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Brain Sciences
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Deep Brain Stimulation in Essential Tremor
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Deep Brain Stimulation in Essential Tremor

A special issue of Brain Sciences (ISSN 2076-3425). This special issue belongs to the section "Behavioral Neuroscience".

Deadline for manuscript submissions: closed (20 November 2020) | Viewed by 12288

Special Issue Editor

Dr. Till A. Dembek

E-Mail Website
Guest Editor
Department of Neurology; Research Group for Movement Disorders and Deep Brain Stimulation, University of Cologne, Koln, Germany
Interests: movement disorders; Parkinson's disease; brain stimulation; DBS; tremor; essential tremor; work-life balance

Special Issue Information

Dear Colleagues,

Since the introduction of modern deep brain stimulation (DBS) thirty years ago, it has become an established treatment for severe and medication‑refractory essential tremor (ET). Nonetheless, with many questions remaining in regard to the physiological background of its effects, the optimal stimulation target and parameters, and its future role in the light of new alternative treatments such as focused‑ultrasound-lesioning, DBS for ET is at the same time still an evolving method.

Novel methods such as connectomics allow us to investigate the networks involved in ET while advances in DBS technology such as sensing or directional leads increase our possibilities for individually-tailored treatments. Additionally, our understanding of ET itself is changing with new classifications highlighting the heterogeneity of patients eligible for advanced treatments.

For this Special Issue of Brain Sciences, we therefore invite researchers to submit their original research regarding all possible aspects of DBS in ET—from basic science, electrophysiology, and neuroimaging to clinical outcomes, therapy optimization, and side‑effects, as well as insights into the possible future of DBS and other advanced treatments in ET.

Dr. Till A. Dembek
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Brain Sciences is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2200 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Deep Brain Stimulation—DBS
  • Essential Tremor—ET
  • Neurophysiology
  • Diffusion imaging and connectomics
  • DBS targeting
  • DBS programming and parameters
  • DBS patient selection
  • DBS induced side effects
  • Closed-loop DBS
  • High-intensity focused ultrasound—HIFU

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Published Papers (3 papers)

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7 pages, 1374 KiB  
Article
Selecting the Most Effective DBS Contact in Essential Tremor Patients Based on Individual Tractography
by Jan Niklas Petry-Schmelzer, Till A. Dembek, Julia K. Steffen, Hannah Jergas, Haidar S. Dafsari, Gereon R. Fink, Veerle Visser-Vandewalle and Michael T. Barbe
Brain Sci. 2020, 10(12), 1015; https://doi.org/10.3390/brainsci10121015 - 20 Dec 2020
Cited by 12 | Viewed by 2660 | Correction
Abstract
Postoperative choice of the most effective deep brain stimulation (DBS) contact in patients with essential tremor (ET) so far relies on lengthy clinical testing. Previous studies showed that the postoperative effectiveness of DBS contacts depends on the distance to the dentatorubrothalamic tract (DRTT). [...] Read more.
Postoperative choice of the most effective deep brain stimulation (DBS) contact in patients with essential tremor (ET) so far relies on lengthy clinical testing. Previous studies showed that the postoperative effectiveness of DBS contacts depends on the distance to the dentatorubrothalamic tract (DRTT). Here, we investigated whether the most effective DBS contact could be determined from calculating stimulation overlap with the individual DRTT. Seven ET patients with bilateral thalamic deep brain stimulation were included retrospectively. Tremor control was assessed for each contact during test stimulation with 2mA. Individual DRTTs were identified from diffusion tensor imaging and contacts were ranked by their stimulation overlap with the respective DRTT in relation to their clinical effectiveness. A linear mixed-effects model was calculated to determine the influence of the DRTT overlap on tremor control. In all investigated DBS leads, the contact with the best clinical effect was the contact with the highest or second-highest DRTT overlap. At the group level, the DRTT-overlap explained 26.7% of the variance in the clinical outcomes (p < 0.001). Our data suggest that the overlap with the DRTT based on individual tractography may serve as a marker to determine the most effective DBS contact in ET patients and reduce burdensome clinical testing in the future. Full article
(This article belongs to the Special Issue Deep Brain Stimulation in Essential Tremor)
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9 pages, 3163 KiB  
Article
Thalamic Deep Brain Stimulation in Essential Tremor Plus Is as Effective as in Essential Tremor
by Julia K. Steffen, Hannah Jergas, Jan N. Petry-Schmelzer, Till A. Dembek, Tabea Thies, Stefanie T. Jost, Haidar S. Dafsari, Josef Kessler, Jochen Wirths, Gereon R. Fink, Veerle Visser-Vandewalle and Michael T. Barbe
Brain Sci. 2020, 10(12), 970; https://doi.org/10.3390/brainsci10120970 - 11 Dec 2020
Cited by 12 | Viewed by 2695
Abstract
The new essential tremor (ET) classification defined ET-plus (ET-p) as an ET subgroup with additional neurological signs besides action tremor. While deep brain stimulation (DBS) is effective in ET, there are no studies specifically addressing DBS effects in ET-p. 44 patients with medication-refractory [...] Read more.
The new essential tremor (ET) classification defined ET-plus (ET-p) as an ET subgroup with additional neurological signs besides action tremor. While deep brain stimulation (DBS) is effective in ET, there are no studies specifically addressing DBS effects in ET-p. 44 patients with medication-refractory ET and thalamic/subthalamic DBS implanted at our center were postoperatively classified into ET and ET-p according to preoperative documentation. Tremor suppression with DBS (stimulation ON vs. preoperative baseline and vs. stimulation OFF), measured via the Fahn–Tolosa–Marin tremor rating scale (TRS), stimulation parameters, and the location of active contacts were compared between patients classified as ET and ET-p. TRS scores at baseline were higher in ET-p. ET-p patients showed comparable tremor reduction as patients with ET, albeit higher stimulation parameters were needed in ET-p. Active electrode contacts were located more dorsally in ET-p of uncertain reason. Our data show that DBS is similarly effective in ET-p compared to ET. TRS scores were higher in ET-p preoperatively, and higher stimulation parameters were needed for tremor reduction compared to ET. The latter may be related to a more dorsal location of active electrode contacts in the ET-p group of this cohort. Prospective studies are warranted to investigate DBS in ET-p further. Full article
(This article belongs to the Special Issue Deep Brain Stimulation in Essential Tremor)
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10 pages, 1489 KiB  
Case Report
Evaluation of Automatic Segmentation of Thalamic Nuclei through Clinical Effects Using Directional Deep Brain Stimulation Leads: A Technical Note
by Marie T. Krüger, Rebecca Kurtev-Rittstieg, Georg Kägi, Yashar Naseri, Stefan Hägele-Link and Florian Brugger
Brain Sci. 2020, 10(9), 642; https://doi.org/10.3390/brainsci10090642 - 17 Sep 2020
Cited by 9 | Viewed by 6139
Abstract
Automatic anatomical segmentation of patients’ anatomical structures and modeling of the volume of tissue activated (VTA) can potentially facilitate trajectory planning and post-operative programming in deep brain stimulation (DBS). We demonstrate an approach to evaluate the accuracy of such software for the ventral [...] Read more.
Automatic anatomical segmentation of patients’ anatomical structures and modeling of the volume of tissue activated (VTA) can potentially facilitate trajectory planning and post-operative programming in deep brain stimulation (DBS). We demonstrate an approach to evaluate the accuracy of such software for the ventral intermediate nucleus (VIM) using directional leads. In an essential tremor patient with asymmetrical brain anatomy, lead placement was adjusted according to the suggested segmentation made by the software (Brainlab). Postoperatively, we used directionality to assess lead placement using side effect testing (internal capsule and sensory thalamus). Clinical effects were then compared to the patient-specific visualization and VTA simulation in the GUIDE™ XT software (Boston Scientific). The patient’s asymmetrical anatomy was correctly recognized by the software and matched the clinical results. VTA models matched best for dysarthria (6 out of 6 cases) and sensory hand side effects (5/6), but least for facial side effects (1/6). Best concordance was observed for the modeled current anterior and back spread of the VTA, worst for the current side spread. Automatic anatomical segmentation and VTA models can be valuable tools for DBS planning and programming. Directional DBS leads allow detailed postoperative assessment of the concordance of such image-based simulation and visualization with clinical effects. Full article
(This article belongs to the Special Issue Deep Brain Stimulation in Essential Tremor)
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