PMC8606815_01
Comparison of pre- and post-operative spiral draw testing. (A) Preoperative baseline attempt at Archimedes spiral drawing with the right hand severely limited by tremor burden. (B) Spiral drawing with the right hand during inpatient extra-operative externalized testing. Left Vim configured on bipolar (3-2+) settings at 3 mA, 60 mus, and 130 Hz. (C) 6-month post-operative spiral drawing with the right hand OFF Vim stimulation. (D) 6-month post-operative spiral drawing with L Vim turned on final setting configuration: 2 mA, 70 mus, and 150 Hz.
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F1
As depicted in Figure 1A, tremor markedly affected spiral drawing. For the right-hand tremor, left Vim stimulation using bipolar configurations of all contacts demonstrated significant tremor benefits (Figure 1B). Figure 1C shows 6-month post-operative spiral drawing test with stimulation turned off, while Figure 1D shows spiral drawing at 6-month on stimulation.
Lead and white matter tract reconstruction. (a) Four DBS [bilateral Vim/DRTT (gray), bilateral GPi (green)] leads reconstructed with patient's preoperative T1 non-contrast MRI as backdrop and DISTAL atlas segmentations of deep brain nuclei. Two distal contacts of Vim leads can be seen intentionally deep to the nucleus, targeting white matter fiber tracts. Lead visualization generated in Lead-DBS. (b,c) The right (red) and left (blue) DRTT (dentato-rubro-thalamic tract) are overlaid onto the patient's T1 non-contrast MRI. The coronal slice (b) showcases the tracking course of the DRTT, while the axial slice (c) captures the DRTT along the AC/PC plane. Tractography images generated in FSL.
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F2
Figure 2a depicts a reconstruction of the implanted leads while Figures 2b,c depicts personal DRTT pathways reconstructed in the patient's native image space using FSL software, described below. Figure 1C shows 6-month post-operative spiral drawing test with stimulation turned off, while Figure 1D shows spiral drawing at 6-month on stimulation.