Distance to white matter tracts is associated with deep brain stimulation motor outcome in Parkinson’s disease

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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.

ABBREVIATIONS CPCT = corticopontocerebellar tract; DBS = deep brain stimulation; DRT = dentatorubrothalamic tract; DTI = diffusion tensor imaging; ML = medial lemniscus; PD = Parkinson’s disease; PT = pyramidal tract; STN = subthalamic nucleus; UPDRS = Unified Parkinson’s Disease Rating Scale; VAT = volume of activated tissue; WM = white matter.
Article Information

Contributor Notes

Correspondence Anne-Fleur van Rootselaar: Amsterdam UMC, University of Amsterdam, The Netherlands. a.f.vanrootselaar@amc.nl.INCLUDE WHEN CITING Published online July 26, 2019; DOI: 10.3171/2019.5.JNS1952.Disclosures Dr. Caan reports being a stockholder in Nico.lab B.V. Dr. Schuurman 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.

© Copyright 1944-2019 American Association of Neurological Surgeons

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