TY  - JOUR
A1  - Friedrich, Maximilian U.
A1  - Eldebakey, Hazem
A1  - Roothans, Jonas
A1  - Capetian, Philipp
A1  - Zwergal, Andreas
A1  - Volkmann, Jens
A1  - Reich, Martin
T1  - Current-dependent ocular tilt reaction in deep brain stimulation of the subthalamic nucleus: Evidence for an incerto-interstitial pathway?
JF  - European Journal of Neurology
N2  - Background and purpose
The aim was to characterize a combined vestibular, ocular motor and postural syndrome induced by deep brain stimulation (DBS) of the subthalamic nucleus in a patient with Parkinson's disease.
Methods
In a systematic DBS programming session, eye, head and trunk position in roll and pitch plane were documented as a function of stimulation amplitude and field direction. Repeat ocular coherence tomography was used to estimate ocular torsion. The interstitial nucleus of Cajal (INC), zona incerta (ZI) and ascending vestibular fibre tracts were segmented on magnetic resonance imaging using both individual and normative structural connectomic data. Thresholded symptom-associated volumes of tissue activated (VTA) were calculated based on documented stimulation parameters.
Results
Ipsilateral ocular tilt reaction and body lateropulsion as well as contralateral torsional nystagmus were elicited by the right electrode in a current-dependent manner and subsided after DBS deactivation. With increasing currents, binocular tonic upgaze and body retropulsion were observed. Symptoms were consistent with an irritative effect on the INC. Symptom-associated VTA was found to overlap with the dorsal ZI and the ipsilateral vestibulothalamic tract, while lying rather distant to the INC proper. A ZI-to-INC ‘incerto-interstitial’ tract with contact to the medial-uppermost portion of the VTA could be traced.
Conclusion
Unilateral stimulation of INC-related circuitry induces an ipsilateral vestibular, ocular motor and postural roll-plane syndrome, which converts into a pitch-plane syndrome when functional activation expands bilaterally. In this case, tractography points to an incerto-interstitial pathway, a tract previously only characterized in non-human primates. Directional current steering proved useful in managing this rare side effect.
KW  - deep brain stimulation
KW  - vestibular
KW  - movement disorders
Y1  - 2022
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-318700
VL  - 29
IS  - 5
SP  - 1545
EP  - 1549
ER  - 
TY  - JOUR
A1  - Kremer, Naomi I.
A1  - Pauwels, Rik W. J.
A1  - Pozzi, Nicolò G.
A1  - Lange, Florian
A1  - Roothans, Jonas
A1  - Volkmann, Jens
A1  - Reich, Martin M.
T1  - Deep Brain Stimulation for Tremor: Update on Long-Term Outcomes, Target Considerations and Future Directions
JF  - Journal of Clinical Medicine
N2  - Deep brain stimulation (DBS) of the thalamic ventral intermediate nucleus is one of the main advanced neurosurgical treatments for drug-resistant tremor. However, not every patient may be eligible for this procedure. Nowadays, various other functional neurosurgical procedures are available. In particular cases, radiofrequency thalamotomy, focused ultrasound and radiosurgery are proven alternatives to DBS. Besides, other DBS targets, such as the posterior subthalamic area (PSA) or the dentato-rubro-thalamic tract (DRT), may be appraised as well. In this review, the clinical characteristics and pathophysiology of tremor syndromes, as well as long-term outcomes of DBS in different targets, will be summarized. The effectiveness and safety of lesioning procedures will be discussed, and an evidence-based clinical treatment approach for patients with drug-resistant tremor will be presented. Lastly, the future directions in the treatment of severe tremor syndromes will be elaborated.
KW  - deep brain stimulation
KW  - tremor
KW  - essential tremor
KW  - Parkinson’s disease
KW  - outcomes
KW  - clinical approach
KW  - target considerations
KW  - future directions
Y1  - 2021
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-244982
SN  - 2077-0383
VL  - 10
IS  - 16
ER  -