Tractography-guided versus clinical contact selection for deep brain stimulation in tremor - A prospective clinical trial

IF 9.7 1区医学 Q1 CLINICAL NEUROLOGY

Brain Stimulation Pub Date : 2026-03-01 Epub Date: 2026-02-23 DOI:10.1016/j.brs.2026.103061

Christina van der Linden , Thea Berger , Till A. Dembek , Gregor A. Brandt , Joshua N. Strelow , Juan Carlos Baldermann , Hannah Jergas , Gereon R. Fink , Veerle Visser-Vandewalle , Michael T. Barbe , Jan Niklas Petry-Schmelzer

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引用次数: 0

Abstract

Background

Imaging-guided programming strategies for deep brain stimulation (DBS) offer the potential to reduce programming time and complexity. However, evidence-based paradigms tailored to tremor remain unavailable. Converging research points to an involvement of the dentato-rubro-thalamic tract (DRTT) in tremor pathophysiology across diseases, providing a potential target for imaging-guided programming in Essential Tremor (ET) and Parkinson's Disease (PD).

Objective

To prospectively evaluate whether imaging-guided contact selection for tremor control based on individual tractography of the DRTT is non-inferior to clinical contact selection.

Methods

Tremor control was assessed in an acute challenge for each DBS contact in 16 ET and 24 PD patients with directional DBS leads in the thalamic ventral intermediate nucleus/posterior subthalamic area (ET) or subthalamic nucleus (PD). The effect of the clinically most effective contact was compared to the effect of the contact with the largest overlap of the stimulation spread with the individual DRTT. Primary outcome was the difference in relative tremor improvement between clinical and imaging-guided contact selection, assessed by an accelerometry-based tremor score, assuming a non-inferiority margin of ≤20%.

Results

Tremor control achieved via the imaging-based selected contact was non-inferior to tremor control via the contact chosen by clinical testing for ET (median difference best clinical vs. best imaging-based contact −8%, 95% CI -11.5% to −3.5%) and PD (median difference −10%, 95% CI -20% to −4%).

Conclusion

This study provides class-II evidence that the overlap of the stimulation spread with the individual DRTT is a suitable marker for imaging-guided contact selection for DBS in tremor.

查看原文本刊更多论文

神经束造影引导与临床接触选择治疗震颤的深部脑刺激-一项前瞻性临床试验。

背景：深部脑刺激（DBS）的成像引导编程策略提供了减少时间和复杂性的潜力。然而，针对震颤的循证范例仍然不可用。越来越多的研究表明，齿状丘丘脑束（DRTT）参与了各种疾病的震颤病理生理，为特发性震颤（ET）和帕金森病（PD）的成像引导编程提供了潜在的靶点。目的：前瞻性评价基于DRTT个体化肌腱束造影的成像引导下震颤控制接触点选择是否优于临床接触点选择。方法：在16例ET和24例PD患者中，定向DBS导联位于丘脑腹侧中间核/后丘脑底核（ET）或丘脑底核（PD），在每次接触DBS的急性刺激中评估震颤控制。将临床最有效接触的效果与个体DRTT刺激传播重叠最大的接触的效果进行比较。主要结局是临床和成像引导下接触选择相对震颤改善的差异，通过基于加速度计的震颤评分评估，假设非劣效裕度≤20%。结果：通过基于成像的选择接触实现的震颤控制不逊于通过临床测试选择的接触实现的震颤控制ET（最佳临床与最佳基于成像的接触的中位数差-8%，95% CI -11.5%至-3.5%）和PD（中位数差-10%，95% CI -20%至-4%）。结论：本研究提供了ii类证据，表明刺激传播与个体DRTT的重叠是成像引导下震颤DBS接触选择的合适标记。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Brain Stimulation 医学-临床神经学

CiteScore

13.10

自引率

9.10%

发文量

256

审稿时长

72 days

期刊介绍： Brain Stimulation publishes on the entire field of brain stimulation, including noninvasive and invasive techniques and technologies that alter brain function through the use of electrical, magnetic, radiowave, or focally targeted pharmacologic stimulation. Brain Stimulation aims to be the premier journal for publication of original research in the field of neuromodulation. The journal includes: a) Original articles; b) Short Communications; c) Invited and original reviews; d) Technology and methodological perspectives (reviews of new devices, description of new methods, etc.); and e) Letters to the Editor. Special issues of the journal will be considered based on scientific merit.