Objective: To investigate the neuroanatomical hotspots for the suppression of rest, postural and intention tremor in Parkinson’s Disease (PD) and Essential Tremor (ET) treated with deep brain stimulation (DBS) of neighbouring anatomical targets.

Background: DBS targeting both the subthalamic nucleus (STN) and the ventral intermediate nucleus (VIM) and posterior subthalamic area (PSA) is known to effectively suppress tremor. Recently, we demonstrated in a prospective trial that stimulation overlap with individually tracked dentato-rubro-thalamic tract (DRTT) was able to predict tremor improvement in both STN-DBS and VIM/PSA-DBS.

Method: We employed voxel-wise DBS mapping as well as fiber‑filtering in a large prospective dataset of n = 24 subjects with PD tremor and STN‑DBS as well as n = 16 subjects with ET and VIM/PSA-DBS¹. During monopolar investigation of each available DBS contact, suppression of rest tremor, postural tremor, and intention tremor was quantified using accelerometry. In total, the dataset yielded around n ~ 800 stimulation settings.

Results: When analysing the full dataset, Bonferroni‑corrected hotspots for the suppression of all investigated tremors (rest, postural, intention) were located within the PSA and the ventral VIM but not within the STN. All hotspots fully covered the atlas-derived trajectory of the DRTT. Fiber-filtering based on the FOCUS atlas showed a significant association between activation of DRTT streamlines and tremor suppression for all forms of tremor with additional significant streamlines mainly belonging to the lenticular fasciculus. A separate analysis of the PD/STN‑DBS dataset again revealed that all hotspots for different tremor types were located medial to the STN within the PSA, in direction of the DRTT. A separate analysis of the ET/VIM/PSA-DBS dataset revealed that, after Bonferroni correction, no significant hotspots remained for rest tremor (possibly due to a lack of rest tremor in that cohort) and postural tremor (possibly due to a lack of gradient in outcomes with pronounced postural tremor suppression in most DBS settings). The hotspot for the suppression of intention tremor entirely resided within the PSA and ventral to the VIM, yet again covering the trajectory of the DRTT.

Conclusion: This analysis provides evidence for the DRTT as common neuroanatomical target for the acute suppression of different tremor types in both STN-DBS and VIM/PSA-DBS.

References: 1. van der Linden, C. et al. Tractography-guided versus Clinical Contact Selection for Deep Brain Stimulation in Tremor – A Prospective Clinical Trial. medRxiv 2025.05.30.25328382 (2025) doi:10.1101/2025.05.30.25328382 https://doi.org/10.1101/2025.05.30.25328382.

« Back to 2026 International Congress

MDS Abstracts - https://www.mdsabstracts.org/abstract/dentatothalamic-projections-mediate-tremor-relief-across-deep-brain-stimulation-targets-and-tremor-types/