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From the Departments of Neurology (Drs. Ceballos–Baumann, Boecker, Conrad, and von Falkenhayn) and Nuclear Medicine (Drs. Bartenstein and Schwaiger), Technische Universität München; Departments of Neurology (Dr. Fogel) and Neurosurgery (Dr. Tronnier), Universität Heidelberg; Department of Neurosurgery (Dr. Moringlane), Universität des Saarlardes, Homburg, Germany; Department of Neurology (N. Diederich), Centre Hospitalier de Luxembourg; and the Department of Neurosurgery (Dr. Alesch), Wiener Universitätsklinik, Vienna, Austria.
Address correspondence and reprint requests to Dr. Andrés O. Ceballos–Baumann, Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Möhlstr. 28, D-81675 Munich, Germany; e-mail: a.ceballos{at}lrz.tum.de
BACKGROUND: The functional effects of deep brain stimulation in the nucleus ventralis intermedius (VIM) of the thalamus on brain circuitry are not well understood. The connectivity of the VIM has so far not been studied functionally. It was hypothesized that VIM stimulation would exert an effect primarily on VIM projection areas, namely motor and parietoinsular vestibular cortex.
METHODS: Six patients with essential tremor who had electrodes implanted in the VIM were studied with PET. Regional cerebral blood flow was measured during three experimental conditions: with 130 Hz (effective) and 50 Hz (ineffective) stimulation, and without stimulation.
RESULTS: Effective stimulation was associated with regional cerebral blood flow increases in motor cortex ipsilateral to the side of stimulation. Right retroinsular (parietoinsular vestibular) cortex showed regional cerebral blood flow decreases with stimulation.
CONCLUSIONS: Beneficial effects of VIM stimulation in essential tremor are associated with increased synaptic activity in motor cortex, possibly due to nonphysiologic activation of thalamofrontal projections or frequency-dependent neuroinhibition. Retroinsular regional cerebral blood flow decreases suggest an interaction of VIM stimulation on vestibular–thalamic–cortical projections that may explain dysequilibrium, a common and reversible stimulation-associated side effect.
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