Determining an efficient deep brain stimulation target in essential tremor - Cohort study and review of the literature

Dorothee Kübler; Daniel Kroneberg; Bassam Al-Fatly; Gerd-Helge Schneider; Siobhan Ewert; Christoph van Riesen; Doreen Gruber; Georg Ebersbach; Andrea A Kühn

doi:10.1016/j.parkreldis.2021.06.019

Determining an efficient deep brain stimulation target in essential tremor - Cohort study and review of the literature

Parkinsonism Relat Disord. 2021 Aug:89:54-62. doi: 10.1016/j.parkreldis.2021.06.019. Epub 2021 Jun 29.

Authors

Dorothee Kübler¹, Daniel Kroneberg¹, Bassam Al-Fatly¹, Gerd-Helge Schneider², Siobhan Ewert³, Christoph van Riesen³, Doreen Gruber⁴, Georg Ebersbach⁴, Andrea A Kühn⁵

Affiliations

¹ Movement Disorders and Neuromodulation Section, Department of Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.
² Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.
³ Movement Disorders and Neuromodulation Section, Department of Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany; Department of Neurology, University Medical Center Göttingen, Germany.
⁴ Movement Disorders Hospital, Beelitz-Heilstätten, Germany.
⁵ Movement Disorders and Neuromodulation Section, Department of Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany; Exzellenzcluster NeuroCure, Charité - Universitätsmedizin Berlin, Berlin, Germany; Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany; Bernstein Center for Computational Neuroscience, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany; Deutsches Zentrum für Neurodegenerative Erkrankungen, Berlin, Germany. Electronic address: andrea.kuehn@charite.de.

PMID: 34225135
DOI: 10.1016/j.parkreldis.2021.06.019

Abstract

Introduction: Deep brain stimulation (DBS) is a highly efficacious treatment for essential tremor (ET). Still, the optimal anatomical target in the (sub)thalamic area is a matter of debate. The aim of this study was to determine the optimal target of DBS for ET regarding beneficial clinical outcome and impact on activities of daily living as well as stimulation-induced side effects and compare it with previously published coordinates.

Methods: In 30 ET patients undergoing bilateral DBS, severity of tremor was assessed by blinded video ratings before and at 1-year follow-up with DBS ON and OFF. Tremor scores and reported side effects and volumes of tissue activated were used to create a probabilistic map of DBS efficiency and side effects.

Results: DBS was effective both in tremor suppression as well as in improving patient reported outcomes, which were positively correlated. The "sweet spot" for tremor suppression was located inferior of the VIM in the subthalamic area, close to the superior margin of the zona incerta. The Euclidean distance of active contacts to this spot as well as to 10 of 13 spots from the literature review was predictive of individual outcome. A cluster associated with the occurrence of ataxia was located in direct vicinity of the "sweet spot".

Conclusion: Our findings suggest the highest clinical efficacy of DBS in the posterior subthalamic area, lining up with previously published targets likely representing the dentato-rubro-thalamic tract. Side effects may not necessarily indicate lead misplacement, but should encourage clinicians to employ novel DBS programing options.

Keywords: Deep brain stimulation; Dentato-rubro-thalamic tract DRTT; Essential tremor; Sweet spot; Ventral intermediate nucleus VIM.

Publication types

Research Support, Non-U.S. Gov't
Review

MeSH terms

Aged
Deep Brain Stimulation* / methods
Deep Brain Stimulation* / standards
Essential Tremor / therapy*
Female
Follow-Up Studies
Humans
Male
Middle Aged
Subthalamus*
Treatment Outcome