R.K. and A.G. share senior and corresponding authorship.
Central oscillators in a patient with neuropathic tremor: Evidence from intraoperative local field potential recordings†
Article first published online: 13 OCT 2010
Copyright © 2010 Movement Disorder Society
Volume 26, Issue 2, pages 323–327, 1 February 2011
How to Cite
Weiss, D., Govindan, R. B., Rilk, A., Wächter, T., Breit, S., Zizlsperger, L., Haarmeier, T., Plewnia, C., Krüger, R. and Gharabaghi, A. (2011), Central oscillators in a patient with neuropathic tremor: Evidence from intraoperative local field potential recordings. Mov. Disord., 26: 323–327. doi: 10.1002/mds.23374
Relevant conflicts of interest/financial disclosures: Nothing to report. Full financial disclosures and author roles can be found in the online version of this article.
T. Wächter has received speaker's honoraria and travel grants from Medtronic and Schwarz Pharma. No further conflicts of interest were reported.
- Issue published online: 14 MAR 2011
- Article first published online: 13 OCT 2010
- Manuscript Accepted: 6 JUL 2010
- Manuscript Revised: 9 JUN 2010
- Manuscript Received: 23 APR 2010
- deep brain stimulation;
- local field potentials
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. © 2010 Movement Disorder Society