Reference : Central oscillators in a patient with neuropathic tremor: evidence from intraoperativ...
Scientific journals : Article
Life sciences : Genetics & genetic processes
Central oscillators in a patient with neuropathic tremor: evidence from intraoperative local field potential recordings.
Weiss, Daniel [> >]
Govindan, Rathinaswamy B. [> >]
Rilk, Albrecht [> >]
Wachter, Tobias [> >]
Breit, Sorin [> >]
Zizlsperger, Leopold [> >]
Haarmeier, Thomas [> >]
Plewnia, Christian [> >]
Krüger, Rejko mailto [University of Luxembourg > Faculty of Science, Technology and Communication (FSTC) > Life Science Research Unit]
Gharabaghi, Alireza [> >]
Movement Disorders
Yes (verified by ORBilu)
United States
[en] Aged ; Biological Clocks/physiology ; Brain/physiopathology/surgery ; Deep Brain Stimulation ; Electroencephalography ; Electromyography ; Female ; Humans ; Muscle, Skeletal/physiopathology ; Neurons/physiology ; Paraproteinemias/complications/physiopathology ; Tremor/etiology/physiopathology/therapy
[en] Present pathophysiological concepts of neuropathic tremor assume mistimed and defective afferent input resulting in deregulation of cerebello-thalamo-cortical motor networks. Here, we provide direct evidence of central tremor processing in a 76-year-old female who underwent bilateral deep brain stimulation of the ventral intermedial nucleus of the thalamus (Vim-DBS) because of neuropathic tremor associated with IgM paraproteinemia. Electrophysiological recordings of EEG and EMG were performed in three perioperative sessions: (1) preoperatively, (2) intraoperatively, and (3) 4 days after surgery in both rest and postural tremor conditions. Tremor-related synchronization (coherence) between motor cortex (M1) and muscles (M. extensor digitorum, M. flexor digitorum) was assessed, and additional intraoperative local field potential (LFP) recordings from Vim allowed comprehensive coherence mapping in thalamo-cortico-muscular networks. Directionality of information flow was determined by directed transfer function (DTF) and phase analyses. Stimulation effects on tremor and corticomuscular coherence were assessed and the patient was followed for 12 months on clinical outcome measures (Tremor Rating Scale, CADET-Score). Vim-DBS reduced tremor (59%) and improved motor functionality in daily activities (31%, CADET-A) after 12 months. Intraoperative recordings demonstrated significant coherence in the tremor frequency (4 Hz) between M1 and contralateral muscle, Vim and ipsilateral M1, Vim and contralateral muscle, but not between Vim and contralateral M1. Information flow was directed from M1 to Vim and bidirectional between M1 and muscle and between Vim and muscle, respectively. Corticomuscular coherence at tremor frequency was completely suppressed by Vim-DBS. Our case study demonstrates central oscillators underlying neuropathic tremor and implies a strong pathophysiological rationale for Vim-DBS.
Luxembourg Centre for Systems Biomedicine (LCSB): Clinical & Experimental Neuroscience (Krüger Group)
Copyright (c) 2010 Movement Disorder Society.

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