Overlapping stimulation of subthalamic nucleus and dentato-rubro-thalamic tract in Parkinson’s disease after deep brain stimulation

Background Deep brain stimulation (DBS) of the subthalamic nucleus (STN) reduces tremor, rigidity, and akinesia. According to the literature, the dentato-rubro-thalamic tract (DRTt) is verified target for DBS in essential tremor; however, its role in the treatment of Parkinson’s disease is only vagu...

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Published in:	Acta neurochirurgica Vol. 166; no. 1; p. 106
Main Authors:	Wiśniewski, K., Gajos, A., Zaczkowski, K., Szulia, A., Grzegorczyk, M., Dąbkowska, A., Wójcik, R., Bobeff, E. J., Kwiecień, K., Brandel, M. G., Fahlström, A., Bogucki, A., Ciszek, B., Jaskólski, D. J.
Format:	Journal Article
Language:	English
Published:	Vienna Springer Vienna 26-02-2024 Springer Nature B.V
Subjects:	Akinesia Deep brain stimulation Deep Brain Stimulation - methods Dento-rubro-thalamic tract Electrical stimuli Functional Neurosurgery – Movement disorders Humans Interventional Radiology Klingler technique Medicine Medicine & Public Health Minimally Invasive Surgery Movement disorders Neurodegenerative diseases Neuroimaging Neurology Neuroradiology Neurosurgery Original Article Parkinson disease Parkinson Disease - diagnostic imaging Parkinson Disease - therapy Parkinson's disease Patients Retrospective Studies Solitary tract nucleus Substantia alba Subthalamic nucleus Subthalamic Nucleus - diagnostic imaging Subthalamic Nucleus - surgery Surgery Surgical Orthopedics Thalamus Thalamus - diagnostic imaging Tractopgraphy Treatment Outcome Tremor Parkinson disease Dento-rubro-thalamic tract Klingler technique Deep brain stimulation Tractopgraphy
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Summary:	Background Deep brain stimulation (DBS) of the subthalamic nucleus (STN) reduces tremor, rigidity, and akinesia. According to the literature, the dentato-rubro-thalamic tract (DRTt) is verified target for DBS in essential tremor; however, its role in the treatment of Parkinson’s disease is only vaguely described. The aim of our study was to identify the relationship between symptom alleviation in PD patients and the distance of the DBS electrode electric field (EF) to the DRTt. Methods A single-center retrospective analysis of patients ( N = 30) with idiopathic Parkinson’s disease (PD) who underwent DBS between November 2018 and January 2020 was performed. DRTt and STN were visualized using diffusion-weighted imaging (DWI) and tractography protocol of magnetic resonance (MR). The EF was calculated and compared with STN and course of DRTt. Evaluation of patients before and after surgery was performed with use of UPDRS-III scale. The association between distance from EF to DRTt and clinical outcomes was examined. To confirm the anatomical variation between DRTt and STN observed in tractography, white matter dissection was performed with the Klingler technique on ten human brains. Results Patients with EF overlapping STN and DRTt benefited from significant motor symptoms improvement. Anatomical findings confirmed the presence of population differences in variability of the DRTt course and were consistent with the DRTt visualized by MR. Conclusions DRTt proximity to STN, the main target in PD DBS surgery, confirmed by DWI with tractography protocol of MR combined with proper predefined stimulation parameters may improve efficacy of DBS-STN.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0942-0940 0001-6268 0942-0940
DOI:	10.1007/s00701-024-06006-0