Tractography patterns of pedunculopontine nucleus deep brain stimulation
| Autor: | Alexander L. Green, Ashley L B Raghu, John F. Stein, Tariq Parker, Stephen J. Payne, Amir P. Divanbeighi Zand, Jesper L. R. Andersson, Tipu Z. Aziz |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
0301 basic medicine
Deep brain stimulation medicine.medical_treatment Deep Brain Stimulation Parkinsonian gait Neurology and Preclinical Neurological Studies - Original Article Pedunculotegmental nucleus 03 medical and health sciences 0302 clinical medicine Gait (human) medicine Pedunculopontine Tegmental Nucleus Humans Gait Biological Psychiatry Gait Disorders Neurologic Pedunculopontine nucleus business.industry Precentral gyrus Parkinson Disease Psychiatry and Mental health 030104 developmental biology Superior cerebellar peduncle medicine.anatomical_structure Neurology Parkinson’s disease Falls Neurology (clinical) medicine.symptom business Neuroscience Tractography 030217 neurology & neurosurgery Diffusion MRI |
| Zdroj: | Journal of Neural Transmission |
| DOI: | 10.1007/s00702-021-02327-x |
| Popis: | Deep brain stimulation of the pedunculopontine nucleus is a promising surgical procedure for the treatment of Parkinsonian gait and balance dysfunction. It has, however, produced mixed clinical results that are poorly understood. We used tractography with the aim to rationalise this heterogeneity. A cohort of eight patients with postural instability and gait disturbance (Parkinson’s disease subtype) underwent pre-operative structural and diffusion MRI, then progressed to deep brain stimulation targeting the pedunculopontine nucleus. Pre-operative and follow-up assessments were carried out using the Gait and Falls Questionnaire, and Freezing of Gait Questionnaire. Probabilistic diffusion tensor tractography was carried out between the stimulating electrodes and both cortical and cerebellar regions of a priori interest. Cortical surface reconstructions were carried out to measure cortical thickness in relevant areas. Structural connectivity between stimulating electrode and precentral gyrus (r = 0.81, p = 0.01), Brodmann areas 1 (r = 0.78, p = 0.02) and 2 (r = 0.76, p = 0.03) were correlated with clinical improvement. A negative correlation was also observed for the superior cerebellar peduncle (r = −0.76, p = 0.03). Lower cortical thickness of the left parietal lobe and bilateral premotor cortices were associated with greater pre-operative severity of symptoms. Both motor and sensory structural connectivity of the stimulated surgical target characterises the clinical benefit, or lack thereof, from surgery. In what is a challenging region of brainstem to effectively target, these results provide insights into how this can be better achieved. The mechanisms of action are likely to have both motor and sensory components, commensurate with the probable nature of the underlying dysfunction. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|