Case Report on Deep Brain Stimulation Rescue After Suboptimal MR-Guided Focused Ultrasound Thalamotomy for Essential Tremor: A Tractography-Based Investigation

Essential tremor (ET) is the most prevalent movement disorder in adults, and can often be medically refractory, requiring surgical intervention. MRI-guided focused ultrasound (MRgFUS) is a less invasive procedure that uses ultrasonic waves to induce lesions in the ventralis intermedius nucleus (VIM)...
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Autor*in:	Sabir Saluja [verfasserIn] Daniel A. N. Barbosa [verfasserIn] Jonathon J. Parker [verfasserIn] Yuhao Huang [verfasserIn] Michael R. Jensen [verfasserIn] Vyvian Ngo [verfasserIn] Veronica E. Santini [verfasserIn] Kim Butts Pauly [verfasserIn] Pejman Ghanouni [verfasserIn] Jennifer A. McNab [verfasserIn] Casey H. Halpern [verfasserIn]

Format:	E-Artikel
Sprache:	Englisch

Erschienen:	2020

Schlagwörter:	essential tremor focused ultrasound deep brain stimulation tractography thalamus MRI

Übergeordnetes Werk:	In: Frontiers in Human Neuroscience - Frontiers Media S.A., 2008, 14(2020)
Übergeordnetes Werk:	volume:14 ; year:2020

Links:	Link aufrufen Link aufrufen Link aufrufen Journal toc

DOI / URN:	10.3389/fnhum.2020.00191

Katalog-ID:	DOAJ017663520

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520			\|a Essential tremor (ET) is the most prevalent movement disorder in adults, and can often be medically refractory, requiring surgical intervention. MRI-guided focused ultrasound (MRgFUS) is a less invasive procedure that uses ultrasonic waves to induce lesions in the ventralis intermedius nucleus (VIM) to treat refractory ET. As with all procedures for treating ET, optimal targeting during MRgFUS is essential for efficacy and durability. Various studies have reported cases of tremor recurrence following MRgFUS and long-term outcome data is limited to 3–4 years. We present a tractography-based investigation on a case of DBS rescue for medically refractory ET that was treated with MRgFUS that was interrupted due to the development of dysarthria during the procedure. After initial improvement, her hand tremor started to recur within 6 months after treatment, and bilateral DBS was performed targeting the VIM 24 months after MRgFUS. DBS induced long-term tremor control with monopolar stimulation. Diffusion MRI tractography was used to reconstruct the dentatorubrothalamic (DRTT) and corticothalmic (CTT) tracts being modulated by the procedures to understand the variability in efficacy between MRgFUS and DBS in treating ET in our patient. By comparing the MRgFUS lesion and DBS volume of activated tissue (VAT), we found that the MRgFUS lesion was located ventromedially to the VAT, and was less than 10% of the size of the VAT. While the lesion encompassed the same proportion of DRTT streamlines, it encompassed fewer CTT streamlines than the VAT. Our findings indicate the need for further investigation of targeting the CTT when using neuromodulatory procedures to treat refractory ET for more permanent tremor relief.
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allfields	10.3389/fnhum.2020.00191 doi (DE-627)DOAJ017663520 (DE-599)DOAJ615a548c7ad8410aae03c4951ee887c2 DE-627 ger DE-627 rakwb eng RC321-571 Sabir Saluja verfasserin aut Case Report on Deep Brain Stimulation Rescue After Suboptimal MR-Guided Focused Ultrasound Thalamotomy for Essential Tremor: A Tractography-Based Investigation 2020 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Essential tremor (ET) is the most prevalent movement disorder in adults, and can often be medically refractory, requiring surgical intervention. MRI-guided focused ultrasound (MRgFUS) is a less invasive procedure that uses ultrasonic waves to induce lesions in the ventralis intermedius nucleus (VIM) to treat refractory ET. As with all procedures for treating ET, optimal targeting during MRgFUS is essential for efficacy and durability. Various studies have reported cases of tremor recurrence following MRgFUS and long-term outcome data is limited to 3–4 years. We present a tractography-based investigation on a case of DBS rescue for medically refractory ET that was treated with MRgFUS that was interrupted due to the development of dysarthria during the procedure. After initial improvement, her hand tremor started to recur within 6 months after treatment, and bilateral DBS was performed targeting the VIM 24 months after MRgFUS. DBS induced long-term tremor control with monopolar stimulation. Diffusion MRI tractography was used to reconstruct the dentatorubrothalamic (DRTT) and corticothalmic (CTT) tracts being modulated by the procedures to understand the variability in efficacy between MRgFUS and DBS in treating ET in our patient. By comparing the MRgFUS lesion and DBS volume of activated tissue (VAT), we found that the MRgFUS lesion was located ventromedially to the VAT, and was less than 10% of the size of the VAT. While the lesion encompassed the same proportion of DRTT streamlines, it encompassed fewer CTT streamlines than the VAT. Our findings indicate the need for further investigation of targeting the CTT when using neuromodulatory procedures to treat refractory ET for more permanent tremor relief. essential tremor focused ultrasound deep brain stimulation tractography thalamus MRI Neurosciences. Biological psychiatry. Neuropsychiatry Daniel A. N. Barbosa verfasserin aut Jonathon J. Parker verfasserin aut Yuhao Huang verfasserin aut Michael R. Jensen verfasserin aut Vyvian Ngo verfasserin aut Veronica E. Santini verfasserin aut Kim Butts Pauly verfasserin aut Pejman Ghanouni verfasserin aut Jennifer A. McNab verfasserin aut Casey H. Halpern verfasserin aut In Frontiers in Human Neuroscience Frontiers Media S.A., 2008 14(2020) (DE-627)56601243X (DE-600)2425477-0 16625161 nnns volume:14 year:2020 https://doi.org/10.3389/fnhum.2020.00191 kostenfrei https://doaj.org/article/615a548c7ad8410aae03c4951ee887c2 kostenfrei https://www.frontiersin.org/article/10.3389/fnhum.2020.00191/full kostenfrei https://doaj.org/toc/1662-5161 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 14 2020
spelling	10.3389/fnhum.2020.00191 doi (DE-627)DOAJ017663520 (DE-599)DOAJ615a548c7ad8410aae03c4951ee887c2 DE-627 ger DE-627 rakwb eng RC321-571 Sabir Saluja verfasserin aut Case Report on Deep Brain Stimulation Rescue After Suboptimal MR-Guided Focused Ultrasound Thalamotomy for Essential Tremor: A Tractography-Based Investigation 2020 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Essential tremor (ET) is the most prevalent movement disorder in adults, and can often be medically refractory, requiring surgical intervention. MRI-guided focused ultrasound (MRgFUS) is a less invasive procedure that uses ultrasonic waves to induce lesions in the ventralis intermedius nucleus (VIM) to treat refractory ET. As with all procedures for treating ET, optimal targeting during MRgFUS is essential for efficacy and durability. Various studies have reported cases of tremor recurrence following MRgFUS and long-term outcome data is limited to 3–4 years. We present a tractography-based investigation on a case of DBS rescue for medically refractory ET that was treated with MRgFUS that was interrupted due to the development of dysarthria during the procedure. After initial improvement, her hand tremor started to recur within 6 months after treatment, and bilateral DBS was performed targeting the VIM 24 months after MRgFUS. DBS induced long-term tremor control with monopolar stimulation. Diffusion MRI tractography was used to reconstruct the dentatorubrothalamic (DRTT) and corticothalmic (CTT) tracts being modulated by the procedures to understand the variability in efficacy between MRgFUS and DBS in treating ET in our patient. By comparing the MRgFUS lesion and DBS volume of activated tissue (VAT), we found that the MRgFUS lesion was located ventromedially to the VAT, and was less than 10% of the size of the VAT. While the lesion encompassed the same proportion of DRTT streamlines, it encompassed fewer CTT streamlines than the VAT. Our findings indicate the need for further investigation of targeting the CTT when using neuromodulatory procedures to treat refractory ET for more permanent tremor relief. essential tremor focused ultrasound deep brain stimulation tractography thalamus MRI Neurosciences. Biological psychiatry. Neuropsychiatry Daniel A. N. Barbosa verfasserin aut Jonathon J. Parker verfasserin aut Yuhao Huang verfasserin aut Michael R. Jensen verfasserin aut Vyvian Ngo verfasserin aut Veronica E. Santini verfasserin aut Kim Butts Pauly verfasserin aut Pejman Ghanouni verfasserin aut Jennifer A. McNab verfasserin aut Casey H. Halpern verfasserin aut In Frontiers in Human Neuroscience Frontiers Media S.A., 2008 14(2020) (DE-627)56601243X (DE-600)2425477-0 16625161 nnns volume:14 year:2020 https://doi.org/10.3389/fnhum.2020.00191 kostenfrei https://doaj.org/article/615a548c7ad8410aae03c4951ee887c2 kostenfrei https://www.frontiersin.org/article/10.3389/fnhum.2020.00191/full kostenfrei https://doaj.org/toc/1662-5161 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 14 2020
allfields_unstemmed	10.3389/fnhum.2020.00191 doi (DE-627)DOAJ017663520 (DE-599)DOAJ615a548c7ad8410aae03c4951ee887c2 DE-627 ger DE-627 rakwb eng RC321-571 Sabir Saluja verfasserin aut Case Report on Deep Brain Stimulation Rescue After Suboptimal MR-Guided Focused Ultrasound Thalamotomy for Essential Tremor: A Tractography-Based Investigation 2020 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Essential tremor (ET) is the most prevalent movement disorder in adults, and can often be medically refractory, requiring surgical intervention. MRI-guided focused ultrasound (MRgFUS) is a less invasive procedure that uses ultrasonic waves to induce lesions in the ventralis intermedius nucleus (VIM) to treat refractory ET. As with all procedures for treating ET, optimal targeting during MRgFUS is essential for efficacy and durability. Various studies have reported cases of tremor recurrence following MRgFUS and long-term outcome data is limited to 3–4 years. We present a tractography-based investigation on a case of DBS rescue for medically refractory ET that was treated with MRgFUS that was interrupted due to the development of dysarthria during the procedure. After initial improvement, her hand tremor started to recur within 6 months after treatment, and bilateral DBS was performed targeting the VIM 24 months after MRgFUS. DBS induced long-term tremor control with monopolar stimulation. Diffusion MRI tractography was used to reconstruct the dentatorubrothalamic (DRTT) and corticothalmic (CTT) tracts being modulated by the procedures to understand the variability in efficacy between MRgFUS and DBS in treating ET in our patient. By comparing the MRgFUS lesion and DBS volume of activated tissue (VAT), we found that the MRgFUS lesion was located ventromedially to the VAT, and was less than 10% of the size of the VAT. While the lesion encompassed the same proportion of DRTT streamlines, it encompassed fewer CTT streamlines than the VAT. Our findings indicate the need for further investigation of targeting the CTT when using neuromodulatory procedures to treat refractory ET for more permanent tremor relief. essential tremor focused ultrasound deep brain stimulation tractography thalamus MRI Neurosciences. Biological psychiatry. Neuropsychiatry Daniel A. N. Barbosa verfasserin aut Jonathon J. Parker verfasserin aut Yuhao Huang verfasserin aut Michael R. Jensen verfasserin aut Vyvian Ngo verfasserin aut Veronica E. Santini verfasserin aut Kim Butts Pauly verfasserin aut Pejman Ghanouni verfasserin aut Jennifer A. McNab verfasserin aut Casey H. Halpern verfasserin aut In Frontiers in Human Neuroscience Frontiers Media S.A., 2008 14(2020) (DE-627)56601243X (DE-600)2425477-0 16625161 nnns volume:14 year:2020 https://doi.org/10.3389/fnhum.2020.00191 kostenfrei https://doaj.org/article/615a548c7ad8410aae03c4951ee887c2 kostenfrei https://www.frontiersin.org/article/10.3389/fnhum.2020.00191/full kostenfrei https://doaj.org/toc/1662-5161 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 14 2020
allfieldsGer	10.3389/fnhum.2020.00191 doi (DE-627)DOAJ017663520 (DE-599)DOAJ615a548c7ad8410aae03c4951ee887c2 DE-627 ger DE-627 rakwb eng RC321-571 Sabir Saluja verfasserin aut Case Report on Deep Brain Stimulation Rescue After Suboptimal MR-Guided Focused Ultrasound Thalamotomy for Essential Tremor: A Tractography-Based Investigation 2020 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Essential tremor (ET) is the most prevalent movement disorder in adults, and can often be medically refractory, requiring surgical intervention. MRI-guided focused ultrasound (MRgFUS) is a less invasive procedure that uses ultrasonic waves to induce lesions in the ventralis intermedius nucleus (VIM) to treat refractory ET. As with all procedures for treating ET, optimal targeting during MRgFUS is essential for efficacy and durability. Various studies have reported cases of tremor recurrence following MRgFUS and long-term outcome data is limited to 3–4 years. We present a tractography-based investigation on a case of DBS rescue for medically refractory ET that was treated with MRgFUS that was interrupted due to the development of dysarthria during the procedure. After initial improvement, her hand tremor started to recur within 6 months after treatment, and bilateral DBS was performed targeting the VIM 24 months after MRgFUS. DBS induced long-term tremor control with monopolar stimulation. Diffusion MRI tractography was used to reconstruct the dentatorubrothalamic (DRTT) and corticothalmic (CTT) tracts being modulated by the procedures to understand the variability in efficacy between MRgFUS and DBS in treating ET in our patient. By comparing the MRgFUS lesion and DBS volume of activated tissue (VAT), we found that the MRgFUS lesion was located ventromedially to the VAT, and was less than 10% of the size of the VAT. While the lesion encompassed the same proportion of DRTT streamlines, it encompassed fewer CTT streamlines than the VAT. Our findings indicate the need for further investigation of targeting the CTT when using neuromodulatory procedures to treat refractory ET for more permanent tremor relief. essential tremor focused ultrasound deep brain stimulation tractography thalamus MRI Neurosciences. Biological psychiatry. Neuropsychiatry Daniel A. N. Barbosa verfasserin aut Jonathon J. Parker verfasserin aut Yuhao Huang verfasserin aut Michael R. Jensen verfasserin aut Vyvian Ngo verfasserin aut Veronica E. Santini verfasserin aut Kim Butts Pauly verfasserin aut Pejman Ghanouni verfasserin aut Jennifer A. McNab verfasserin aut Casey H. Halpern verfasserin aut In Frontiers in Human Neuroscience Frontiers Media S.A., 2008 14(2020) (DE-627)56601243X (DE-600)2425477-0 16625161 nnns volume:14 year:2020 https://doi.org/10.3389/fnhum.2020.00191 kostenfrei https://doaj.org/article/615a548c7ad8410aae03c4951ee887c2 kostenfrei https://www.frontiersin.org/article/10.3389/fnhum.2020.00191/full kostenfrei https://doaj.org/toc/1662-5161 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 14 2020
allfieldsSound	10.3389/fnhum.2020.00191 doi (DE-627)DOAJ017663520 (DE-599)DOAJ615a548c7ad8410aae03c4951ee887c2 DE-627 ger DE-627 rakwb eng RC321-571 Sabir Saluja verfasserin aut Case Report on Deep Brain Stimulation Rescue After Suboptimal MR-Guided Focused Ultrasound Thalamotomy for Essential Tremor: A Tractography-Based Investigation 2020 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Essential tremor (ET) is the most prevalent movement disorder in adults, and can often be medically refractory, requiring surgical intervention. MRI-guided focused ultrasound (MRgFUS) is a less invasive procedure that uses ultrasonic waves to induce lesions in the ventralis intermedius nucleus (VIM) to treat refractory ET. As with all procedures for treating ET, optimal targeting during MRgFUS is essential for efficacy and durability. Various studies have reported cases of tremor recurrence following MRgFUS and long-term outcome data is limited to 3–4 years. We present a tractography-based investigation on a case of DBS rescue for medically refractory ET that was treated with MRgFUS that was interrupted due to the development of dysarthria during the procedure. After initial improvement, her hand tremor started to recur within 6 months after treatment, and bilateral DBS was performed targeting the VIM 24 months after MRgFUS. DBS induced long-term tremor control with monopolar stimulation. Diffusion MRI tractography was used to reconstruct the dentatorubrothalamic (DRTT) and corticothalmic (CTT) tracts being modulated by the procedures to understand the variability in efficacy between MRgFUS and DBS in treating ET in our patient. By comparing the MRgFUS lesion and DBS volume of activated tissue (VAT), we found that the MRgFUS lesion was located ventromedially to the VAT, and was less than 10% of the size of the VAT. While the lesion encompassed the same proportion of DRTT streamlines, it encompassed fewer CTT streamlines than the VAT. Our findings indicate the need for further investigation of targeting the CTT when using neuromodulatory procedures to treat refractory ET for more permanent tremor relief. essential tremor focused ultrasound deep brain stimulation tractography thalamus MRI Neurosciences. Biological psychiatry. Neuropsychiatry Daniel A. N. Barbosa verfasserin aut Jonathon J. Parker verfasserin aut Yuhao Huang verfasserin aut Michael R. Jensen verfasserin aut Vyvian Ngo verfasserin aut Veronica E. Santini verfasserin aut Kim Butts Pauly verfasserin aut Pejman Ghanouni verfasserin aut Jennifer A. McNab verfasserin aut Casey H. Halpern verfasserin aut In Frontiers in Human Neuroscience Frontiers Media S.A., 2008 14(2020) (DE-627)56601243X (DE-600)2425477-0 16625161 nnns volume:14 year:2020 https://doi.org/10.3389/fnhum.2020.00191 kostenfrei https://doaj.org/article/615a548c7ad8410aae03c4951ee887c2 kostenfrei https://www.frontiersin.org/article/10.3389/fnhum.2020.00191/full kostenfrei https://doaj.org/toc/1662-5161 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 14 2020
language	English
source	In Frontiers in Human Neuroscience 14(2020) volume:14 year:2020
sourceStr	In Frontiers in Human Neuroscience 14(2020) volume:14 year:2020
format_phy_str_mv	Article
institution	findex.gbv.de
topic_facet	essential tremor focused ultrasound deep brain stimulation tractography thalamus MRI Neurosciences. Biological psychiatry. Neuropsychiatry
isfreeaccess_bool	true
container_title	Frontiers in Human Neuroscience
authorswithroles_txt_mv	Sabir Saluja @@aut@@ Daniel A. N. Barbosa @@aut@@ Jonathon J. Parker @@aut@@ Yuhao Huang @@aut@@ Michael R. Jensen @@aut@@ Vyvian Ngo @@aut@@ Veronica E. Santini @@aut@@ Kim Butts Pauly @@aut@@ Pejman Ghanouni @@aut@@ Jennifer A. McNab @@aut@@ Casey H. Halpern @@aut@@
publishDateDaySort_date	2020-01-01T00:00:00Z
hierarchy_top_id	56601243X
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callnumber-first	R - Medicine
author	Sabir Saluja
spellingShingle	Sabir Saluja misc RC321-571 misc essential tremor misc focused ultrasound misc deep brain stimulation misc tractography misc thalamus misc MRI misc Neurosciences. Biological psychiatry. Neuropsychiatry Case Report on Deep Brain Stimulation Rescue After Suboptimal MR-Guided Focused Ultrasound Thalamotomy for Essential Tremor: A Tractography-Based Investigation
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issn	16625161
topic_title	RC321-571 Case Report on Deep Brain Stimulation Rescue After Suboptimal MR-Guided Focused Ultrasound Thalamotomy for Essential Tremor: A Tractography-Based Investigation essential tremor focused ultrasound deep brain stimulation tractography thalamus MRI
topic	misc RC321-571 misc essential tremor misc focused ultrasound misc deep brain stimulation misc tractography misc thalamus misc MRI misc Neurosciences. Biological psychiatry. Neuropsychiatry
topic_unstemmed	misc RC321-571 misc essential tremor misc focused ultrasound misc deep brain stimulation misc tractography misc thalamus misc MRI misc Neurosciences. Biological psychiatry. Neuropsychiatry
topic_browse	misc RC321-571 misc essential tremor misc focused ultrasound misc deep brain stimulation misc tractography misc thalamus misc MRI misc Neurosciences. Biological psychiatry. Neuropsychiatry
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title	Case Report on Deep Brain Stimulation Rescue After Suboptimal MR-Guided Focused Ultrasound Thalamotomy for Essential Tremor: A Tractography-Based Investigation
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title_full	Case Report on Deep Brain Stimulation Rescue After Suboptimal MR-Guided Focused Ultrasound Thalamotomy for Essential Tremor: A Tractography-Based Investigation
author_sort	Sabir Saluja
journal	Frontiers in Human Neuroscience
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author_browse	Sabir Saluja Daniel A. N. Barbosa Jonathon J. Parker Yuhao Huang Michael R. Jensen Vyvian Ngo Veronica E. Santini Kim Butts Pauly Pejman Ghanouni Jennifer A. McNab Casey H. Halpern
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author-letter	Sabir Saluja
doi_str_mv	10.3389/fnhum.2020.00191
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title_sort	case report on deep brain stimulation rescue after suboptimal mr-guided focused ultrasound thalamotomy for essential tremor: a tractography-based investigation
callnumber	RC321-571
title_auth	Case Report on Deep Brain Stimulation Rescue After Suboptimal MR-Guided Focused Ultrasound Thalamotomy for Essential Tremor: A Tractography-Based Investigation
abstract	Essential tremor (ET) is the most prevalent movement disorder in adults, and can often be medically refractory, requiring surgical intervention. MRI-guided focused ultrasound (MRgFUS) is a less invasive procedure that uses ultrasonic waves to induce lesions in the ventralis intermedius nucleus (VIM) to treat refractory ET. As with all procedures for treating ET, optimal targeting during MRgFUS is essential for efficacy and durability. Various studies have reported cases of tremor recurrence following MRgFUS and long-term outcome data is limited to 3–4 years. We present a tractography-based investigation on a case of DBS rescue for medically refractory ET that was treated with MRgFUS that was interrupted due to the development of dysarthria during the procedure. After initial improvement, her hand tremor started to recur within 6 months after treatment, and bilateral DBS was performed targeting the VIM 24 months after MRgFUS. DBS induced long-term tremor control with monopolar stimulation. Diffusion MRI tractography was used to reconstruct the dentatorubrothalamic (DRTT) and corticothalmic (CTT) tracts being modulated by the procedures to understand the variability in efficacy between MRgFUS and DBS in treating ET in our patient. By comparing the MRgFUS lesion and DBS volume of activated tissue (VAT), we found that the MRgFUS lesion was located ventromedially to the VAT, and was less than 10% of the size of the VAT. While the lesion encompassed the same proportion of DRTT streamlines, it encompassed fewer CTT streamlines than the VAT. Our findings indicate the need for further investigation of targeting the CTT when using neuromodulatory procedures to treat refractory ET for more permanent tremor relief.
abstractGer	Essential tremor (ET) is the most prevalent movement disorder in adults, and can often be medically refractory, requiring surgical intervention. MRI-guided focused ultrasound (MRgFUS) is a less invasive procedure that uses ultrasonic waves to induce lesions in the ventralis intermedius nucleus (VIM) to treat refractory ET. As with all procedures for treating ET, optimal targeting during MRgFUS is essential for efficacy and durability. Various studies have reported cases of tremor recurrence following MRgFUS and long-term outcome data is limited to 3–4 years. We present a tractography-based investigation on a case of DBS rescue for medically refractory ET that was treated with MRgFUS that was interrupted due to the development of dysarthria during the procedure. After initial improvement, her hand tremor started to recur within 6 months after treatment, and bilateral DBS was performed targeting the VIM 24 months after MRgFUS. DBS induced long-term tremor control with monopolar stimulation. Diffusion MRI tractography was used to reconstruct the dentatorubrothalamic (DRTT) and corticothalmic (CTT) tracts being modulated by the procedures to understand the variability in efficacy between MRgFUS and DBS in treating ET in our patient. By comparing the MRgFUS lesion and DBS volume of activated tissue (VAT), we found that the MRgFUS lesion was located ventromedially to the VAT, and was less than 10% of the size of the VAT. While the lesion encompassed the same proportion of DRTT streamlines, it encompassed fewer CTT streamlines than the VAT. Our findings indicate the need for further investigation of targeting the CTT when using neuromodulatory procedures to treat refractory ET for more permanent tremor relief.
abstract_unstemmed	Essential tremor (ET) is the most prevalent movement disorder in adults, and can often be medically refractory, requiring surgical intervention. MRI-guided focused ultrasound (MRgFUS) is a less invasive procedure that uses ultrasonic waves to induce lesions in the ventralis intermedius nucleus (VIM) to treat refractory ET. As with all procedures for treating ET, optimal targeting during MRgFUS is essential for efficacy and durability. Various studies have reported cases of tremor recurrence following MRgFUS and long-term outcome data is limited to 3–4 years. We present a tractography-based investigation on a case of DBS rescue for medically refractory ET that was treated with MRgFUS that was interrupted due to the development of dysarthria during the procedure. After initial improvement, her hand tremor started to recur within 6 months after treatment, and bilateral DBS was performed targeting the VIM 24 months after MRgFUS. DBS induced long-term tremor control with monopolar stimulation. Diffusion MRI tractography was used to reconstruct the dentatorubrothalamic (DRTT) and corticothalmic (CTT) tracts being modulated by the procedures to understand the variability in efficacy between MRgFUS and DBS in treating ET in our patient. By comparing the MRgFUS lesion and DBS volume of activated tissue (VAT), we found that the MRgFUS lesion was located ventromedially to the VAT, and was less than 10% of the size of the VAT. While the lesion encompassed the same proportion of DRTT streamlines, it encompassed fewer CTT streamlines than the VAT. Our findings indicate the need for further investigation of targeting the CTT when using neuromodulatory procedures to treat refractory ET for more permanent tremor relief.
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title_short	Case Report on Deep Brain Stimulation Rescue After Suboptimal MR-Guided Focused Ultrasound Thalamotomy for Essential Tremor: A Tractography-Based Investigation
url	https://doi.org/10.3389/fnhum.2020.00191 https://doaj.org/article/615a548c7ad8410aae03c4951ee887c2 https://www.frontiersin.org/article/10.3389/fnhum.2020.00191/full https://doaj.org/toc/1662-5161
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author2	Daniel A. N. Barbosa Jonathon J. Parker Yuhao Huang Michael R. Jensen Vyvian Ngo Veronica E. Santini Kim Butts Pauly Pejman Ghanouni Jennifer A. McNab Casey H. Halpern
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up_date	2024-07-03T13:21:01.787Z
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