Category: Tremor
Objective: To evaluate the efficacy of stereotactic thalamotomy with tractography-based targeting of the dentatorubrothalamic tract (DRT) for tremor reduction in drug-refractory patients and to analyze the correlation between clinical outcomes and quantitative DRT metrics.
Background: Stereotactic thalamotomy is an established treatment for drug-refractory tremor. Modern tractography techniques allow precise targeting of the dentatorubrothalamic tract (DRT), but quantitative imaging biomarkers for treatment response assessment remain underexplored.
Method: Treatment outcomes for 7 patients with drug-refractory tremor were analyzed. DRT targeting was performed using tractography in DSI Studio. Tract density (TD) and its distribution were quantified using the total TD sum and Shannon entropy before and after surgery. Tremor severity was assessed using the Clinical Rating Scale for Tremor (CRST) pre- and post-operatively(Fig. 1).
Results: A significant reduction in tremor on the CRST was observed in all cases post-operatively. The total TD sum and TD entropy across all slices decreased after surgery, which correlated with clinical improvement. The decrease in TD sum indicates suppression of the DRT, while reduced entropy reflects a more ordered (less re-organized) TD distribution (Figs. 2-3). One patient experienced transient hemiparesis that completely resolved within one week.
Conclusion: Tractography-based DRT targeting is an effective method for stereotactic thalamotomy in drug-refractory tremor. The total TD sum and its entropy correlate with CRST scores and may serve as quantitative markers for assessing DRT suppression and objective evaluation of thalamotomy outcomes.
Fig. 1
Fig. 2
Fig. 3
References: 1. Parras O, Domínguez P, Tomás-Biosca A, Guridi J. The role of tractography in the localisation of the Vim nucleus of the thalamus and the dentatorubrothalamic tract for the treatment of tremor. Neurologia (Engl Ed). 2022 Oct;37(8):691-699. doi: 10.1016/j.nrleng.2019.09.008. Epub 2021 Sep 23. PMID: 34563477.
To cite this abstract in AMA style:
V. Bayarchyk, A. Buniak, A. Mikitchuk. Evaluation of neurosurgical treatment outcomes for tremor using dynamics of tract density and total entropy of the dentatorubrothalamic tract [abstract]. Mov Disord. 2026; 41 (suppl 1). https://www.mdsabstracts.org/abstract/evaluation-of-neurosurgical-treatment-outcomes-for-tremor-using-dynamics-of-tract-density-and-total-entropy-of-the-dentatorubrothalamic-tract/. Accessed October 1, 2026.« Back to 2026 International Congress
MDS Abstracts - https://www.mdsabstracts.org/abstract/evaluation-of-neurosurgical-treatment-outcomes-for-tremor-using-dynamics-of-tract-density-and-total-entropy-of-the-dentatorubrothalamic-tract/