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Thalamic Local Field Potentials and Closed-Loop Deep Brain Stimulation in Orthostatic Tremor
Wilson K W Fung1, Srdjan Sumarac2, Gianluca Sorrento1
1Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, Ontario, Canada.
Summary
Orthostatic tremor (OT) is a rare movement disorder. Closed-loop deep brain stimulation (DBS) targeting the thalamus effectively reduced tremor and gait ataxia by sensing and adapting to the tremor frequency.
Area of Science:
- Neuroscience
- Movement Disorders
- Biomedical Engineering
Background:
- Orthostatic tremor (OT) is a rare neurological condition causing unsteadiness and leg tremors.
- Characterized by high-frequency (13-18 Hz) tremors that improve with rest or ambulation.
- Medication-refractory cases present significant management challenges.
Purpose of the Study:
- To investigate brain electrophysiology in medication-refractory orthostatic tremor using chronic deep brain stimulation (DBS).
- To evaluate the efficacy of closed-loop DBS in managing OT symptoms.
- To analyze thalamic local field potentials (LFPs) during standing and walking.
Main Methods:
- Utilized bilateral ventral intermedius nucleus DBS (Medtronic Percept PC) with sensing capabilities.
- Recorded local field potentials (LFPs) and synchronized them with leg accelerometers and gait analysis.
- Compared continuous DBS with adaptive, single-threshold closed-loop DBS.
Main Results:
- Identified strong oscillatory coupling between thalamic LFPs and leg tremor at 14.65 Hz during weight-bearing.
- Demonstrated that adaptive DBS, sensing at the tremor frequency, significantly reduced tremor and gait ataxia.
- Showed superiority of closed-loop DBS over continuous stimulation for symptom management.
Conclusions:
- This study offers novel insights into the pathophysiology of orthostatic tremor.
- Closed-loop DBS represents a promising, adaptive therapeutic strategy for managing medication-refractory OT.
- Highlights the potential of sensing-based neuromodulation for movement disorders.
