Network-Based Deep Brain Stimulation Rescue After Magnetic Resonance-Guided Focused Ultrasound Thalamotomy for Essential Tremor: Two Targeting Strategies.
Francisco Aranda Godoy, Evan Wilson, Danielle Pietramalla et al.
✦ AI-curated · Sources linked
Case in brief
Two men developed recurrent essential tremor after MRgFUS thalamotomy. In the 71-year-old, DBS was placed along a Vim–posterior subthalamic area trajectory. Microelectrode activity was attenuated in the lesioned thalamus, and Vim test stimulation did not help, whereas stimulation in the posterior subthalamic area suppressed tremor. The 79-year-old, whose tremor recurred after staged bilateral MRgFUS, underwent left DBS targeting the rubral wing. The report describes DBS as an effective rescue option after failed focused ultrasound and supports targeting intact cerebellothalamic pathways when prior lesioning has altered the original target.
What made this case unusual
Prior thalamic lesioning altered local physiology: Vim test stimulation was ineffective, while posterior subthalamic area stimulation suppressed tremor. The second case used a different network-based target, the rubral wing.
Diagnostic / clinical pearl
After MRgFUS thalamotomy, assess whether the original thalamic target remains anatomically and physiologically suitable; these cases illustrate rescue DBS directed to intact cerebellothalamic pathways.