TY - JOUR
T1 - Distance to white matter tracts is associated with deep brain stimulation motor outcome in Parkinson’s disease
AU - Prent, Naomi
AU - Potters, Wouter V.
AU - Boon, Lennard I.
AU - Caan, Matthan W. A.
AU - de Bie, Rob M. A.
AU - van den Munckhof, Pepijn
AU - Schuurman, P. Richard
AU - van Rootselaar, Anne-Fleur
N1 - Funding Information: man reports consulting for Medtronic, Boston Scientific, and Elekta. Dr. de Bie reports receiving funding for research from ZonMw, Stichting ParkinsonFonds, Stichting Parkinson Nederland, Parkinson Vereniging, and an unrestricted research grant from GeHealth. The Amsterdam UMC (location AMC) Movement Disorders group provides courses for ECMT. Publisher Copyright: ©AANS 2020, except where prohibited by US copyright law
PY - 2020/8/1
Y1 - 2020/8/1
N2 - OBJECTIVE Deep brain stimulation (DBS) of the subthalamic nucleus (STN) alleviates motor symptoms in patients with Parkinson’s disease (PD). However, the underlying mechanism of tremor suppression is not well understood. Stimulation of white matter tracts, such as the dentatorubrothalamic tract (DRT), might be involved. Also, side effects, including dysarthria, might result from (unwanted) stimulation of white matter tracts in proximity to the STN. The aim of this study was to establish an association between stimulation effect on tremor and dysarthria and stimulation location relative to relevant white matter tracts. METHODS In 35 PD patients in whom a bilateral STN DBS system was implanted, the authors established clinical outcome measures per electrode contact. The distance from each stimulation location to the center of the DRT, corticopontocerebellar tract, pyramidal tract (PT), and medial lemniscus was determined using diffusion-weighted MRI data. Clinical outcome measures were subsequently related to the distances to the white matter tracts. RESULTS Patients with activated contacts closer to the DRT showed increased tremor improvement. Proximity of activated contacts to the PT was associated with dysarthria. CONCLUSIONS Proximity to specific white matter tracts is associated with tremor outcome and side effects in DBS. This knowledge can help to optimize both electrode placement and postsurgical electrode contact selection. Presurgical white matter tract visualization may improve targeting and DBS outcome. These findings are of interest not only for treatment in PD, but potentially also for other (movement) disorders.
AB - OBJECTIVE Deep brain stimulation (DBS) of the subthalamic nucleus (STN) alleviates motor symptoms in patients with Parkinson’s disease (PD). However, the underlying mechanism of tremor suppression is not well understood. Stimulation of white matter tracts, such as the dentatorubrothalamic tract (DRT), might be involved. Also, side effects, including dysarthria, might result from (unwanted) stimulation of white matter tracts in proximity to the STN. The aim of this study was to establish an association between stimulation effect on tremor and dysarthria and stimulation location relative to relevant white matter tracts. METHODS In 35 PD patients in whom a bilateral STN DBS system was implanted, the authors established clinical outcome measures per electrode contact. The distance from each stimulation location to the center of the DRT, corticopontocerebellar tract, pyramidal tract (PT), and medial lemniscus was determined using diffusion-weighted MRI data. Clinical outcome measures were subsequently related to the distances to the white matter tracts. RESULTS Patients with activated contacts closer to the DRT showed increased tremor improvement. Proximity of activated contacts to the PT was associated with dysarthria. CONCLUSIONS Proximity to specific white matter tracts is associated with tremor outcome and side effects in DBS. This knowledge can help to optimize both electrode placement and postsurgical electrode contact selection. Presurgical white matter tract visualization may improve targeting and DBS outcome. These findings are of interest not only for treatment in PD, but potentially also for other (movement) disorders.
KW - Deep brain stimulation
KW - Dentatorubrothalamic tract
KW - Diffusion tensor imaging
KW - Dysarthria
KW - Functional neurosurgery
KW - Parkinson’s disease
KW - Tremor
UR - http://www.scopus.com/inward/record.url?scp=85082299466&partnerID=8YFLogxK
U2 - https://doi.org/10.3171/2019.5.JNS1952
DO - https://doi.org/10.3171/2019.5.JNS1952
M3 - Article
C2 - 31349226
SN - 0022-3085
VL - 133
SP - 433
EP - 442
JO - Journal of neurosurgery
JF - Journal of neurosurgery
IS - 2
ER -