Abstract
High-frequency peripheral nerve stimulation has emerged as a noninvasive alternative to thalamic deep brain stimulation for some patients with essential tremor. It is not known whether such techniques might be effective for movement disorders in children, nor is the mechanism and transmission of the peripheral stimuli to central brain structures understood. This study was designed to investigate the fidelity of transmission from peripheral nerves to thalamic nuclei in children with dystonia undergoing deep brain stimulation surgery. The ventralis intermediate (VIM) thalamus nuclei showed a robust evoked response to peripheral high-frequency burst stimulation, with a greatest response magnitude to intra-burst frequencies between 50 and 100 Hz, and reliable but smaller responses up to 170 Hz. The earliest response occurred at 12–15 ms following stimulation onset, suggesting rapid high-fidelity transmission between peripheral nerve and thalamic nuclei. A high-bandwidth, low-latency transmission path from peripheral nerve to VIM thalamus is consistent with the importance of rapid and accurate sensory information for the control of coordination and movement via the cerebello-thalamo-cortical pathway. Our results suggest the possibility of non-invasive modulation of thalamic activity in children with dystonia, and therefore the possibility that a subset of children could have beneficial clinical response without the need for invasive deep brain stimulation.
Highlights
High-frequency peripheral nerve stimulation has emerged as a noninvasive alternative to thalamic deep brain stimulation for some patients with essential tremor
Some patients with dystonia have benefited from noninvasive methods of nerve stimulation such as transcutaneous electrical nerve stimulation (TENS), which modulates the motor cortex though sensory afferent inputs, and peripheral nerve stimulation (PNS), which acts at the subcortical level[1,2]
Electrode locations were confirmed by postoperative computerized tomography (CT) scan, referenced to the preoperative MRI in MNI (Montreal Neurological Institute) coordinates, and rendered in 3 dimensions relative to the location of ventralis intermediate (VIM) specified in the DISTAL a tlas[14] (Fig. 1)
Summary
High-frequency peripheral nerve stimulation has emerged as a noninvasive alternative to thalamic deep brain stimulation for some patients with essential tremor. It is not known whether such techniques might be effective for movement disorders in children, nor is the mechanism and transmission of the peripheral stimuli to central brain structures understood. Stimulation in ventralis intermediate (VIM) or ventral posterolateral (VPL) nuclei of the thalamus has been helpful in a subset of c hildren[3] This raises the possibility that if peripheral noninvasive stimulation could activate VIM, clinical benefit could perhaps be obtained if appropriate pulse frequencies and patterns can be determined. A total of 20 DBS electrodes in 10 dystonic patients are represented through DSI Studio, V3 (http://dsi-studio.labsolver.org)
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