Work

Network-Based Deep Brain Stimulation Rescue After Magnetic Resonance-Guided Focused Ultrasound Thalamotomy for Essential Tremor: Two Targeting Strategies

Year: 2026

Type: article

Abstract: Background: Tremor may recur after magnetic resonance-guided focused ultrasound (MRgFUS) thalamotomy, and the optimal target for deep brain stimulation (DBS) rescue remains uncertain. Cases: A 71-year-old man with recurrent essential tremor after ventral intermediate nucleus (Vim) MRgFUS underwent DBS along a Vim-posterior subthalamic area (PSA) trajectory. Microelectrode activity was attenuated in the lesioned thalamus; Vim test stimulation was ineffective, whereas PSA stimulation suppressed tremor. A 79-year-old man with recurrent tremor after staged bilateral MRgFUS underwent left DBS targeting the rubral wing. Conclusions: When the original thalamic target is anatomically or physiologically altered, targeting intact cerebellothalamic pathways provides a rational rescue strategy. Highlights: Deep brain stimulation can remain effective after failed focused ultrasound thalamotomy. These cases illustrate a lesion-informed, network-based strategy that preserves access to the cerebellothalamic network when prior lesioning has altered local anatomy or physiology.

Source: Tremor and Other Hyperkinetic Movements

DOI: 10.5334/tohm.1279

Authors: Francisco Aranda Godoy, Evan Wilson, Danielle Pietramalla, Christopher R. Honey, Stefan Lang

Institutions: University of British Columbia, Pontificia Universidad Católica de Chile

Language: English

Topic: Deep Brain Stimulation and Movement Disorders

Subfield: Clinical Neurology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $800