Structural connectivity-based segmentation of the thalamus and prediction of tremor improvement following thalamic deep brain stimulation of the ventral intermediate nucleus

Autor: Elizabeth R. Lesser, Markus Bredel, Leonardo Almeida, Ibrahim Sacit Tuna, Erik H. Middlebrooks, Michael S. Okun, Kelly D. Foote, Vanessa M. Holanda, Michael G. Heckman, Joshua K. Wong, Sanjeet S. Grewal
Rok vydání: 2018
Předmět:
Male
Brain connectomics
medicine.medical_treatment
Deep Brain Stimulation
FSL
Functional MRI of the Brain Software Library
lcsh:RC346-429
030218 nuclear medicine & medical imaging
0302 clinical medicine
Thalamus
ET
essential tremor
Tremor
Aged
80 and over
Supplementary motor area
Essential tremor
SMA
supplementary motor area
MRgFUS
magnetic resonance–guided focus ultrasonography
MP-RAGE
magnetization-prepared rapid gradient-echo
Middle Aged
SMA
Diffusion tensor imaging
SRS
stereotactic radiosurgery
medicine.anatomical_structure
Treatment Outcome
PMC
premotor cortex
Neurology
lcsh:R858-859.7
Female
Primary motor cortex
Adult
Deep brain stimulation
Cognitive Neuroscience
Essential Tremor
SCBS
structural connectivity–based segmentation
TRS
Tremor Rating Scale
lcsh:Computer applications to medicine. Medical informatics
Article
Premotor cortex
03 medical and health sciences
medicine
Humans
Radiology
Nuclear Medicine and imaging
lcsh:Neurology. Diseases of the nervous system
Aged
Retrospective Studies
business.industry
medicine.disease
VO
ventralis oralis
VIM
ventral intermediate nucleus
HARDI
high angular resolution diffusion-weighted imaging
Ventral intermediate nucleus
nervous system
VTA
volume of tissue activated
Ventral thalamic nuclei
Neurology (clinical)
business
DBS
deep brain stimulation
MRI
magnetic resonance imaging
Neuroscience
030217 neurology & neurosurgery
Diffusion MRI
Zdroj: NeuroImage: Clinical, Vol 20, Iss, Pp 1266-1273 (2018)
NeuroImage : Clinical
ISSN: 2213-1582
Popis: Objectives Traditional targeting methods for thalamic deep brain stimulation (DBS) performed to address tremor have predominantly relied on indirect atlas-based methods that focus on the ventral intermediate nucleus despite known variability in thalamic functional anatomy. Improvements in preoperative targeting may help maximize outcomes and reduce thalamic DBS–related complications. In this study, we evaluated the ability of thalamic parcellation with structural connectivity–based segmentation (SCBS) to predict tremor improvement following thalamic DBS. Methods In this retrospective analysis of 40 patients with essential tremor, hard segmentation of the thalamus was performed by using probabilistic tractography to assess structural connectivity to 7 cortical targets. The volume of tissue activated (VTA) was modeled in each patient on the basis of the DBS settings. The volume of overlap between the VTA and the 7 thalamic segments was determined and correlated with changes in preoperative and postoperative Fahn-Tolosa-Marin Tremor Rating Scale (TRS) scores by using multivariable linear regression models. Results A significant association was observed between greater VTA in the supplementary motor area (SMA) and premotor cortex (PMC) thalamic segment and greater improvement in TRS score when considering both the raw change (P = .001) and percentage change (P = .011). In contrast, no association was observed between change in TRS score and VTA in the primary motor cortex thalamic segment (P ≥ .19). Conclusions Our data suggest that greater VTA in the thalamic SMA/PMC segment during thalamic DBS was associated with significant improvement in TRS score in patients with tremor. These findings support the potential role of thalamic SCBS as an independent predictor of tremor improvement in patients who receive thalamic DBS.
Highlights • Pre-operative connectivity data may improve thalamic DBS targeting for tremor. • Tremor control was positively correlated with connectivity-based thalamic segmentation. • Stimulation of the SMA/PMC connected thalamic region correlated with tremor control.
Databáze: OpenAIRE
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