Central oscillators in a patient with neuropathic tremor: Evidence from intraoperative local field potential recordings

Authors

  • Daniel Weiss MD,

    1. Center of Neurology and Hertie Institute for Clinical Brain Research, and German Center for Neurodegenerative Diseases, University of Tübingen, Germany
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  • Rathinaswamy B. Govindan PhD,

    1. Department of Obstetrics and Gynaecology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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  • Albrecht Rilk MD,

    1. Department of Psychiatry and Psychotherapy, University of Tübingen, Germany
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  • Tobias Wächter MD,

    1. Center of Neurology and Hertie Institute for Clinical Brain Research, and German Center for Neurodegenerative Diseases, University of Tübingen, Germany
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  • Sorin Breit MD,

    1. Center of Neurology and Hertie Institute for Clinical Brain Research, and German Center for Neurodegenerative Diseases, University of Tübingen, Germany
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  • Leopold Zizlsperger MD,

    1. Center of Neurology and Hertie Institute for Clinical Brain Research, and German Center for Neurodegenerative Diseases, University of Tübingen, Germany
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  • Thomas Haarmeier MD,

    1. Center of Neurology and Hertie Institute for Clinical Brain Research, and German Center for Neurodegenerative Diseases, University of Tübingen, Germany
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  • Christian Plewnia MD,

    1. Department of Psychiatry and Psychotherapy, University of Tübingen, Germany
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  • Rejko Krüger MD,

    Corresponding author
    1. Center of Neurology and Hertie Institute for Clinical Brain Research, and German Center for Neurodegenerative Diseases, University of Tübingen, Germany
    • Center of Neurology and Hertie Institute for Clinical Brain Research, and German Center for Neurodegenerative Diseases, University of Tübingen, Hoppe-Seyler-Str. 3, D-72076 Tübingen, Germany
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    • R.K. and A.G. share senior and corresponding authorship.

  • Alireza Gharabaghi MD

    Corresponding author
    1. Werner Reichardt Centre for Integrative Neuroscience and Department of Neurosurgery, University of Tübingen, Germany
    • Werner Reichardt Centre for Integrative Neuroscience and Department of Neurosurgery, University of Tübingen, Hoppe-Seyler-Str. 3, D-72076 Tübingen, Germany
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    • R.K. and A.G. share senior and corresponding authorship.


  • 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.

Abstract

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

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