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. 2017 Sep 28;4:54. doi: 10.3389/fsurg.2017.00054

Table 2.

Deep brain stimulation with diffusion tensor imaging for tremor.

First author (ref) Response Scale Mean preop, score (range) Mean postop, score (range) Mean improvement (%) Target
Prospective direct tract targeting

Fenoy (16) 20 responders TETRAS (head) 2.3 ± 0.5 (2–3) 0.8 ± 0.4 (0–1) 63.9 ± 19.5 VIM
TETRAS (right arm) 2.6 ± 0.5 (2–3.5) 0.8 ± 0.5 (0–1.5) 71.7 ± 18.4
TETRAS (left arm) 2.7 ± 0.5 (2–4) 0.8 ± 0.6 (0–1.5) 71.9 ± 20.6
Coenen (17) 1 responder ETRS 51 20 61 VIM
O’Halloran (18) 2 responders UPDRS–III global 41.0 ± 46.7 (8–74) 8.5 ± 5.0 (5–12) 60.6 ± 32.5 cZIa
Coenen (19) 2 responders UPDRS–III global 59.5 ± 5.0 (56–63) Both 11 81.4 ± 1.5 STN
UPDRS–III tremor 13.5 ± 3.5 (11–16) 2.5 ± 0.7 (2–3) 81.5 ± 0.4
Coenen (20) 1 responder ETRS 63 22 65 VIM
Coenen (21) 1 responderb ETRS 11 9 18 VIM
Head tremor 90

Retrospective tract proximity analyses

King (22)/Sammartino (23) 6 responders CRST B 19.2 ± 5.7 (11–28)
17.8 ± 5.4
7.8 ± 2.6 (5–11) 56.9 ± 15.5
56.0 ± 11.9 (overall)
78.0 ± 17.2 (op side)
VIM
TETRAS
Coenen (24) 8 responders CRST 49.6 ± 12.8 (36–68) 12.4 ± 7.4 (3–23) 76.7 ± 10.9 VIM
1c non-responder 35 21 40.0
Sweet (25) 4d responders
3 non-responders
UPDRS–III tremor 8.2 ± 3.1 (5.5–11.5)
7.5 ± 4.2 (3–13)
6.3 ± 2.1 (4–8)
1.1 ± 1.4 (0–3)
87.8 ± 17.4
21.3 ± 12.5
STN
Coenen (26) 1 responder ETRS
UPDRS–III global
UPDRS–III tremor
33
27
7
9
17
1
72.7
37.0 (stopped meds)
85.7 (stopped meds)
VIM

Retrospective tract stimulation modeling

Boccard (27) 1 responder CRST 25 7 72.0 VOP-ZI
Klein (28) 12 responder FTM A + B 46.2 ± 16.5 (18–77) 13.6 ± 8.6 (3–33) 71.8 ± 11.8 VIM
Pouratian (29) 6 responder FTM global
FTM A
FTM B
53.7 ± 24.0 (9–73)
10.0 ± 6.3 (2–19)
5.4 ± 2.7 (2–10)
32.8 ± 24.0 (9–66)
5.9 ± 4.5 (0–15)
2.1 ± 1.4 (0–4)
39.0
41.0
61.0
VIM

Prospective cohort: Retrospective cohort:
Overall responder proportion = 27 out of 27 (100%) Overall responder proportion = 38 out of 42 (90%)
Overall mean improvement in responders = 71.7 ± 17.9% Overall mean improvement in responders = 73.1 ± 11.6%
Overall mean improvement among non-responders = nil Overall mean improvement among non-responders = 31.0 ± 13.2%

Scales. TETRAS, The Essential Tremor Rating Assessment Scale (51); ETRS, Essential Tremor Rating Scale; UPDRS-III, Unified Parkinson’s Disease Rating Scale part III measures motor signs of PD (52); CRST, clinical rating scale for tremor (53); FTM, Fahn-Tolosa-Marin tremor rating scale (54); FTM A measures tremor severity; FTM B measures task-related tremor.

Targets. cZI, caudal zona incerta; STN, subthalamic nucleus; VIM, ventral intermediate thalamus; VOP-ZI, ventral oral posterior thalamic nucleus-zona incerta.

aOne patient had initial right-sided lead implanted within cZI, but the DRT (with an atypical anterior trajectory) was outside of field of stimulation. Patient experienced stimulation-induced dystonic symptoms and the lead was replaced with one implanted in a more anterior position within DRT, giving good tremor relief with reduced side effects.

bPatient demonstrated excellent head tremor control (>90%) which was not well expressed by 18% improvement in ETRS.

cPatient showed 42% improvement in ETRS but had complicated ET with “yes-yes”-type of head tremor which was hard to judge intraoperatively.

dExcluded two patients who did not have tremor symptoms preoperatively.