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Deep brain stimulation of the dentato-rubro-thalamic tract in a case of Holmes tremor: a constrained spherical deconvolution (CSD)–guided procedure

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Abstract

Deep brain stimulation (DBS) is an established treatment for movement disorders, including Holmes tremor (HT). HT is a rest and action tremor that occurs as a late symptom of brainstem lesions such as stroke. Unfortunately, it is frequently refractory to medical treatment, hence DBS surgery may be a good option. Due to variable results, the ideal target for DBS in HT still remains to be established, ranging from the thalamus to the globus pallidus internus, to the subthalamic nucleus. Pre-operative imaging also is very challenging, as the complexity of brain fiber architecture may prevent the correct positioning of the directional lead. Herein, we describe the case of a patient affected by a rubral tremor secondary to a brain hemorrhage, who had advanced pre-operative neuroimaging with constrained spherical deconvolution (CSD)–based tractography obtained from diffusion-weighted imaging (DWI) to identify the dentato-rubro-thalamic tract, involved in the pathophysiology of HT. The patient was then addressed to an awake DBS surgery, and with the help of intraoperative microelectrode recordings, a tailored DRTT-targeted procedure was performed. The stimulation determined an almost complete tremor suppression, with no significant side effects at a follow-up of 6 months, paving the way towards new effective techniques for the planning, i.e., CSD-based tractography and the treatment of refractory tremors.

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Data are available for any authorized researcher upon formal request to the corresponding author.

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Authors and Affiliations

  1. Operative research unit of of Neurology, Neurophysiology and Neurobiology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy

    Valeria Pozzilli, Massimo Marano, Alessandro Magliozzi & Vincenzo Di Lazzaro

  2. Operative Research Unit of Neuroradiology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy

    Carlo Augusto Mallio

  3. Neurosurgery Unit, Ospedale Belcolle Di Viterbo, Rome, Italy

    Daniele Marruzzo, Francesca Romana Barbieri & Riccardo Antonio Ricciuti

Authors
  1. Valeria Pozzilli
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  2. Massimo Marano
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  3. Alessandro Magliozzi
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  4. Carlo Augusto Mallio
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  5. Daniele Marruzzo
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  6. Francesca Romana Barbieri
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  7. Vincenzo Di Lazzaro
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  8. Riccardo Antonio Ricciuti
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Correspondence to Massimo Marano.

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Pozzilli, V., Marano, M., Magliozzi, A. et al. Deep brain stimulation of the dentato-rubro-thalamic tract in a case of Holmes tremor: a constrained spherical deconvolution (CSD)–guided procedure. Neurol Sci 44, 411–415 (2023). https://doi.org/10.1007/s10072-022-06514-w

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