INTRODUCTION Deep brain stimulation alleviates tremor of various origins. The dentato-rubro-thalamic tract (DRT) has been suspected as a common tremor-reducing structure. Statistical evidence has not been obtained. We here report the results of an uncontrolled case series of patients with refractory tremor who underwent deep brain stimulation under tractographic assistance. METHODS A total of 36 patients were enrolled (essential tremor (17), Parkinson's tremor (8), multiple sclerosis (7), dystonic head tremor (3), tardive dystonia (1)) and received 62 DBS electrodes (26 bilateral; 10 unilateral). Preoperatively, diffusion tensor magnetic resonance imaging sequences were acquired together with high-resolution anatomical T1W and T2W sequences. The DRT was individually tracked and used as a direct thalamic or subthalamic target. Intraoperative tremor reduction was graded on a 4-point scale (0 = no tremor reduction to 3 = full tremor control) and recorded together with the current amplitude, respectively. Stimulation point coordinates were recorded and compared to DRT. The relation of the current amplitude needed to reduce tremor was expressed as TiCR (tremor improvement per current ratio). RESULTS Stimulation points of 241 were available for analysis. A total of 68 trajectories were tested (62 dB leads, 1.1 trajectories tested per implanted lead). Tremor improvement was significantly decreasing (p < 0.01) if the distance to both the border and the center of the DRT was increasing. On the initial trajectory, 56 leads (90.3%) were finally placed. Long-term outcomes were not part of this analysis. DISCUSSION Tremor of various origins was acutely alleviated at different points along the DRT fiber tract (above and below the MCP plane) despite different tremor diseases. DRT is potentially a common tremor-reducing structure. Individual targeting helps to reduce brain penetrating tracts. TiCR characterizes stimulation efficacy and might help to identify an optimal stimulation point.

中文翻译：

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齿状-丘脑-丘脑束作为潜在的常见深部脑刺激目标，可引起各种震颤：一个观察病例系列。

简介深度脑刺激可减轻各种原因的震颤。齿状-丘脑-丘脑束（DRT）被怀疑是一种常见的减震结构。尚未获得统计证据。我们在这里报告了一系列不受控制的难治性震颤患者的结果，这些患者在放射线照相辅助下进行了深部脑刺激。方法纳入36例患者（基本震颤（17），帕金森氏震颤（8），多发性硬化症（7），肌张力障碍性头震颤（3），迟发性肌张力障碍（1））并接受62根DBS电极（26根双侧; 10根单方面）。术前，获得了扩散张量磁共振成像序列以及高分辨率的解剖T1W和T2W序列。对DRT进行了单独跟踪，并将其用作直接丘脑或丘脑下目标。术中震颤减轻分为4分制（0 =无震颤减轻至3 =完全震颤控制），并与电流幅度一起记录。记录刺激点坐标并将其与DRT进行比较。减少震颤所需的电流幅度的关系表示为TiCR（每电流比的震颤改善）。结果241个刺激点可供分析。总共测试了68条轨迹（62 dB引线，每条植入的引线测试1.1条轨迹）。如果到DRT的边界和中心的距离都在增加，震颤的改善将显着降低（p <0.01）。在最初的轨迹上，最终放置了56条导线（90.3％）。长期结果不属于该分析的一部分。讨论尽管震颤疾病不同，但沿DRT纤维束（MCP平面上方和下方）不同点的各种起源的震颤仍得到了急性缓解。DRT潜在地是一种常见的减少震动的结构。个体靶向有助于减少大脑的穿透力。TiCR表征刺激功效，可能有助于确定最佳刺激点。