Thalamic stimulation for parkinsonian tremor: correlation between regional cerebral blood flow and physiological tremor characteristics.

Abstract

We used (15)O-labeled water (H(2)(15)O) positron emission tomography (PET) to study eight Parkinson's disease (PD) patients with unilateral ventral intermediate (Vim) thalamic nucleus deep brain stimulation (DBS) for severe tremor. Triaxial accelerometry (TRIAX) was used during imaging to obtain on-line measures of tremor characteristics. Regional cerebral blood flow (rCBF) scans together with TRIAX recordings were collected in three stimulation conditions (OFF, MID, and ON, corresponding, respectively, to 0%, 50%, and 100% reductions in mean accelerometry signal). Statistical Parametric Mapping (SPM99) revealed significant rCBF reductions during stimulation in the ipsilateral sensorimotor cortex (SMC) and the contralateral cerebellum, as well as concurrent increases in the ipsilateral ventral thalamus (P < 0.05, corrected). Covariate analysis of rCBF with physiological tremor characteristics revealed that tremor acceleration correlated positively with changes in the SMC and supplementary motor cortex ipsilaterally (P < 0.05, uncorrected), and negatively with changes in the ipsilateral cuneus (P < 0.05, corrected). After removing tremor acceleration effects, changes in tremor frequency correlated negatively with changes in the contralateral dentate nucleus and pons (P < 0.05, uncorrected). Our results suggest that Vim DBS for PD tremor modulates the activity of cerebello-thalamo-cortical pathways. Specific tremor characteristics relate to activity in different nodes of this system.

• Authors: Masafumi Fukuda, Anna Barnes, Ely S Simon, Andrew Holmes, Vijay Dhawan, Nir Giladi, Harald Fodstad, Yilong Ma, David Eidelberg
• Journal: NeuroImage (Neuroimage) Vol. 21 Issue 2 Pg. 608-15 (Feb 2004) ISSN: 1053-8119 [Print] United States
• PMID: 14980563 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, P.H.S.)

Topics

• Aged
• Brain Mapping
• Cerebellar Nuclei (diagnostic imaging, physiopathology)
• Dominance, Cerebral (physiology)
• Electric Stimulation Therapy
• Female
• Humans
• Image Processing, Computer-Assisted
• Male
• Middle Aged
• Motor Cortex (diagnostic imaging, physiopathology)
• Neural Pathways (diagnostic imaging, physiopathology)
• Parkinson Disease (diagnostic imaging, physiopathology, therapy)
• Pons (diagnostic imaging, physiopathology)
• Regional Blood Flow (physiology)
• Somatosensory Cortex (diagnostic imaging, physiopathology)
• Tomography, Emission-Computed
• Tremor (physiopathology, therapy)
• Ventral Thalamic Nuclei (diagnostic imaging, physiopathology)