Nuklearmedizin 2020; 59(02): 190-191
DOI: 10.1055/s-0040-1708417
Wissenschaftliche Poster
Neurologie II
© Georg Thieme Verlag KG Stuttgart · New York

Stimulation-induced cerebellar syndromes in VIM/DRT-DBS: An F-18-FDG PET activation study

G Blazhenets
1   Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Department of Nuclear Medicine, Freiburg
,
BE Sajonz
2   Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Department of Stereotactic and Functional Neurosurgery, Freiburg
,
I Walz
3   Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Department of Neurology, Freiburg
,
ML Frommer
2   Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Department of Stereotactic and Functional Neurosurgery, Freiburg
,
J Thurow
1   Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Department of Nuclear Medicine, Freiburg
,
L Frings
1   Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Department of Nuclear Medicine, Freiburg
,
C Maurer
3   Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Department of Neurology, Freiburg
,
M Rijntjes
3   Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Department of Neurology, Freiburg
,
VA Coenen
2   Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Department of Stereotactic and Functional Neurosurgery, Freiburg
,
PT Meyer
1   Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Department of Nuclear Medicine, Freiburg
› Author Affiliations
Further Information

Publication History

Publication Date:
08 April 2020 (online)

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Ziel/Aim The VIM/dentato-rubro-thalamic bundle (DRT) has been described as a relevant target for tremor control. However, up to 20 % of patients with deep brain stimulation (DBS) of the VIM/DRT develop a stimulation-induced cerebellar syndrome. While the exact cause is elusive, it is hypothesized that the (supratherapeutic) co-stimulation of further cerebellar output pathways in addition to the DRT and antidromic stimulation of the cerebellum plays a role.

Methodik/Methods 8 patients who complained about recurrent tremor and symptoms of a cerebellar syndrome after DBS were enrolled. Cerebral F-18-FDG PET scans were performed with activated DBS (DBSON) and 72 hours after deactivation of DBS (DBSOFF) in each of the patients. Voxel-based changes of normalized glucose metabolism as a marker of regional neuronal activity between DBSON and DBSOFF conditions were assessed using a paired t-test and SPM. The correlation between regional uptake in thalamus and cerebral uptake was analyzed by regression analysis. Tremor (accelerometer and EMG) and gait analyses (video-based markerless motion capture system) were performed under both conditions.

Ergebnisse/Results Across all patients, we found a significantly increased metabolism of the thalamus and dentate nucleus and a decreased metabolism of the cerebellar hemispheres with DBSON (p < 0.01). Thalamic metabolism correlated positively with the metabolism of the dentate nucleus (both conditions pooled, p < 0.01). The coefficient of variation of step length (a marker of gait ataxia) with DBSON correlated negatively with the change in metabolism of the right cerebellar hemisphere (p < 0.01).

Schlussfolgerungen/Conclusions Increased neuronal activity of the thalamus with DBSON correlated positively with the increase of neuronal activity of the dentate nucleus, supporting the theory of antidromic stimulation, in particular via the DRT.