Increased structural connectivity of thalamic stimulation sites to motor cortex relates to tremor suppression

Autor: Nader Pouratian, Hiro Sparks, Hannah Riskin-Jones, Evangelia Tsolaki, Alon Kashanian
Rok vydání: 2021
Předmět:
Deep brain stimulation
Deep Brain Stimulation
Essential Tremor
Cognitive Neuroscience
medicine.medical_treatment
Computer applications to medicine. Medical informatics
Thalamus
R858-859.7
050105 experimental psychology
03 medical and health sciences
0302 clinical medicine
Tremor
medicine
Humans
0501 psychology and cognitive sciences
Radiology
Nuclear Medicine and imaging
RC346-429
Thalamic stimulator
Essential tremor
business.industry
05 social sciences
Motor Cortex
Precentral gyrus
Regular Article
medicine.disease
Probabilistic tractography
Diffusion Tensor Imaging
Treatment Outcome
medicine.anatomical_structure
nervous system
Neurology
Surgical planning
Neurology. Diseases of the nervous system
Neurology (clinical)
Primary motor cortex
business
Neuroscience
030217 neurology & neurosurgery
Diffusion MRI
Motor cortex
Zdroj: NeuroImage : Clinical
NeuroImage: Clinical, Vol 30, Iss, Pp 102628-(2021)
ISSN: 2213-1582
Popis: Highlights • Clinically weighted tractography reveals key patterns of therapeutic brain stimulation. • Thalamic stimulation for tremor preferentially connects to precentral gyrus and cerebellum. • Thalamic DBS of areas most connected to motor cortex results in superior outcomes. • Acute and chronic therapeutic outcomes demonstrate converging connectivity patterns.
Deep brain stimulation (DBS) of the ventral intermediate nucleus (VIM-DBS) is a highly successful treatment for medication-refractory essential tremor (ET). Clinical outcomes are dependent on accurate targeting. Here, we aim to develop a framework for connectivity-guided DBS targeting by evaluating probabilistic tractography and clinical response at both initial programming (IP) and clinical follow-up (CF). Magnetic resonance imaging and clinical outcomes were evaluated in 23 ET patients who were treated by VIM-DBS at the University of California Los Angeles (20 at IP, 18 at CF, 14 at both). Lead-DBS was used to model the volume of tissue activated tissue (VTA) based on programming configurations at both IP and CF. Probabilistic tractography, calculated in FSL, was used to evaluate 1) clinically weighted whole brain connectivity of VTA; 2) connectivity between VTA and freesurfer-derived target regions of interest (ROI) including primary motor, premotor, and prefrontal cortices, and cerebellum; and 3) volume of intersection between VTA and probabilistic tractography-based segmentation of the thalamus. At IP, individual contacts were scored as high or low efficacy based on acute tremor improvement. At CF, clinical response was measured by percent of change of the Clinical Rating Scale for Tremor (CRST) compared to preoperative scores. Contributions from each target ROI to clinical response was measured using logistic regression for IP and linear regression for CF. The clinically weighted map of whole brain connectivity of VTA shows preferential connectivity to precentral gyrus and brainstem/cerebellum. The volume of intersection between VTA and thalamic segmentation map based on probabilistic connectivity to primary motor cortex was a significant predictor of contact efficacy at IP (OR = 2.26 per 100 mm3 of overlap, p = .04) and percent change in CRST at CF (β = 14.67 per 100 mm3 of overlap, p = .003). Targeting DBS to the area of thalamus most connected to primary motor cortex based on probabilistic tractography is associated with superior outcomes, providing a potential guide not only for lead targeting but also therapeutic programming.
Databáze: OpenAIRE
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