controlled trials Limits: Humans Language: English Journal: Neuroradiol J Year: 2022 Document Type: Article Affiliation country: 19714009211036689