Comparison of tractography-assisted to atlas-based targeting for deep brain stimulation in essential tremor
Comparison of tractography-assisted to atlas-based targeting for deep brain stimulation in essential tremor
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DOI：
10.1002/mds.27463
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发表时间：
2018-12-01
影响因子：
8.6
通讯作者：
Schiess, Mya C.
中科院分区：
文献类型：
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作者：
Fenoy, Albert J.;Schiess, Mya C.
背景直接靶向齿状核-红核-丘脑束在DBS中抑制震颤是有效的。目的：我们试图比较结果和最佳刺激参数震颤控制使用的技术，直接针对齿状核-红核-丘脑束的那些谁经历了间接靶向丘脑腹侧中间核。方法对20例原发性震颤患者进行术前弥散MRI检查，术中分别绘制齿状核-红核-丘脑束，直接靶向丘脑腹侧中间核。将这些患者与使用基于地图集的坐标进行手术的20名连续患者的早期队列进行比较。使用原发性震颤评定量表记录基线和术后1年的震颤幅度，以及成功控制震颤所需的参数。结果间接靶向治疗组的基线和术后震颤严重程度均高于直接靶向治疗组（基线2.9 vs. 2.6; P = 0.02;术后1.1 vs. 0.8; P = 0.03）。直接靶向组（38个电极）中最佳震颤控制的平均电压、脉冲宽度和频率= 2.8 V，80 μ s，153 Hz;间接靶向组（38个电极）的参数= 2.9 V，86 μ s，179 Hz（显著更大，P < 0.001）。两组的手臂震颤幅度均较基线有显著改善（P < 0.001），且无持续副作用。结论直接靶向齿状核-红核-丘脑束可提供良好的震颤控制，与间接靶向丘脑腹侧中间核相当。使用较低的刺激参数，特别是频率，来控制直接靶向组中的震颤表明，这是一种更有效的靶向方法，可以使电池消耗最小化。(c)2018国际帕金森和运动障碍协会
Background Direct targeting of the dentato-rubro-thalamic tract is efficacious in DBS for tremor suppression. Objectives We sought to compare outcomes and optimal stimulation parameters for tremor control using the technique of directly targeting the dentato-rubro-thalamic tract to those who underwent indirect targeting of the ventral intermediate nucleus thalamus. Methods Twenty consecutive essential tremor patients obtained preoperative diffusion MRIs, where the dentato-rubro-thalamic tract was individually drawn and used to directly target the ventral intermediate nucleus of the thalamus during surgery. These patients were compared to an earlier cohort of 20 consecutive patients who underwent surgery using atlas-based coordinates. Baseline and 1-year postsurgery tremor amplitude using The Essential Tremor Rating Assessment Scale was recorded, as were the parameters needed for successful tremor control. Results The indirectly targeted group had greater baseline and postop tremor severity relative to those directly targeted (baseline, 2.9 vs. 2.6; P = 0.02; postop, 1.1 vs. 0.8; P = 0.03). Mean voltage, pulse width, and frequency for optimal tremor control in the directly targeted group (38 electrodes) = 2.8 V, 80 mu s, 153 Hz; the parameters for the indirectly targeted group (38 electrodes) = 2.9 V, 86 mu s, 179 Hz (significantly greater, P < 0.001). Both groups had significant improvement in arm tremor amplitude from baseline (P < 0.001) without sustained side effects. Conclusion Direct targeting of the dentato-rubro-thalamic tract provides excellent tremor control, comparable to indirectly targeting the ventral intermediate nucleus of the thalamus. Use of lower stimulation parameters, especially frequency, to control tremor in the directly targeted group suggests that it is a more efficient targeting methodology, which may minimize battery depletion. (c) 2018 International Parkinson and Movement Disorder Society