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Gerardin E, Regnier M, Dricot L, Lambert J, van Ravestyn C, De Coene B, Bihin B, Lindberg P, Vandermeeren Y. Dexterity in the Acute Phase of Stroke: Impairments and Neural Substrates. Neurorehabil Neural Repair 2024; 38:229-239. [PMID: 38329006 DOI: 10.1177/15459683241230029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
BACKGROUND Stroke can impair manual dexterity, leading to loss of independence following incomplete recovery. Enhancing our understanding of dexterity impairment may improve neurorehabilitation. OBJECTIVES The study aimed to measure dexterity components in acute stroke patients with and without hand motor deficits, compare them to those of healthy controls (HC), and to explore the neural substrates involved in specific components of dexterity. METHODS We used the Dextrain Manipulandum to quantify fine finger force control, finger selection accuracy, coactivation, and reaction time (RT). Dexterity was evaluated twice (2 days apart) in 74 patients and 14 HC. Voxel-Lesion-Symptom-Mapping (VLSM) was used to analyze the relationship between tissue damage and dexterity. Results. Due to severe paresis or fatigue, 24 patients could not perform these tasks. In 50 patients (included 4.6 ± 3.3 days post-stroke), finger force control improved (P < .001), as it did in HC (P = .03) who performed better than patients on both evaluations. Accuracy of finger selection did not improve significantly in any group, but the HC performed better on both evaluations. Unexpectedly, coactivation was better in patients than in HC at D3 (P = .03). There were no between-group differences in RT. VLSM showed that damage to the superior temporal gyrus (STG) impaired finger force control while damage to the posterior limb of the internal capsule (PLIC) impaired finger selectivity. CONCLUSIONS Acute stroke affecting the STG or PLIC impaired selective components of dexterity. Patients with mild to moderate impairment showed better finger force control and accuracy selection within 48 hours, suggesting the feasibility of detecting early dexterity improvements.
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Affiliation(s)
- Eloïse Gerardin
- UCLouvain/CHU UCL Namur (Godinne), Neurology Department, Stroke Unit, Yvoir, Belgium
- UClouvain, Louvain Bionics, Louvain-la-Neuve, Belgium
- UCLouvain, Institute of NeuroScience (IoNS), NEUR Division, Brussels, Belgium
| | - Maxime Regnier
- UCLouvain, CHU UCL Namur (Godinne), Scientific Support Unit (USS), Yvoir, Belgium
| | - Laurence Dricot
- UCLouvain, Institute of NeuroScience (IoNS), NEUR Division, Brussels, Belgium
| | - Julien Lambert
- UCLouvain, Institute of NeuroScience (IoNS), COSY Division, Brussels, Belgium
| | - Coralie van Ravestyn
- UCLouvain/CHU UCL Namur (Godinne), Neurology Department, Stroke Unit, Yvoir, Belgium
- UClouvain, Louvain Bionics, Louvain-la-Neuve, Belgium
- UCLouvain, Institute of NeuroScience (IoNS), NEUR Division, Brussels, Belgium
| | - Béatrice De Coene
- UCLouvain/CHU UCL Namur (Godinne), Radiology Department, Yvoir, Belgium
| | - Benoît Bihin
- UCLouvain, CHU UCL Namur (Godinne), Scientific Support Unit (USS), Yvoir, Belgium
| | - Påvel Lindberg
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Paris, France
| | - Yves Vandermeeren
- UCLouvain/CHU UCL Namur (Godinne), Neurology Department, Stroke Unit, Yvoir, Belgium
- UClouvain, Louvain Bionics, Louvain-la-Neuve, Belgium
- UCLouvain, Institute of NeuroScience (IoNS), NEUR Division, Brussels, Belgium
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Dabala E, Guédon A, Ficheux G, Béal L, Moxham B, Plaisant O. Homologies of spinal ascending nociceptive pathways between rats and macaques: can we transpose to human? A review and analysis of the literature. Surg Radiol Anat 2023; 45:1443-1460. [PMID: 37507602 DOI: 10.1007/s00276-023-03212-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 07/18/2023] [Indexed: 07/30/2023]
Abstract
PURPOSE Due to the difficulty of using neural tracers in humans, knowledge of the nociceptive system's anatomy is mainly derived from studies in animals and mainly in rats. The aim of this study was to investigate the morphological differences of the ascending spinal nociceptive pathways between the rat and the macaque monkey; in order to evaluate the variability of this anatomy during phylogenesis, and thus to know if the anatomical description of these pathways can be transposed from the rat to the human. METHODS A review and analysis of the literature were performed. The criteria used for comparison were: origins, pathways, their terminations in target structures, and projections from target structures of ascending spinal nociceptive pathways. The monkey was used as an intermediate species for comparison because of the lack of data in humans. The hypothesis of transposition of anatomy between rat and human was considered rejected if differences were found between rat and monkey. RESULTS An anatomical difference in termination was found for the spino-annular or spino-periaqueductal grey (spino-PAG) pathway and transposition of its anatomy from rat to human was rejected. No difference was found in other pathways and the transposition of their anatomy from rat to human was therefore, not rejected. CONCLUSION This work highlights the conservation of most of the ascending spinal nociceptive pathways' anatomy between rat and monkey. Thus, the possibility for a transposition of their anatomy between rat and human is not rejected.
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Affiliation(s)
- Eric Dabala
- Department of Anatomy, Université Catholique de Lille, Lille, France.
- Université Paris Cité, Paris, France.
| | - Alexis Guédon
- Université Paris Cité, Paris, France
- Department of Interventional Neuroradiology, INSERM UMR_S 1140, Lariboisière Hospital, AP-HP Nord, Paris, France
| | - Guillaume Ficheux
- Department of Anatomy, Université Catholique de Lille, Lille, France
| | - Louis Béal
- Department of Anatomy, Université Catholique de Lille, Lille, France
| | - Bernard Moxham
- Cardiff School of Biosciences, Cardiff University, Cardiff, CF10 3AX, UK
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Hassa T, Zbytniewska-Mégret M, Salzmann C, Lambercy O, Gassert R, Liepert J, Schoenfeld MA. The locations of stroke lesions next to the posterior internal capsule may predict the recovery of the related proprioceptive deficits. Front Neurosci 2023; 17:1248975. [PMID: 37854290 PMCID: PMC10579562 DOI: 10.3389/fnins.2023.1248975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 09/12/2023] [Indexed: 10/20/2023] Open
Abstract
Background Somatosensory deficits after stroke correlate with functional disabilities and impact everyday-life. In particular, the interaction of proprioception and motor dysfunctions affects the recovery. While corticospinal tract (CST) damage is linked to poor motor outcome, much less is known on proprioceptive recovery. Identifying a predictor for such a recovery could help to gain insights in the complex functional recovery processes thereby reshaping rehabilitation strategies. Methods 50 patients with subacute stroke were tested before and after neurological rehabilitation. Proprioceptive and motor impairments were quantified with three clinical assessments and four hand movement and proprioception measures using a robotic device. Somatosensory evoked potentials (SSEP) to median nerve stimulation and structural imaging data (MRI) were also collected. Voxel-based lesion-symptom mapping (VLSM) along with a region of interest (ROI) analysis were performed for the corticospinal tract (CST) and for cortical areas. Results Before rehabilitation, the VLSM revealed lesion correlates for all clinical and three robotic measures. The identified voxels were located in the white matter within or near the CST. These regions associated with proprioception were located posterior compared to those associated with motor performance. After rehabilitation the patients showed an improvement of all clinical and three robotic assessments. Improvement in the box and block test was associated with an area in anterior CST. Poor recovery of proprioception was correlated with a high lesion load in fibers towards primary sensorymotor cortex (S1 and M1 tract). Patients with loss of SSEP showed higher lesion loads in these tracts and somewhat poorer recovery of proprioception. The VSLM analysis for SSEP loss revealed a region within and dorsal of internal capsule next to the posterior part of CST, the posterior part of insula and the rolandic operculum. Conclusion Lesions dorsal to internal capsule next to the posterior CST were associated with proprioceptive deficits and may have predictive value. Higher lesion load was correlated with poorer restoration of proprioceptive function. Furthermore, patients with SSEP loss trended towards poor recovery of proprioception, the corresponding lesions were also located in the same location. These findings suggest that structural imaging of the internal capsule and CST could serve as a recovery predictor of proprioceptive function.
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Affiliation(s)
- Thomas Hassa
- Lurija Institute for Rehabilitation and Health Sciences, University of Konstanz, Konstanz, Germany
- Neurological Rehabilitation Center Kliniken Schmieder, Allensbach, Germany
| | - Monika Zbytniewska-Mégret
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, Institute of Robotics and Intelligent Systems, ETH Zurich, Zurich, Switzerland
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore
| | - Christian Salzmann
- Neurological Rehabilitation Center Kliniken Schmieder, Allensbach, Germany
| | - Olivier Lambercy
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, Institute of Robotics and Intelligent Systems, ETH Zurich, Zurich, Switzerland
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore
| | - Roger Gassert
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, Institute of Robotics and Intelligent Systems, ETH Zurich, Zurich, Switzerland
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore
| | - Joachim Liepert
- Lurija Institute for Rehabilitation and Health Sciences, University of Konstanz, Konstanz, Germany
- Neurological Rehabilitation Center Kliniken Schmieder, Allensbach, Germany
| | - Mircea Ariel Schoenfeld
- Department of Neurology, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
- Department of Behavioral Neurology, Leibniz-Institute for Neurobiology, Magdeburg, Germany
- Neurological Rehabilitation Center Kliniken Schmieder, Heidelberg, Germany
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Neophytou K, Wiley R, Litovsky C, Tsapkini K, Rapp B. The right hemisphere's capacity for language: evidence from primary progressive aphasia. Cereb Cortex 2023; 33:9971-9985. [PMID: 37522277 PMCID: PMC10502784 DOI: 10.1093/cercor/bhad258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 06/21/2023] [Accepted: 06/22/2023] [Indexed: 08/01/2023] Open
Abstract
The role of the right hemisphere (RH) in core language processes is still a matter of intense debate. Most of the relevant evidence has come from studies of gray matter, with relatively little research on RH white matter (WM) connectivity. Using Diffusion Tensor Imaging-based tractography, the current work examined the role of the two hemispheres in language processing in 33 individuals with Primary Progressive Aphasia (PPA), aiming to better characterize the contribution of the RH to language processing in the context of left hemisphere (LH) damage. The findings confirm the impact of PPA on the integrity of the WM language tracts in the LH. Additionally, an examination of the relationship between tract integrity and language behaviors provides robust evidence of the involvement of the WM language tracts of both hemispheres in language processing in PPA. Importantly, this study provides novel evidence of a unique contribution of the RH to language processing (i.e. a contribution independent from that of the language-dominant LH). Finally, we provide evidence that the RH contribution is specific to language processing rather than being domain general. These findings allow us to better characterize the role of RH in language processing, particularly in the context of LH damage.
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Affiliation(s)
- Kyriaki Neophytou
- Department of Neurology, Johns Hopkins Medicine, Baltimore, MD, United States
| | - Robert Wiley
- Department of Psychology, University of North Carolina at Greensboro, Greensboro, NC, United States
- Department of Cognitive Science, Johns Hopkins University, Baltimore, MD, United States
| | - Celia Litovsky
- Department of Cognitive Science, Johns Hopkins University, Baltimore, MD, United States
| | - Kyrana Tsapkini
- Department of Neurology, Johns Hopkins Medicine, Baltimore, MD, United States
- Department of Cognitive Science, Johns Hopkins University, Baltimore, MD, United States
| | - Brenda Rapp
- Department of Cognitive Science, Johns Hopkins University, Baltimore, MD, United States
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Park JG, Hong BY, Park HY, Yoo YJ, Yoon MJ, Kim JS, Lim SH. Alteration of White Matter in Patients with Central Post-Stroke Pain. J Pers Med 2021; 11:417. [PMID: 34063462 PMCID: PMC8156708 DOI: 10.3390/jpm11050417] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 05/06/2021] [Accepted: 05/13/2021] [Indexed: 11/25/2022] Open
Abstract
A stroke may be followed by central post-stroke pain (CPSP), which is characterized by chronic neuropathic pain. The exact mechanism has not yet been fully uncovered. We investigated alterations in the white matters in patients with CPSP, compared with stroke patients without CPSP and normal controls. Our retrospective cross-sectional, case-control study participants were assigned to three groups: CPSP (stroke patients with CPSP (n = 17)); stroke control (stroke patients without CPSP (n = 26)); and normal control (normal subjects (n = 34)). The investigation of white matter for CPSP was focused on the values of fiber numbers (FN) and fractional anisotrophy (FA) for spinothalamic tract (STT), anterior thalamic radiation (ATR), superior thalamic radiation (STR) and posterior thalamic radiation (PTR), and corticospinal tract (CST) was measured. The FA for the STT and STR of the CPSP group were lower than those for the stroke control and normal control groups. The FA of CST and ATR did not differ between the CPSP and stroke groups, but both differed from the normal control. The FA of PTR in the stroke control group differed from the normal control group, but not from the CPSP group. The FN of CST, STT, ATR, and STR for the CPSP and stroke control groups did not differ from each other, but both differed from those of normal controls. FN of PTR did not differ between the CPSP and normal control groups. The alterations in the spinothalamic tract and superior thalamic radiation after stroke would play a role in the pathogenesis of CPSP.
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Affiliation(s)
- Jung Geun Park
- Department of Rehabilitation Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, 93 Jungbu-daero, Paldal-gu, Suwon 16247, Korea; (J.G.P.); (B.Y.H.); (Y.J.Y.); (M.-J.Y.); (J.-S.K.)
| | - Bo Young Hong
- Department of Rehabilitation Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, 93 Jungbu-daero, Paldal-gu, Suwon 16247, Korea; (J.G.P.); (B.Y.H.); (Y.J.Y.); (M.-J.Y.); (J.-S.K.)
| | - Hae-Yeon Park
- Department of Rehabilitation Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea;
| | - Yeun Jie Yoo
- Department of Rehabilitation Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, 93 Jungbu-daero, Paldal-gu, Suwon 16247, Korea; (J.G.P.); (B.Y.H.); (Y.J.Y.); (M.-J.Y.); (J.-S.K.)
| | - Mi-Jeong Yoon
- Department of Rehabilitation Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, 93 Jungbu-daero, Paldal-gu, Suwon 16247, Korea; (J.G.P.); (B.Y.H.); (Y.J.Y.); (M.-J.Y.); (J.-S.K.)
| | - Joon-Sung Kim
- Department of Rehabilitation Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, 93 Jungbu-daero, Paldal-gu, Suwon 16247, Korea; (J.G.P.); (B.Y.H.); (Y.J.Y.); (M.-J.Y.); (J.-S.K.)
| | - Seong Hoon Lim
- Department of Rehabilitation Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, 93 Jungbu-daero, Paldal-gu, Suwon 16247, Korea; (J.G.P.); (B.Y.H.); (Y.J.Y.); (M.-J.Y.); (J.-S.K.)
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Fang F, Luo Q, Ge RB, Lai MY, Gong YJ, Kang M, Ma MM, Zhang L, Li Y, Wang YF, Peng YD. Decreased Microstructural Integrity of the Central Somatosensory Tracts in Diabetic Peripheral Neuropathy. J Clin Endocrinol Metab 2021; 106:1566-1575. [PMID: 33711158 DOI: 10.1210/clinem/dgab158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Indexed: 11/19/2022]
Abstract
CONTEXT Although diabetic peripheral neuropathy (DPN) is predominantly considered a disorder of the peripheral nerves, some evidence for central nervous system involvement has recently emerged. However, whether or to what extent the microstructure of central somatosensory tracts may be injured remains unknown. OBJECTIVE This work aimed to detect the microstructure of central somatosensory tracts in type 2 diabetic patients and to correlate it with the severity of DPN. METHODS A case-control study at a tertiary referral hospital took place with 57 individuals with type 2 diabetes (25 with DPN, 32 without DPN) and 33 nondiabetic controls. The fractional anisotropy (FA) values of 2 major somatosensory tracts (the spinothalamic tract and its thalamocortical [spino-thalamo-cortical, STC] pathway, the medial lemniscus and its thalamocortical [medial lemnisco-thalamo-cortical, MLTC] pathway) were assessed based on diffusion tensor tractography. Regression models were further applied to detect the association of FA values with the severity of DPN in diabetic patients. RESULTS The mean FA values of left STC and left MLTC pathways were significantly lower in patients with DPN than those without DPN and controls. Moreover, FA values of left STC and left MLTC pathways were significantly associated with the severity of DPN (expressed as Toronto Clinical Scoring System values) in patients after adjusting for multiple confounders. CONCLUSION Our findings demonstrated the axonal degeneration of central somatosensory tracts in type 2 diabetic patients with DPN. The parallel disease progression of the intracranial and extracranial somatosensory system merits further attention to the central nerves in diabetic patients with DPN.
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Affiliation(s)
- Fang Fang
- Department of Endocrinology and Metabolism, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Qian Luo
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Ren-Bin Ge
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Meng-Yu Lai
- Department of Endocrinology and Metabolism, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yu-Jia Gong
- Department of Endocrinology and Metabolism, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Mei Kang
- Clinical Research Center, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Ming-Ming Ma
- Department of Ophthalmology, National Clinical Research Center for Eye Disease, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Lei Zhang
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yao Li
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Yu-Fan Wang
- Department of Endocrinology and Metabolism, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yong-De Peng
- Department of Endocrinology and Metabolism, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
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Jang SH, Seo JP. Anatomical location of the spinothalamic tract in the subcortical white matter in the human brain: A diffusion tensor imaging study. Clin Anat 2021; 34:736-741. [DOI: 10.1002/ca.23709] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/29/2020] [Accepted: 12/06/2020] [Indexed: 12/20/2022]
Affiliation(s)
- Sung Ho Jang
- Department of Physical Medicine and Rehabilitation, College of Medicine Yeungnam University Taegu Republic of Korea
| | - Jeong Pyo Seo
- Department of Physical Therapy College of Health Sciences, Dankook University Cheonan Chungnam Republic of Korea
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Kang DH, Kim GW. Changes in Diffuse Tensor Imaging and Therapeutic Effect of Repetitive Transcranial Magnetic Stimulation in Traumatic Brain Injury with Central Pain. Brain Sci 2020; 10:brainsci10120929. [PMID: 33276440 PMCID: PMC7759834 DOI: 10.3390/brainsci10120929] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 11/22/2020] [Accepted: 11/25/2020] [Indexed: 12/21/2022] Open
Abstract
Post-trauma chronic pain characterized by central pain is a symptom following traumatic brain injury (TBI). Studies on the effect of repetitive transcranial magnetic stimulation (rTMS) on central pain and the association between central pain and spinothalamic tract (STT) have been reported, but few studies have examined the effect of rTMS in patients with mild TBI with central pain through changes in diffusion tensor imaging (DTI)-based metrics of STT before and after rTMS. This case series aimed to investigate the therapeutic effect of rTMS in TBI with central pain and the changes in diffusion tensor imaging (DTI)-based metrics of the spinothalamic tract (STT) before and after rTMS. This study included four patients who complained of severe pain in the left or right side of the body below the neck area after a car accident. We performed numeric rating scale (NRS), bedside sensory examination, electrodiagnostic study, and DTI-based metrics of the STT before and after rTMS. According to the guidelines of the diagnosis and grading for neuropathic pain, all patients had neuropathic pain corresponding to “probable grade.” In all patients, rTMS was applied to the contralateral M1 cortex on the more painful side. There were no medication changes and other interventions during the rTMS. After rTMS, NRS decreased, bed sensory testing improved, and DTI-based STT metrics increased in all patients compared to before rTMS.
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Affiliation(s)
- Dong-Ha Kang
- Department of Physical Medicine & Rehabilitation, Jeonbuk National University Medical School, Jeonju 54907, Korea;
- Research Institute of Clinical Medicine of Jeonbuk National University—Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju 54907, Korea
| | - Gi-Wook Kim
- Department of Physical Medicine & Rehabilitation, Jeonbuk National University Medical School, Jeonju 54907, Korea;
- Research Institute of Clinical Medicine of Jeonbuk National University—Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju 54907, Korea
- Correspondence: ; Tel.: +82-10-5279-1421
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Jang SH, Kwon YH, Lee SJ. Abdominal pain due to the spinothalamic tract injury in patients with mild traumatic brain injury: a case report. BMC Neurol 2020; 20:117. [PMID: 32241253 PMCID: PMC7119278 DOI: 10.1186/s12883-020-01695-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 03/24/2020] [Indexed: 12/05/2022] Open
Abstract
Background We report on a patient with a mild traumatic brain injury (TBI) who developed abdominal pain due to spinothalamic tract (STT) injuries revealed by diffusion tensor tractography (DTT). Case presentation A 53-year-old female patient suffered head trauma resulting from a backward fall. While bathing at a public bathhouse, she fell backward and struck the occipital area of her head against the floor. After the head trauma, she experienced pain in the abdomen and in both hands and feet. She underwent evaluations including conventional brain MRI, abdominal and pelvic ultrasonography, and stomach and intestine endoscopy. No abnormality was observed in her brain or abdomen. In addition, her abdominal pain had not been relieved by medical management. When she came to our hospital 4 years after the head trauma, her pain characteristics and severity were as follows: intermittent pain without allodynia or hyperalgesia; squeezing and warm creeping-like pain in the abdomen (visual analog scale score: 7); tingling pain in both hands and feet (visual analog scale score: 7). She was prescribed pregabalin and gabapentin, and her abdominal and limb pain was well-controlled at a tolerable level. On DTT 4 years after head trauma, the upper portion of the spinothalamic tracts (STTs) in both hemispheres showed partial tearing. Discussion and conclusions Injury of the STT was demonstrated by using DTT in a patient who showed abdominal pain that was refractory to medical management following mild TBI. Our results suggest that central pain due to STT injury might be suspected in patients with abdominal pain that is refractory to medical management following TBI.
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Affiliation(s)
- Sung Ho Jang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University 317-1, Daemyungdong, Namku, Taegu, 705-717, Republic of Korea
| | - Young Hyeon Kwon
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University 317-1, Daemyungdong, Namku, Taegu, 705-717, Republic of Korea
| | - Sung Jun Lee
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University 317-1, Daemyungdong, Namku, Taegu, 705-717, Republic of Korea.
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10
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Ofoghi Z, Dewey D, Barlow KM. A Systematic Review of Structural and Functional Imaging Correlates of Headache or Pain after Mild Traumatic Brain Injury. J Neurotrauma 2020; 37:907-923. [DOI: 10.1089/neu.2019.6750] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Zahra Ofoghi
- Department of Neuroscience, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Deborah Dewey
- Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Karen M. Barlow
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Paediatric Neurology Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia
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11
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Khanh L, Bac ND, Nguyen PT, Tien TV, Ngoc VTN, Chu-Dinh T, Phuong NT. Anatomical Characteristics of Thalamus-Cortical Sensory Tract in the Human Brain Using Diffusion Tensor Tractography at 3.0 Tesla Scanner. Open Access Maced J Med Sci 2019; 7:4220-4223. [PMID: 32215067 PMCID: PMC7084031 DOI: 10.3889/oamjms.2019.364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 09/20/2019] [Accepted: 09/21/2019] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND: Our knowledge about characteristics of the thalamocortical tract (THT) according to the cerebral origin is still few of studies about this structure on Vietnamese. AIM: Here, we aim to characterise the morphology of the thalamocortical tract in the human brain using diffusion tensor tractography (DTT) at 3.0 tesla scanner. METHODS: Fifty healthy subjects have enrolled in this study. Reconstructed images of the thalamocortical tract in the human brain were built using DTT at 3.0 tesla scanner. RESULTS: The median length of the right thalamocortical tract was 130.64 mm, and the left THT was 123.14 mm, and an average of two sides was 126.34 mm. The difference between the two sides was statically significance (p < 0.001). The median fibre number of the right THT was 401.50, and the left THT was 315.00, and an average of two sides was 365.50. There was a diverse branch of THT: two branches (5%); three branches (25%); four branches (42%); five branches (16%); six branches (12%); in which branched contralateral for the right was 50%, and for the left was 50%. CONCLUSION: Using the DTI and 3D image reconstruction techniques allow to build the image of sensory THT intuitively and accurately, which helps to identify the morphological characteristic of the thalamocortical tract of healthy people without invasive effects.
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Affiliation(s)
- Lam Khanh
- 108 Military Central Hospital, 1 Tran Hung Dao, Hai Ba Trung, Ha Noi, Vietnam
| | | | - Pham Thanh Nguyen
- Hai Phong University of Medicine and Pharmacy, 72A Nguyen Binh Khiem, Ngo Quyen, Hai Phong, Vietnam
| | - Tran Viet Tien
- 103 Militæra Hospital, 26 Phung Hung, Phuc La, Ha Dong, Ha Noi, Vietnam
| | | | - Thien Chu-Dinh
- Institute for Research and Development, Duy Tan University, Danang, Vietnam
| | - Nguyen Thi Phuong
- NTT Hi-tech Institute, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam
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12
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Polanski WH, Zolal A, Klein J, Kitzler HH, Schackert G, Eisner W, Sobottka SB. Somatosensory functional MRI tractography for individualized targeting of deep brain stimulation in patients with chronic pain after brachial plexus injury. Acta Neurochir (Wien) 2019; 161:2485-2490. [PMID: 31591648 DOI: 10.1007/s00701-019-04065-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 09/09/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND The optimal targets for deep brain stimulation (DBS) in patients with refractory chronic pain are not clearly defined. We applied sensory functional MRI (fMRI)- and diffusion tensor imaging (DTI)-based DBS in chronic pain patients into 3 different targets to ascertain the most beneficial individual stimulation site. METHODS Three patients with incapacitating chronic pain underwent DBS into 3 targets (periventricular gray (PVG), ventroposterolateral thalamus (VPL), and posterior limb of the internal capsule according to fMRI and DTI (PLIC). The electrodes were externalized and double-blinded tested for several days. Finally, the two electrodes with the best pain reduction were kept for permanent stimulation. The patients were then followed up for 12 months. Outcome measures comprised the numerical rating scale (NRS), short-form McGill's score (SF-MPQ), and health-related quality of life (SF-36). RESULTS Continuous pain (mean NRS 6.6) was reduced to NRS 3.6 after 12 months. Only with stimulation of the PLIC pain attacks, that occurred at least 3 times a week (mean NRS 9.6) resolved in 2 patients and improved in one patient concerning both intensity (NRS 5) and frequency (twice a month). The mean SF-MPQ decreased from 92.7 to 50. The health-related quality of life improved considerably. CONCLUSION fMRI- and DTI-based DBS to the PLIC was the only target with a significant effect on pain attacks and seems to be the most promising target in chronic pain patients after brachial plexus injury. The combination with PVG or VPL can further improve patients' outcome especially in terms of reducing the continuous pain.
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13
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Jang SH, Lee HD. Diagnostic Approach to Traumatic Axonal Injury of the Spinothalamic Tract in Individual Patients with Mild Traumatic Brain Injury. Diagnostics (Basel) 2019; 9:diagnostics9040199. [PMID: 31766511 PMCID: PMC6963842 DOI: 10.3390/diagnostics9040199] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 11/13/2019] [Accepted: 11/18/2019] [Indexed: 11/23/2022] Open
Abstract
Objectives: We investigated an approach for the diagnosis of traumatic axonal injury (TAI) of the spinothalamic tract (STT) that was based on diffusion tensor tractography (DTT) results and a statistical comparison of individual patients who showed central pain following mild traumatic brain injury (mTBI) with the control group. Methods: Five right-handed female patients in their forties and with central pain following mTBI and 12 age-, sex-, and handedness-matched healthy control subjects were recruited. After DTT reconstruction of the STT, we analyzed the STT in terms of three DTT parameters (fractional anisotropy (FA), mean diffusivity (MD), and fiber number (FN)) and its configuration (narrowing and tearing). To assess narrowing, we determined the area of the STT on an axial slice of the subcortical white matter. Results: the FN values were significantly lower in at least one hemisphere of each patient when compared to those of the control subjects (p < 0.05). Significant decrements from the STT area in the control group were observed in at least one hemisphere of each patient (p < 0.05). Regarding configurational analysis, the STT showed narrowing and/or partial tearing in at least one hemisphere of each of the five patients. Conclusions: Herein, we demonstrate a DTT-based approach for the diagnosis of TAI of the STT. The approach involves a statistical comparison between DTT parameters of individual patients who show central pain following mTBI and those of an age-, gender-, and handedness-matched control group. We think that the method described in this study can be useful in the diagnosis of TAI of the STT in individual mTBI patients.
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Affiliation(s)
- Sung Ho Jang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, HyunChungro 170, Daegu 705-717, Korea;
| | - Han Do Lee
- Department of Physical Therapy, College of Natural Science, Ulsan College University, Bongsuro 101 Dongku, Ulsan 44022, Korea
- Correspondence: ; Tel.: +82-52-230-0786; Fax: +82-52-230-0780
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14
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Baker CM, Burks JD, Briggs RG, Sheets JR, Conner AK, Glenn CA, Sali G, McCoy TM, Battiste JD, O'Donoghue DL, Sughrue ME. A Connectomic Atlas of the Human Cerebrum-Chapter 3: The Motor, Premotor, and Sensory Cortices. Oper Neurosurg (Hagerstown) 2019; 15:S75-S121. [PMID: 30260446 DOI: 10.1093/ons/opy256] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 09/18/2018] [Indexed: 12/31/2022] Open
Abstract
In this supplement, we build on work previously published under the Human Connectome Project. Specifically, we show a comprehensive anatomic atlas of the human cerebrum demonstrating all 180 distinct regions comprising the cerebral cortex. The location, functional connectivity, and structural connectivity of these regions are outlined, and where possible a discussion is included of the functional significance of these areas. In part 3, we specifically address regions relevant to the sensorimotor cortices.
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Affiliation(s)
- Cordell M Baker
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Joshua D Burks
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Robert G Briggs
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - John R Sheets
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Andrew K Conner
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Chad A Glenn
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Goksel Sali
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Tressie M McCoy
- De-partment of Physical Therapy, Uni-versity of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - James D Battiste
- Department of Neurology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Daniel L O'Donoghue
- Department of Cell Biology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Michael E Sughrue
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.,De-partment of Neurosurgery, Prince of Wales Private Hospital, Sydney, Australia
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15
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Jang SH, Seo JP, Lee SJ. Diffusion Tensor Tractography Studies of Central Post-stroke Pain Due to the Spinothalamic Tract Injury: A Mini-Review. Front Neurol 2019; 10:787. [PMID: 31428032 PMCID: PMC6688072 DOI: 10.3389/fneur.2019.00787] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 07/08/2019] [Indexed: 11/18/2022] Open
Abstract
Elucidation of the pathophysiological mechanism of central post-stroke pain (CPSP) is essential to the development of effective therapeutic modalities for CPSP. However, the pathophysiological mechanism of CPSP has not yet been clearly elucidated. The recent development of diffusion tensor tractography (DTT), derived from diffusion tensor imaging (DTI), has allowed visualization and estimation of the spinothalamic tract (STT), which has been considered the most plausible neural tract responsible for the pathogenesis of CPSP. In this mini-review, six DTT studies in which CPSP due to STT injury in stroke patients was demonstrated are reviewed. The information provided in the reviewed studies suggests that DTT is useful in the elucidation of the pathophysiological mechanism associated with CPSP. We believe that the reviewed studies will facilitate neurorehabilitation of stroke patients with CPSP. However, DTT studies of CPSP are still in the beginning stage because the total number (six studies) of the reviewed studies is very low and half were case reports. Therefore, further studies involving large numbers of subjects are warranted.
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Affiliation(s)
- Sung Ho Jang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu, South Korea
| | - Jeong Pyo Seo
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu, South Korea
| | - Sung Jun Lee
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu, South Korea
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16
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Jang SH, Kim J, Lee HD. Delayed-onset central poststroke pain due to degeneration of the spinothalamic tract following thalamic hemorrhage: A case report. Medicine (Baltimore) 2018; 97:e13533. [PMID: 30558012 PMCID: PMC6319862 DOI: 10.1097/md.0000000000013533] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Recent studies have used diffusion tensor tractography (DTT) to demonstrate that central poststroke pain (CPSP) was related to spinothalamic tract (STT) injury in patients with stroke. However, few studies have been reported about delayed-onset CPSP due to degeneration of the STT following a stroke. PATIENT'S CONCERNS A 57-year-old female patient presented with right hemiparesis after stroke. Two weeks after onset, she did not report any pain. At approximately 6 months after onset, she reported pain in the right arm and leg, and the pain slowly intensified with the passage of time. At 14 months after onset, the characteristics and severity of her pain were assessed to be continuous pain without allodynia or hyperalgesia; tingling and cold-sensational pain in her right whole arm and leg (visual analog scale score: 5). DIAGNOSES The patient was diagnosed as the right hemiparesis due to spontaneous thalamic hemorrhage. INTERVENTIONS Clinical assessment and diffusion tensor imaging (DTI) were performed 2 weeks and 14 months after onset. OUTCOMES She suffered continuous pain in her right whole arm and leg (visual analog scale score: 5). On DTT of the 2-week postonset DTI scans, the configuration of the STT was well-preserved in both hemispheres. However, in contrast to those 2-week postonset results, the 14-month postonset DTT results showed partial tearing and thinning in the left STT. Regardless, both the 2-week and 14-month postonset DTT showed that the left STT passed through the vicinity of the thalamic lesion. LESSONS Diagnostic importance of performing a DTT-based evaluation of the STT in patients exhibiting delayed-onset CPSP following intracerebral hemorrhage.
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Affiliation(s)
- Sung Ho Jang
- Department of Physical Medicine and Rehabilitation
| | - JongHoon Kim
- Department of Neurosurgery, College of Medicine, Yeungnam University, Daegu, Republic of Korea
| | - Han Do Lee
- Department of Physical Medicine and Rehabilitation
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17
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Jang SH, Kwon YH. Central Pain Due to Traumatic Axonal Injury of the Spinothalamic Tract in Patients with Mild Traumatic Brain Injury. BRAIN & NEUROREHABILITATION 2018. [DOI: 10.12786/bn.2018.11.e7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Affiliation(s)
- Sung Ho Jang
- Department of Physical Medicine and Rehabilitation, Yeungnam University College of Medicine, Daegu, Korea
| | - Young Hyeon Kwon
- Department of Physical Medicine and Rehabilitation, Yeungnam University College of Medicine, Daegu, Korea
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18
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Wilkinson M, Kane T, Wang R, Takahashi E. Migration Pathways of Thalamic Neurons and Development of Thalamocortical Connections in Humans Revealed by Diffusion MR Tractography. Cereb Cortex 2017; 27:5683-5695. [PMID: 27913428 PMCID: PMC6075593 DOI: 10.1093/cercor/bhw339] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 09/28/2016] [Accepted: 10/19/2016] [Indexed: 11/13/2022] Open
Abstract
The thalamus plays an important role in signal relays in the brain, with thalamocortical (TC) neuronal pathways linked to various sensory/cognitive functions. In this study, we aimed to see fetal and postnatal development of the thalamus including neuronal migration to the thalamus and the emergence/maturation of the TC pathways. Pathways from/to the thalami of human postmortem fetuses and in vivo subjects ranging from newborns to adults with no neurological histories were studied using high angular resolution diffusion MR imaging (HARDI) tractography. Pathways likely linked to neuronal migration from the ventricular zone and ganglionic eminence (GE) to the thalami were both successfully detected. Between the ventricular zone and thalami, more tractography pathways were found in anterior compared with posterior regions, which was well in agreement with postnatal observations that the anterior TC segment had more tract count and volume than the posterior segment. Three different pathways likely linked to neuronal migration from the GE to the thalami were detected. No hemispheric asymmetry of the TC pathways was quantitatively observed during development. These results suggest that HARDI tractography is useful to identify multiple differential neuronal migration pathways in human brains, and regional differences in brain development in fetal ages persisted in postnatal development.
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Affiliation(s)
- Molly Wilkinson
- Department of Behavioral Neuroscience, Northeastern University, Boston, MA 02115, USA
| | - Tara Kane
- Department of Behavioral Neuroscience, Northeastern University, Boston, MA 02115, USA
- Division of Newborn Medicine, Department of Medicine, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Rongpin Wang
- Division of Newborn Medicine, Department of Medicine, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
- Department of Radiology, Guizhou Provincial People's Hospital, 83 Zhong Shan Dong Lu, Guiyang, Guizhou Province550002, P.R. China
| | - Emi Takahashi
- Division of Newborn Medicine, Department of Medicine, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02219, USA
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19
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Wang R, Wilkinson M, Kane T, Takahashi E. Convergence of Cortical, Thalamocortical, and Callosal Pathways during Human Fetal Development Revealed by Diffusion MRI Tractography. Front Neurosci 2017; 11:576. [PMID: 29163000 PMCID: PMC5671991 DOI: 10.3389/fnins.2017.00576] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 10/02/2017] [Indexed: 11/17/2022] Open
Abstract
There has been evidence that during brain development, emerging thalamocortical (TC) and corticothalamic (CT) pathways converge in some brain regions and follow each other's trajectories to their final destinations. Corpus callosal (CC) pathways also emerge at a similar developmental stage, and are known to converge with TC pathways in specific cortical regions in mature brains. Given the functional relationships between TC and CC pathways, anatomical convergence of the two pathways are likely important for their functional integration. However, it is unknown (1) where TC and CT subcortically converge in the human brain, and (2) where TC and CC converge in the cortex of the human brain, due to the limitations of non-invasive methods. The goals of this study were to describe the spatio-temporal relationships in the development of the TC/CT and CC pathways in the human brain, using high-angular resolution diffusion MR imaging (HARDI) tractography. Emerging cortical, TC and CC pathways were identified in postmortem fetal brains ranging from 17 gestational weeks (GW) to 30 GW, as well as in vivo 34-40 GW newborns. Some pathways from the thalami were found to be converged with pathways from the cerebral cortex as early as 17 GW. Such convergence was observed mainly in anterior and middle regions of the brain until 21 GW. At 22 GW and onwards, posterior pathways from the thalami also converged with cortical pathways. Many CC pathways reached the full length up to the cortical surface as early as 17 GW, while pathways linked to thalami (not only TC axons but also including pathways linked to thalamic neuronal migration) reached the cortical surface at and after 20 GW. These results suggest that CC pathways developed earlier than the TC pathways. The two pathways were widespread at early stages, but by 40 GW they condensed and formed groups of pathways that projected to specific regions of the cortex and overlapped in some brain regions. These results suggest that HARDI tractography has the potential to identify developing TC/CT and CC pathways with the timing and location of their convergence in fetal stages persisting in postnatal development.
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Affiliation(s)
- Rongpin Wang
- Division of Newborn Medicine, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States
- Department of Radiology, Guizhou Provincial People's Hospital, Guiyang, China
| | - Molly Wilkinson
- Department of Behavioral Neuroscience, Northeastern University, Boston, MA, United States
| | - Tara Kane
- Department of Behavioral Neuroscience, Northeastern University, Boston, MA, United States
| | - Emi Takahashi
- Division of Newborn Medicine, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States
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20
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Lee SY, Kang SH, Kim DK, Seo KM, Ro HJ, Kim JK. Changes in the corticospinal tract after wearing prosthesis in bilateral transtibial amputation. Prosthet Orthot Int 2017; 41:507-511. [PMID: 28094680 DOI: 10.1177/0309364616684216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND After amputation, the brain is known to be reorganized especially in the primary motor cortex. We report a case to show changes in the corticospinal tract in a patient with serial bilateral transtibial amputations using diffusion tensor imaging. Case Description and Methods: A 78-year-old man had a transtibial amputation on his left side in 2008 and he underwent a right transtibial amputation in 2011. An initial brain magnetic resonance imaging with a diffusion tensor imaging was performed before starting rehabilitation on his right transtibial prosthesis, and a follow-up magnetic resonance imaging with diffusion tensor imaging was performed 2 years after this. Findings and Outcomes: In the initial diffusion tensor imaging, the number of fiber lines in his right corticospinal tract was larger than that in his left corticospinal tract. At follow-up diffusion tensor imaging, there was no definite difference in the number of fiber lines between both corticospinal tracts. CONCLUSION We found that side-to-side corticospinal tract differences were equalized after using bilateral prostheses. Clinical relevance This case report suggests that diffusion tensor imaging tractography could be a useful method to understand corticomotor reorganization after using prosthesis in transtibial amputation.
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Affiliation(s)
- Sang Yoon Lee
- 1 Department of Physical Medicine & Rehabilitation, Chung-Ang University College of Medicine, Seoul, Korea
| | - Si Hyun Kang
- 1 Department of Physical Medicine & Rehabilitation, Chung-Ang University College of Medicine, Seoul, Korea
| | - Don-Kyu Kim
- 1 Department of Physical Medicine & Rehabilitation, Chung-Ang University College of Medicine, Seoul, Korea
| | - Kyung Mook Seo
- 1 Department of Physical Medicine & Rehabilitation, Chung-Ang University College of Medicine, Seoul, Korea
| | - Hee Joon Ro
- 1 Department of Physical Medicine & Rehabilitation, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jae Kyun Kim
- 2 Department of Radiology, Chung-Ang University College of Medicine, Seoul, Korea
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Microstructural mechanisms of analgesia in percutaneous cervical cordotomy revealed by diffusion tensor imaging. J Clin Neurosci 2017; 45:311-314. [PMID: 28887076 DOI: 10.1016/j.jocn.2017.08.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 08/10/2017] [Indexed: 11/23/2022]
Abstract
The purpose of this study is to demonstrate the potential of diffusion tensor imaging (DTI) to reveal structural mechanisms underlying spinal ablative procedures, including percutaneous radiofrequency cordotomy (PRFC). PRFC is a surgical procedure that produces analgesia through focal ablation of the lateral spinothalamic tract (STT), thereby interrupting the flow of pain information from the periphery to the brain. To date, studies regarding mechanisms of analgesia after PRFC have been limited to postmortem cadaveric dissection and histology. However, with recent advances in DTI, the opportunity has arisen to study the STT non-invasively in vivo. In this technical note, an individual with successful pain relief following unilateral STT PRFC was examined using DTI, with the contralateral STT serving as an internal control. PRFC substantially reduced rostrocaudal directional DTI signal in the STT from the lesion in the cervical spinal cord through the pons and mesencephalon. Our findings confirm that focal ablation and anterograde degeneration accompany the analgesic effects of PRFC. In vivo imaging of the STT with DTI may contribute to surgical targeting for PRFC procedures, better understanding of the therapeutic and untoward effects of PRFC, and a deeper understanding of spinothalamic contributions to nociception.
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Jang SH, Lee J, Yeo SS. Central post-stroke pain due to injury of the spinothalamic tract in patients with cerebral infarction: a diffusion tensor tractography imaging study. Neural Regen Res 2017; 12:2021-2024. [PMID: 29323041 PMCID: PMC5784350 DOI: 10.4103/1673-5374.221159] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Many studies using diffusion tensor tractography (DTT) have demonstrated that injury of the spinothalamic tract (STT) is the pathogenetic mechanism of central post-stroke pain (CPSP) in intracerebral hemorrhage; however, there is no DTT study reporting the pathogenetic mechanism of CPSP in cerebral infarction. In this study, we investigated injury of the STT in patients with CPSP following cerebral infarction, using DTT. Five patients with CPSP following cerebral infarction and eight age- and sex-matched healthy control subjects were recruited for this study. STT was examined using DTT. Among DTT parameters of the affected STT, fractional anisotropy and tract volume were decreased by more than two standard deviations in two patients (patients 1 and 2) and three patients (patients 3, 4, and 5), respectively, compared with those of the control subjects, while mean diffusivity value was increased by more than two standard deviations in one patient (patient 2). Regarding DTT configuration, all affected STTs passed through adjacent part of the infarct and three STTs showed narrowing. These findings suggest that injury of the STT might be a pathogenetic etiology of CPSP in patients with cerebral infarction.
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Affiliation(s)
- Sung Ho Jang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Namku, Daegu, Republic of Korea
| | - Jun Lee
- Department of Neurology, College of Medicine, Yeungnam University, Namku, Daegu, Republic of Korea
| | - Sang Seok Yeo
- Department of Physical Therapy, College of Health Sciences, Dankook University, Chungnam, Republic of Korea
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Weiss Lucas C, Tursunova I, Neuschmelting V, Nettekoven C, Oros-Peusquens AM, Stoffels G, Faymonville AM, Jon SN, Langen KJ, Lockau H, Goldbrunner R, Grefkes C. Functional MRI vs. navigated TMS to optimize M1 seed volume delineation for DTI tractography. A prospective study in patients with brain tumours adjacent to the corticospinal tract. NEUROIMAGE-CLINICAL 2016; 13:297-309. [PMID: 28050345 PMCID: PMC5192048 DOI: 10.1016/j.nicl.2016.11.022] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 11/18/2016] [Accepted: 11/19/2016] [Indexed: 01/01/2023]
Abstract
BACKGROUND DTI-based tractography is an increasingly important tool for planning brain surgery in patients suffering from brain tumours. However, there is an ongoing debate which tracking approaches yield the most valid results. Especially the use of functional localizer data such as navigated transcranial magnetic stimulation (nTMS) or functional magnetic resonance imaging (fMRI) seem to improve fibre tracking data in conditions where anatomical landmarks are less informative due to tumour-induced distortions of the gyral anatomy. We here compared which of the two localizer techniques yields more plausible results with respect to mapping different functional portions of the corticospinal tract (CST) in brain tumour patients. METHODS The CSTs of 18 patients with intracranial tumours in the vicinity of the primary motor area (M1) were investigated by means of deterministic DTI. The core zone of the tumour-adjacent hand, foot and/or tongue M1 representation served as cortical regions of interest (ROIs). M1 core zones were defined by both the nTMS hot-spots and the fMRI local activation maxima. In addition, for all patients, a subcortical ROI at the level of the inferior anterior pons was implemented into the tracking algorithm in order to improve the anatomical specificity of CST reconstructions. As intra-individual control, we additionally tracked the CST of the hand motor region of the unaffected, i.e., non-lesional hemisphere, again comparing fMRI and nTMS M1 seeds. The plausibility of the fMRI-ROI- vs. nTMS-ROI-based fibre trajectories was assessed by a-priori defined anatomical criteria. Moreover, the anatomical relationship of different fibre courses was compared regarding their distribution in the anterior-posterior direction as well as their location within the posterior limb of the internal capsule (PLIC). RESULTS Overall, higher plausibility rates were observed for the use of nTMS- as compared to fMRI-defined cortical ROIs (p < 0.05) in tumour vicinity. On the non-lesional hemisphere, however, equally good plausibility rates (100%) were observed for both localizer techniques. fMRI-originated fibres generally followed a more posterior course relative to the nTMS-based tracts (p < 0.01) in both the lesional and non-lesional hemisphere. CONCLUSION NTMS achieved better tracking results than fMRI in conditions when the cortical tract origin (M1) was located in close vicinity to a brain tumour, probably influencing neurovascular coupling. Hence, especially in situations with altered BOLD signal physiology, nTMS seems to be the method of choice in order to identify seed regions for CST mapping in patients.
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Key Words
- APB, Abductor pollicis brevis muscle
- BOLD, Blood-oxygenation-level dependent
- CST
- CST, Corticospinal tract
- DCS, Direct cortical stimulation
- DTI, Diffusion tensor imaging
- Deterministic
- EF, Electric field
- EMG, Electromyography
- FA(T), Fractional anisotropy (threshold)
- FACT, Fibre assignment by continuous tracking
- FOV, Field-of-view
- FWE, Family-wise error
- KPS, Karnofsky performance scale
- LT, Lateral tongue muscle, anterior third
- M1, Primary motor cortex
- MEP, Motor-evoked potential
- MFL, Minimal fibre length
- MPRAGE, Magnetization prepared rapid acquisition gradient echo (T1 MR seq.)
- OR, Odd's ratio
- PLIC, Posterior limb of the internal capsule
- PM, Plantar muscle
- Pyramidal tract
- RMT, Resting motor threshold
- ROI
- ROI, Region-of-interest
- SD, Standard deviation
- SE, Standard error
- Somatotopic
- X-sq, X-squared (Pearson's chi-square test)
- dMRI, Diffusion magnetic resonance imaging (i.e., diffusion-weighted imaging, DWI)
- fMRI
- fMRI, Functional magnetic resonance imaging
- nTMS
- nTMS, Neuronavigated transcranial magnetic stimulation
- pxsq, p-value according to Pearson's chi-square test
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Affiliation(s)
| | - Irada Tursunova
- University of Cologne, Center of Neurosurgery, 50924 Cologne, Germany
| | | | | | | | - Gabriele Stoffels
- Institute of Neuroscience and Medicine, Research Centre Jülich, 52425 Jülich, Germany
| | | | - Shah N Jon
- Institute of Neuroscience and Medicine, Research Centre Jülich, 52425 Jülich, Germany; RWTH Aachen University, University Clinic Aachen, Departments of Nuclear Medicine and Neurology, 52074 Aachen, Germany; Department of Electrical and Computer Systems Engineering, Monash University, Melbourne, Victoria, Australia; Monash Institute of Medical Engineering, Monash University, Melbourne, Victoria, Australia; Monash Biomedical Imaging, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Karl Josef Langen
- Institute of Neuroscience and Medicine, Research Centre Jülich, 52425 Jülich, Germany; RWTH Aachen University, University Clinic Aachen, Departments of Nuclear Medicine and Neurology, 52074 Aachen, Germany
| | - Hannah Lockau
- University of Cologne, Department of Radiology, 50937 Cologne, Germany
| | | | - Christian Grefkes
- Institute of Neuroscience and Medicine, Research Centre Jülich, 52425 Jülich, Germany; University of Cologne, Department of Neurology, 50924 Cologne, Germany
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The Relation Between Injury of the Spinothalamocortical Tract and Central Pain in Chronic Patients With Mild Traumatic Brain Injury. J Head Trauma Rehabil 2015; 30:E40-6. [DOI: 10.1097/htr.0000000000000121] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Chilla GS, Tan CH, Xu C, Poh CL. Diffusion weighted magnetic resonance imaging and its recent trend-a survey. Quant Imaging Med Surg 2015; 5:407-22. [PMID: 26029644 DOI: 10.3978/j.issn.2223-4292.2015.03.01] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 01/15/2015] [Indexed: 12/14/2022]
Abstract
Since its inception in 1985, diffusion weighted magnetic resonance imaging has been evolving and is becoming instrumental in diagnosis and investigation of tissue functions in various organs including brain, cartilage, and liver. Even though brain related pathology and/or investigation remains as the main application, diffusion weighted magnetic resonance imaging (DWI) is becoming a standard in oncology and in several other applications. This review article provides a brief introduction of diffusion weighted magnetic resonance imaging, challenges involved and recent advancements.
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Affiliation(s)
- Geetha Soujanya Chilla
- 1 School of Chemical & Biomedical Engineering, Nanyang Technological University, Singapore 637459, Singapore ; 2 Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore 308433, Singapore
| | - Cher Heng Tan
- 1 School of Chemical & Biomedical Engineering, Nanyang Technological University, Singapore 637459, Singapore ; 2 Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore 308433, Singapore
| | - Chenjie Xu
- 1 School of Chemical & Biomedical Engineering, Nanyang Technological University, Singapore 637459, Singapore ; 2 Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore 308433, Singapore
| | - Chueh Loo Poh
- 1 School of Chemical & Biomedical Engineering, Nanyang Technological University, Singapore 637459, Singapore ; 2 Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore 308433, Singapore
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Weiss C, Tursunova I, Neuschmelting V, Lockau H, Nettekoven C, Oros-Peusquens AM, Stoffels G, Rehme AK, Faymonville AM, Shah NJ, Langen KJ, Goldbrunner R, Grefkes C. Improved nTMS- and DTI-derived CST tractography through anatomical ROI seeding on anterior pontine level compared to internal capsule. NEUROIMAGE-CLINICAL 2015; 7:424-37. [PMID: 25685709 PMCID: PMC4314616 DOI: 10.1016/j.nicl.2015.01.006] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Revised: 01/07/2015] [Accepted: 01/08/2015] [Indexed: 12/16/2022]
Abstract
Imaging of the course of the corticospinal tract (CST) by diffusion tensor imaging (DTI) is useful for function-preserving tumour surgery. The integration of functional localizer data into tracking algorithms offers to establish a direct structure–function relationship in DTI data. However, alterations of MRI signals in and adjacent to brain tumours often lead to spurious tracking results. We here compared the impact of subcortical seed regions placed at different positions and the influences of the somatotopic location of the cortical seed and clinical co-factors on fibre tracking plausibility in brain tumour patients. The CST of 32 patients with intracranial tumours was investigated by means of deterministic DTI and neuronavigated transcranial magnetic stimulation (nTMS). The cortical seeds were defined by the nTMS hot spots of the primary motor area (M1) of the hand, the foot and the tongue representation. The CST originating from the contralesional M1 hand area was mapped as intra-individual reference. As subcortical region of interests (ROI), we used the posterior limb of the internal capsule (PLIC) and/or the anterior inferior pontine region (aiP). The plausibility of the fibre trajectories was assessed by a-priori defined anatomical criteria. The following potential co-factors were analysed: Karnofsky Performance Scale (KPS), resting motor threshold (RMT), T1-CE tumour volume, T2 oedema volume, presence of oedema within the PLIC, the fractional anisotropy threshold (FAT) to elicit a minimum amount of fibres and the minimal fibre length. The results showed a higher proportion of plausible fibre tracts for the aiP-ROI compared to the PLIC-ROI. Low FAT values and the presence of peritumoural oedema within the PLIC led to less plausible fibre tracking results. Most plausible results were obtained when the FAT ranged above a cut-off of 0.105. In addition, there was a strong effect of somatotopic location of the seed ROI; best plausibility was obtained for the contralateral hand CST (100%), followed by the ipsilesional hand CST (>95%), the ipsilesional foot (>85%) and tongue (>75%) CST. In summary, we found that the aiP-ROI yielded better tracking results compared to the IC-ROI when using deterministic CST tractography in brain tumour patients, especially when the M1 hand area was tracked. In case of FAT values lower than 0.10, the result of the respective CST tractography should be interpreted with caution with respect to spurious tracking results. Moreover, the presence of oedema within the internal capsule should be considered a negative predictor for plausible CST tracking. Somatotopic CST tractography was done in 32 patients with eloquent brain tumours. Seeding ROIs were defined by navigated TMS of the M1 hot spot (hand, foot, tongue). Using the anterior pons as a second ROI yielded more plausible tracts than the PLIC. Low FAT and oedema of the internal capsule were negative predictors.
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Key Words
- ANOVA, analysis of variance
- APB, abductor pollicis brevis muscle
- AUC, area under the curve
- BOLD, blood oxygenation level dependent
- CST
- CST, corticospinal tract
- DTI
- DTI, diffusion tensor imaging
- FA(T), fractional anisotropy (threshold)
- FACT, fibre assignment by continuous tracking
- FMRI, functional magnetic resonance imaging
- FOV, field-of-view
- FWE, family-wise error
- Fractional anisotropy
- KPS, Karnofsky performance scale
- LDA/C, linear discriminant analysis/coefficient
- LT, lateral tongue muscle, anterior third
- M1, primary motor cortex
- MEP, motor evoked potential
- MFL, minimal fibre length
- MPRAGE, magnetization prepared rapid acquisition gradient echo (T1 MR sequence)
- OR, odd's ratio
- PLIC, posterior limb of the internal capsule
- PM, plantar muscle
- RMT, resting motor threshold
- ROI
- ROI, region-of-interest
- SD, standard deviation
- SE, standard error
- Somatotopic
- X-sq, X-squared (Pearson's chi-square test)
- aiP, anterior inferior pons
- nTMS
- nTMS, neuronavigated transcranial magnetic stimulation
- pxsq, p-value according to Pearson's chi-square test.
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Affiliation(s)
- Carolin Weiss
- Department of Neurosurgery, University of Cologne, Cologne 50924, Germany
| | - Irada Tursunova
- Department of Neurosurgery, University of Cologne, Cologne 50924, Germany ; Department of Neurosurgery, University of Cologne, Cologne 50924, Germany
| | | | - Hannah Lockau
- Department of Radiology, University of Cologne, Cologne 50937, Germany
| | - Charlotte Nettekoven
- Institute of Neuroscience and Medicine, Research Centre Jülich, Jülich 52425, Germany
| | | | - Gabriele Stoffels
- Institute of Neuroscience and Medicine, Research Centre Jülich, Jülich 52425, Germany
| | - Anne K Rehme
- Institute of Neuroscience and Medicine, Research Centre Jülich, Jülich 52425, Germany ; Department of Neurology, University of Cologne, Cologne 50924, Germany
| | | | - N Jon Shah
- Institute of Neuroscience and Medicine, Research Centre Jülich, Jülich 52425, Germany ; Department of Neurology, University Clinic Aachen, RWTH Aachen University, Aachen 52074, Germany
| | - Karl Josef Langen
- Institute of Neuroscience and Medicine, Research Centre Jülich, Jülich 52425, Germany
| | - Roland Goldbrunner
- Department of Neurosurgery, University of Cologne, Cologne 50924, Germany
| | - Christian Grefkes
- Institute of Neuroscience and Medicine, Research Centre Jülich, Jülich 52425, Germany ; Department of Neurology, University of Cologne, Cologne 50924, Germany
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Jang SH, Seo JP. Differences of the medial lemniscus and spinothalamic tract according to the cortical termination areas: A diffusion tensor tractography study. Somatosens Mot Res 2014; 32:67-71. [PMID: 25365478 DOI: 10.3109/08990220.2014.966899] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
We investigated differences of the medial lemniscus and its thalamocortical pathway (ML), and the spinothalamic tract and its thalamocortical pathway (STT) according to the cortical termination areas. We found that the ML and STT terminated in the motor cortex and the somatosensory cortex. The ML may be closely related to the motor cortex for motor planning and execution, while the STT may be closely related to the cerebral cortex for somatosensory function and motor execution.
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Affiliation(s)
- Sung Ho Jang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University , Namku, Taegu , Republic of Korea
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Kwon YH, Jang SH, Yeo SS. Age-related changes of lateral ventricular width and periventricular white matter in the human brain: a diffusion tensor imaging study. Neural Regen Res 2014; 9:986-9. [PMID: 25206922 PMCID: PMC4146227 DOI: 10.4103/1673-5374.133152] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2014] [Indexed: 11/04/2022] Open
Affiliation(s)
- Yong Hyun Kwon
- Department of Physical Therapy, Yeungnam University College, Namgu, Daegu, Republic of Korea
| | - Sung Ho Jang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Namgu, Daegu, Republic of Korea
| | - Sang Seok Yeo
- Department of Physical Therapy, College of Health Sciences, Dankook University, Dongnam-gu, Cheonan-si, Chungnam, Republic of Korea
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Min K, Song J, Kang JY, Ko J, Ryu JS, Kang MS, Jang SJ, Kim SH, Oh D, Kim MK, Kim SS, Kim M. Umbilical cord blood therapy potentiated with erythropoietin for children with cerebral palsy: a double-blind, randomized, placebo-controlled trial. Stem Cells 2014; 31:581-91. [PMID: 23281216 PMCID: PMC3744768 DOI: 10.1002/stem.1304] [Citation(s) in RCA: 132] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Revised: 10/30/2012] [Accepted: 11/26/2012] [Indexed: 12/16/2022]
Abstract
Allogeneic umbilical cord blood (UCB) has therapeutic potential for cerebral palsy (CP). Concomitant administration of recombinant human erythropoietin (rhEPO) may boost the efficacy of UCB, as it has neurotrophic effects. The objectives of this study were to assess the safety and efficacy of allogeneic UCB potentiated with rhEPO in children with CP. Children with CP were randomly assigned to one of three parallel groups: the pUCB group, which received allogeneic UCB potentiated with rhEPO; the EPO group, which received rhEPO and placebo UCB; and the Control group, which received placebo UCB and placebo rhEPO. All participants received rehabilitation therapy. The main outcomes were changes in scores on the following measures during the 6 months treatment period: the gross motor performance measure (GMPM), gross motor function measure, and Bayley scales of infant development-II (BSID-II) Mental and Motor scales (18). F-fluorodeoxyglucose positron emission tomography (18F-FDG-PET/CT) and diffusion tensor images (DTI) were acquired at baseline and followed up to detect changes in the brain. In total, 96 subjects completed the study. Compared with the EPO (n = 33) and Control (n = 32) groups, the pUCB (n = 31) group had significantly higher scores on the GMPM and BSID-II Mental and Motor scales at 6 months. DTI revealed significant correlations between the GMPM increment and changes in fractional anisotropy in the pUCB group. 18F-FDG-PET/CT showed differential activation and deactivation patterns between the three groups. The incidence of serious adverse events did not differ between groups. In conclusion, UCB treatment ameliorated motor and cognitive dysfunction in children with CP undergoing active rehabilitation, accompanied by structural and metabolic changes in the brain. Stem Cells2013;31:581–591
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Affiliation(s)
- Kyunghoon Min
- Department of Rehabilitation Medicine, CHA University, Seongnam-si, Gyeonggi-do, Korea.
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Hunsche S, Sauner D, Runge MJR, Lenartz D, El Majdoub F, Treuer H, Sturm V, Maarouf M. Tractography-guided stimulation of somatosensory fibers for thalamic pain relief. Stereotact Funct Neurosurg 2013; 91:328-34. [PMID: 23969597 DOI: 10.1159/000350024] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2012] [Accepted: 02/04/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND The spinothalamocortical tract (STC) is seen as a neural tract responsible for or involved in the generation or transmission of thalamic pain. Either the thalamus itself or the posterior limb of the internal capsule (PLIC) are targets for deep brain stimulation (DBS) in patients with thalamic pain, but due to its low contrast, conventional MRI cannot visualize the STC directly. OBJECTIVES To show the feasibility of integrating diffusion tensor imaging-based tractography into the stereotactic treatment planning for identification of an object-oriented lead trajectory that allows STC-DBS with multiple electrode contacts. METHODS Diffusion tensor imaging was performed in 4 patients with thalamic pain. The STC was modeled and integrated into the stereotactic treatment planning for DBS. DBS-lead implantation was done according to trajectory planning along the modeled STC at the level of the PLIC. RESULTS After implantation, electrode stimulation was possible over a length of more than 20 mm with a tractography-based trajectory along the PLIC part of the STC. After a follow-up of 12 months, pain relief of more than 40% was achieved in 3 of 4 patients with rating on a visual analogue scale. In 1 patient, stimulation failed to reach any long-lasting positive effects. CONCLUSIONS Integrating tractography data into stereotactic planning of DBS in thalamic pain is technically feasible. It can be used to identify a lead trajectory that allows for multiple contact stimulation along the STC at the level of the PLIC. Due to long-lasting positive stimulation effect, tractography-guided stimulation of sensory fibers seems to be beneficial for thalamic pain relief.
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Affiliation(s)
- Stefan Hunsche
- Department of Stereotactic and Functional Neurosurgery, University of Cologne, Cologne, Germany
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Yeo SS, Chang PH, Jang SH. The ascending reticular activating system from pontine reticular formation to the thalamus in the human brain. Front Hum Neurosci 2013; 7:416. [PMID: 23898258 PMCID: PMC3722571 DOI: 10.3389/fnhum.2013.00416] [Citation(s) in RCA: 90] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 07/11/2013] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION Action of the ascending reticular activating system (ARAS) on the cerebral cortex is responsible for achievement of consciousness. In this study, we attempted to reconstruct the lower single component of the ARAS from the reticular formation (RF) to the thalamus in the normal human brain using diffusion tensor imaging (DTI). METHODS Twenty six normal healthy subjects were recruited for this study. A 1.5-T scanner was used for scanning of diffusion tensor images, and the lower single component of the ARAS was reconstructed using FMRIB software. We utilized two ROIs for reconstruction of the lower single component of the ARAS: the seed ROI - the RF of the pons at the level of the trigeminal nerve entry zone, the target ROI - the intralaminar nuclei of the thalamus at the level of the commissural plane. RESULTS The reconstructed ARAS originated from the pontine RF, ascended through the mesencephalic tegmentum just posterior to the red nucleus, and then terminated on the intralaminar nuclei of the thalamus. No significant differences in fractional anisotropy, mean diffusivity, and tract number were observed between hemispheres (p > 0.05). CONCLUSION We reconstructed the lower single component of the ARAS from the RF to the thalamus in the human brain using DTI. The results of this study might be of value for the diagnosis and prognosis of patients with impaired consciousness.
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Affiliation(s)
- Sang Seok Yeo
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University Taegu, South Korea
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Jang SH, Kwon HG. Anatomical location of the medial lemniscus and spinothalamic tract at the pons in the human brain: a diffusion tensor tractography study. Somatosens Mot Res 2013; 30:206-9. [PMID: 23738628 DOI: 10.3109/08990220.2013.796923] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Using diffusion tensor tractography, we investigated the anatomical location of medial lemniscus (ML) and spinothalamic tract (STT) at pons. We recruited 47 healthy volunteers. Evaluation of the anatomical location of ML and STT was performed using the highest probabilistic location at the upper, middle, and lower pons. According to findings, MLs were located around the middle to medial one-third, between midline and lateral boundary of pons in the pontine tegmentum and STTs were located posterolaterally to ML.
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Affiliation(s)
- Sung Ho Jang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University , Namku, Taegu , Republic of Korea
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Jang SH, Son SM, Lee DY, Hong JH. Relationship between somatosensory function and the spinothalamocortical pathway in chronic stroke patients. Somatosens Mot Res 2013; 30:197-200. [PMID: 23697637 DOI: 10.3109/08990220.2013.790808] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Diffusion tensor tractography (DTT) allows for identification and evaluation of the spinothalamic tract and its thalamocortical pathway (STP). We attempted to investigate the relationship between tactile sensation and the STP in chronic stroke patients. We measured fractional anisotropy, mean diffusivity, and tract volume of the STP. The tactile sensation score of the affected side in patients with preserved STP integrity was higher compared with that of patients with an interrupted STP. The remaining volume and integrity of the STP in the affected hemisphere were important factors for tactile sensation of the affected side in chronic patients with intracerebral hemorrhage (ICH).
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Affiliation(s)
- Sung Ho Jang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University , Daegu , Republic of Korea and
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Seo JP, Jang SH. Traumatic thalamic injury demonstrated by diffusion tensor tractography of the spinothalamic pathway. Brain Inj 2013; 27:749-53. [PMID: 23672449 DOI: 10.3109/02699052.2013.771794] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND This study reports on a patient with traumatic brain injury (TBI) with a thalamic lesion in the ventroposterolateral nucleus which was demonstrated by diffusion tensor tractography (DTT) for the spinothalamic tract and its thalamocortical pathway (STP). METHODS One patient with TBI and eight normal control subjects were recruited. A 64-year-old woman who had suffered a motor vehicle accident presented with a persisting tingling sensation and pain in her right upper and lower extremities at 3 weeks after onset. The patient showed impaired touch sensation, but normal proprioception. Diffusion tensor imaging was performed at 1 month after onset. Fractional anisotropy (FA) and mean diffusivity were measured using a region of interest method along the STP. RESULTS DTT showed normal STP integrities as compared with normal controls. However, the FA values of the left STP at the thalamus were more than 2 SD decreased. The diminished FA value of the left STP in the left thalamus seems to indicate injury of the left ventrolateroposterior nucleus. Central pain and impaired touch sensation of right extremities supports the presence of left STP injury at the ventroposterolateral nucleus in this patient. CONCLUSION It is believed that DTT for the STP provides a useful means of detecting thalamic injury in TBI.
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Affiliation(s)
- Jeong Pyo Seo
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University , Taegu , Republic of Korea
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Recovery mechanisms of somatosensory function in stroke patients: implications of brain imaging studies. Neurosci Bull 2013; 29:366-72. [PMID: 23471867 DOI: 10.1007/s12264-013-1315-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Accepted: 08/20/2012] [Indexed: 10/27/2022] Open
Abstract
Somatosensory dysfunction is associated with a high incidence of functional impairment and safety in patients with stroke. With developments in brain mapping techniques, many studies have addressed the recovery of various functions in such patients. However, relatively little is known about the mechanisms of recovery of somatosensory function. Based on the previous human studies, a review of 11 relevant studies on the mechanisms underlying the recovery of somatosensory function in stroke patients was conducted based on the following topics: (1) recovery of an injured somatosensory pathway, (2) peri-lesional reorganization, (3) contribution of the unaffected somatosensory cortex, (4) contribution of the secondary somatosensory cortex, and (5) mechanisms of recovery in patients with thalamic lesions. We believe that further studies in this field using combinations of diffusion tensor imaging, functional neuroimaging, and magnetoencephalography are needed. In addition, the clinical significance, critical period, and facilitatory strategies for each recovery mechanism should be clarified.
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Chronic opioid therapy and opioid tolerance: a new hypothesis. PAIN RESEARCH AND TREATMENT 2013; 2013:407504. [PMID: 23401765 PMCID: PMC3557641 DOI: 10.1155/2013/407504] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2012] [Revised: 12/23/2012] [Accepted: 12/27/2012] [Indexed: 11/17/2022]
Abstract
Opioids are efficacious and cost-effective analgesics, but tolerance limits their effectiveness. This paper does not present any new clinical or experimental data but demonstrates that there exist ascending sensory pathways that contain few opioid receptors. These pathways are located by brain PET scans and spinal cord autoradiography. These nonopioid ascending pathways include portions of the ventral spinal thalamic tract originating in Rexed layers VI-VIII, thalamocortical fibers that project to the primary somatosensory cortex (S1), and possibly a midline dorsal column visceral pathway. One hypothesis is that opioid tolerance and opioid-induced hyperalgesia may be caused by homeostatic upregulation during opioid exposure of nonopioid-dependent ascending pain pathways. Upregulation of sensory pathways is not a new concept and has been demonstrated in individuals impaired with deafness or blindness. A second hypothesis is that adjuvant nonopioid therapies may inhibit ascending nonopioid-dependent pathways and support the clinical observations that monotherapy with opioids usually fails. The uniqueness of opioid tolerance compared to tolerance associated with other central nervous system medications and lack of tolerance from excess hormone production is discussed. Experimental work that could prove or disprove the concepts as well as flaws in the concepts is discussed.
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Abstract
OBJECTIVES : Little is known about the usefulness and findings of brain herniation on diffusion tensor tractography (DTT). Using DTT, we demonstrated neural tract injuries in 2 patients who showed subfalcine and trasntentorial herniations after subdural hematoma resulting from motor vehicle accident. DESIGN : Two patients and 6 age- and sex-matched, healthy volunteers were recruited for this study. SETTING : An inpatient rehabilitation unit. MAIN OUTCOME MEASURES : Diffusion tensor tractography for the patients was performed 5 weeks after onset. RESULTS : Diffusion tensor tractography of patient 1 showed complete injury of both cingulums at or around the rostrum of the corpus callosum, the fornix at the anterior and posterior body, and both corticospinal tracts at the pons. In addition, partial injury of both somatosensory tracts at the midbrain was also observed. Patient 2 showed complete injury of both cingulums above the body of the corpus callosum, the fornix at the anterior and posterior body, and right corticospinal tracts at the pons level and partial injury of the right somatosensory tract. We found that the fractional anisotropy values of all neural tracts, except fornix, in both patients and left somatosensory tract in patient 2 and voxel number for left somatosensory tract in patient 2 were decreased 2 SDs below that of normal controls. CONCLUSIONS : We determined that DTT would be a good technique for use in the detection of underlying lesions in patients with brain herniation.
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Jang SH, Kwon YH, Lee MY, Lee DY, Hong JH. Termination differences in the primary sensorimotor cortex between the medial lemniscus and spinothalamic pathways in the human brain. Neurosci Lett 2012; 516:50-3. [PMID: 22480695 DOI: 10.1016/j.neulet.2012.03.053] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2012] [Accepted: 03/20/2012] [Indexed: 11/18/2022]
Abstract
The medial lemniscus (ML) and its thalamocortical pathway is responsible for proprioception, in contrast, the spinothalamic tract (ST) and its thalamocortical pathway is the neural tract for pain and body temperature. Therefore, the ML pathway plays a crucial role in skillful movements and may be more linked to motor function than the ST pathway. We investigated the differences in the distribution of the primary motor cortex (M1) and the primary somatosensory cortex (S1) between the ML and ST pathways. Adults (mean age: 40.4 years, range: 21-61 years) were recruited for this study. The seed masks for the ML and ST pathways were given on the color map of the medulla according to the known anatomy and waypoint masks were placed on the ventro-postero-lateral nucleus of the thalamus. The volume of ML pathway did not show any difference between the M1 (10.94) and S1 (13.02) (p>0.05). By contrast, the mean voxel number of the ST pathway in the M1 (18.25) and S1 (27.38) showed significant difference between the M1 and S1 (p<0.05). As for relative voxel number percentage of the M1 compared to the S1, the ML pathway (84%) was significantly higher than ST pathway (67%) (p<0.05). We found that more neural fibers of the ML pathway were terminated in the M1 relative to the S1 compared to the SLP, and this may be linked to the inherent execution of movements of the M1.
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Affiliation(s)
- Sung Ho Jang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Republic of Korea
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Corticoreticular pathway in the human brain: diffusion tensor tractography study. Neurosci Lett 2011; 508:9-12. [PMID: 22197953 DOI: 10.1016/j.neulet.2011.11.030] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2011] [Revised: 11/16/2011] [Accepted: 11/17/2011] [Indexed: 11/21/2022]
Abstract
The corticoreticular pathway (CRP) is involved in postural control and locomotor function. No study has been conducted for identification of the CRP in the human brain. In the current study, we attempted to identify the CRP in the human brain, using diffusion tensor tractography (DTT). We recruited 24 healthy volunteers for this study. Diffusion tensor images were scanned using 1.5-T. For reconstruction of the CRP, a seed region of interest (ROI) was placed on the reticular formation of the medulla. The first target ROI was placed on the midbrain tegmentum and the second target ROI was placed on the premotor cortex (Brodmann area 6). Values of fractional anisotropy, mean diffusivity, and tract volume of the CRP were measured. The CRP, which originated from the premotor cortex, descended through the corona radiata and the posterior limb of the internal capsule anterior to the corticospinal tract. In the midbrain and pons, it passed through the tegmentum and terminated at the pontomedullary reticular formation. No differences in terms of fractional anisotropy, mean diffusivity, and tract volume were observed between hemispheres (P>0.05). We identified the CRP in the human brain using DTT. These methods and results would be helpful to both clinicians and researchers in the neuroscience field.
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Hong JH, Choi BY, Chang CH, Kim SH, Jung YJ, Lee DG, Kwon YH, Jang SH. The prevalence of central poststroke pain according to the integrity of the spino-thalamo-cortical pathway. Eur Neurol 2011; 67:12-7. [PMID: 22142796 DOI: 10.1159/000333012] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2011] [Accepted: 09/12/2011] [Indexed: 01/21/2023]
Abstract
OBJECTIVES Little is known about the prevalence of central poststroke pain (CPSP) according to the integrity of the spino-thalamo-cortical pathway (STP). Using diffusion tensor tractography, we investigated the prevalence of CPSP according to the integrity of the STP in patients with intracerebral hemorrhage. METHODS We recruited 52 consecutive chronic patients and 10 normal control subjects. Patients were classified into two groups according to preservation of the integrity of the STP. Each group was divided into two subgroups according to the presence of CPSP. RESULTS The preserved group included 34 patients [CPSP subgroup, 16 (47%) patients; non-CPSP subgroup, 18 (53%) patients], and 18 patients were enrolled into the disrupted group [CPSP subgroup, 3 (17%) patients; non-CPSP subgroup, 15 (83%) patients]. The fractional anisotropy and mean diffusivity values of the CPSP and non-CPSP subgroups of the preserved group were decreased and increased when compared with those of the control group, respectively (p < 0.05). CONCLUSIONS We found that the prevalence of CPSP in patients with partial injury of the STP was higher than that of patients with complete injury of the STP. Partial injury of the STP appears to be more vulnerable to development of CPSP than complete injury of the STP in patients with intracerebral hemorrhage.
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Affiliation(s)
- Ji Heon Hong
- Department of Physical Therapy, Yeungnam College of Science and Technology, Yeungnam University, Taegu, Republic of Korea
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Hong JH, Kwon HG, Jang SH. Probabilistic somatotopy of the spinothalamic pathway at the ventroposterolateral nucleus of the thalamus in the human brain. AJNR Am J Neuroradiol 2011; 32:1358-62. [PMID: 21596807 DOI: 10.3174/ajnr.a2497] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The STP has been regarded as the most plausible neural tract responsible for pathogenesis of central poststroke pain. The VPL nucleus has been a target for neurosurgical procedures for control of central poststroke pain. However, to our knowledge, no DTI studies have been conducted to investigate the somatotopic location of the STP at the VPL nucleus of the thalamus. In the current study, we attempted to investigate this location in the human brain by using a probabilistic tractography technique of DTI. MATERIALS AND METHODS DTI was performed at 1.5T by using a Synergy-L SENSE head coil. STPs for both the hand and leg were obtained by selection of fibers passing through 2 regions of interest (the area of the spinothalamic tract in the posterolateral medulla and the postcentral gyrus) for 41 healthy volunteers. Somatotopic mapping was obtained from the highest probabilistic location at the ACPC level. RESULTS The highest probabilistic locations for the hand and leg were an average of 16.86 and 16.37 mm lateral to the ACPC line and 7.53 and 8.71 mm posterior to the midpoint of the ACPC line, respectively. Somatotopic locations for the hand and leg were different in the anteroposterior direction (P < .05); however, no difference was observed in the mediolateral direction (P > .05). CONCLUSIONS We found the somatotopic locations for hand and leg of the STP at the VPL nucleus; these somatotopies were arranged in the anteroposterior direction.
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Affiliation(s)
- J H Hong
- Department of Physical Therapy, Yeungnam College of Science and Technology, Daegu, Republic of Korea
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Yeo SS, Kim SH, Ahn YH, Son SM, Jang SH. Anatomical location of the pedunculopontine nucleus in the human brain: diffusion tensor imaging study. Stereotact Funct Neurosurg 2011; 89:152-6. [PMID: 21494066 DOI: 10.1159/000324890] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2010] [Accepted: 02/07/2011] [Indexed: 11/19/2022]
Abstract
We investigated the anatomical location of the pedunculopontine nucleus (PPN) in the human brain using diffusion tensor imaging. Forty normal healthy subjects were recruited. To confirm the boundary of the PPN, we analyzed the superior cerebellar peduncle and medial lemniscus using DTI-Studio software. We identified the PPN on red green blue (RGB) images, and defined four points of the PPN and four boundaries of the midbrain: point a - the most anterior point, point b - the most posterior point, point c - the most medial point, point d - the most lateral point; anterior boundary - the line of the most posterior point of the interpeduncular fossa, posterior boundary - the line of the upper part of the inferior colliculus, lateral boundary - the line of the most lateral point of the midbrain, medial boundary - the line of the midline of the midbrain. Points a and b were located at an average of 20.19 and 30.52% from the anterior boundary, respectively. By contrast, points c and d were located at an average of 22.50 and 41.65% from the medial boundary, respectively. We believe that the methodology and data of this study would be helpful in research and procedures on the PPN.
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Affiliation(s)
- Sang Seok Yeo
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Taegu, Republic of Korea
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