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Brain region to treat tremors can now be directly and accurately located.
Posted On: October 17, 2016
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Around one in ten of those 65 years or older experience ‘essential tremor’—uncontrollable shaking that intensifies when attempting a movement (such as writing).
The most common movement disorder—known as ‘essential tremor’—causes uncontrollable shaking in the hands, arms and sometimes the head and vocal cords. While it is often mild, it worsens with age and can lead to difficulty completing daily tasks.
When medications fail to improve the tremors, a surgical treatment is performed: a small region of the brain, known as the ventral intermediate nucleus (VIM), is targeted and shut down.
Targeting the VIM is challenging; it is a small region of the brain that is only a few millimeters in length. Furthermore, current imaging techniques are limited and clinicians must rely on indirect methods to approximate the location of the target.
To address this issue, Krembil Scientist and Techna Affiliated Faculty Dr. Mojgan Hodaie and her team developed a new approach to more accurately identify the location of the VIM. Her strategy involved direct visualization of the white matter fibers coursing through VIM using a technique called diffusion tensor imaging (DTI). To overcome the difficulty in targeting the region, Dr. Hodaie’s team employed novel methods to improve the accuracy of targeting, and compared the location of the DTI tracts with the location of the target found during surgery.
The results showed that this method of targeting is accurate and, because it is not time-consuming, represents a clinically feasible strategy to precisely locate the VIM nucleus in each patient.
Future studies will determine whether DTI targeting translates into better outcomes for those suffering from medication-resistant tremors. The results of these studies are particularly far-reaching because targeting the VIM is also used to treat the severe tremors experienced by individuals suffering from medication resistant Parkinson disease.
This work was supported by the Toronto General & Western Hospital Foundation. AM Lozano holds a Tier 1 Canada Research Chair in Neuroscience .To learn more about Dr. Hodaie’s research, visit the Hodaie Lab Website.
Sammartino F, Krishna V, Kon Kam King N, Lozano AM, Schwartz ML, Huang Y, Hodaie M. Tractography-based ventral intermediate nucleus targeting: novel methodology and intraoperative validation. Movement Disorders. 2016 May 23. doi: 10.1002/mds.26633. [Pubmed abstract]
When medications fail to improve the tremors, a surgical treatment is performed: a small region of the brain, known as the ventral intermediate nucleus (VIM), is targeted and shut down.
Targeting the VIM is challenging; it is a small region of the brain that is only a few millimeters in length. Furthermore, current imaging techniques are limited and clinicians must rely on indirect methods to approximate the location of the target.
To address this issue, Krembil Scientist and Techna Affiliated Faculty Dr. Mojgan Hodaie and her team developed a new approach to more accurately identify the location of the VIM. Her strategy involved direct visualization of the white matter fibers coursing through VIM using a technique called diffusion tensor imaging (DTI). To overcome the difficulty in targeting the region, Dr. Hodaie’s team employed novel methods to improve the accuracy of targeting, and compared the location of the DTI tracts with the location of the target found during surgery.
The results showed that this method of targeting is accurate and, because it is not time-consuming, represents a clinically feasible strategy to precisely locate the VIM nucleus in each patient.
Future studies will determine whether DTI targeting translates into better outcomes for those suffering from medication-resistant tremors. The results of these studies are particularly far-reaching because targeting the VIM is also used to treat the severe tremors experienced by individuals suffering from medication resistant Parkinson disease.
This work was supported by the Toronto General & Western Hospital Foundation. AM Lozano holds a Tier 1 Canada Research Chair in Neuroscience .To learn more about Dr. Hodaie’s research, visit the Hodaie Lab Website.
Sammartino F, Krishna V, Kon Kam King N, Lozano AM, Schwartz ML, Huang Y, Hodaie M. Tractography-based ventral intermediate nucleus targeting: novel methodology and intraoperative validation. Movement Disorders. 2016 May 23. doi: 10.1002/mds.26633. [Pubmed abstract]