1
|
Bruno F, Badini P, Innocenzi A, Saporito G, Catalucci A, Sucapane P, Barile A, Cesare ED, Marini C, Pistoia F, Splendiani A. Early re-emerging tremor after MRgFUS thalamotomy: case-control analysis of procedural and imaging features. Front Neurol 2024; 15:1356613. [PMID: 38903176 PMCID: PMC11187326 DOI: 10.3389/fneur.2024.1356613] [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: 12/15/2023] [Accepted: 05/15/2024] [Indexed: 06/22/2024] Open
Abstract
Purpose This study aimed to identify possible prognostic factors determining early tremor relapse after Magnetic Resonance guided Focused Ultrasound Surgery (MRgFUS) thalamotomy in patients with essential tremor (ET) and Parkinson's disease (PD). Methods Nine patients (six ET and three PD) who underwent Vim MRgFUS thalamotomy in a single institution and developed early re-emergent tremor were analyzed. A control group of patients matched pairwise for sex, pathology, age, disease duration, and skull density ratio (SDR) was selected to compare the technical-procedural data and MR imaging evidence. MR imaging findings compared between groups included lesion shape and volume in multiparametric sequences, as well as Fractiona Anisotropy (FA) and Apparent Diffusion Coefficient (ADC) values derived from Diffusion Tensor Imaging Diffusion Weighted Imaging (DTI) and Diffusion Weighted Imaging (DWI) sequences. Results We did not find statistically significant differences in gender and age between the two groups. Technical and procedural parameters were also similar in both treatment groups. In MRI analysis, we found lesions of similar size but with greater caudal extension in the control group with stable outcomes compared to patients with tremor relapse. Conclusion In our analysis of early recurrences after thalamotomy with focused ultrasound, there were neither technical and procedural differences nor prognostic factors related to lesion size or ablation temperatures. Greater caudal extension of the lesion in patients without recurrence might suggest the importance of spatial consolidation during treatment.
Collapse
Affiliation(s)
- Federico Bruno
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
- Neuroradiology and Interventional Radiology, San Salvatore Hospital, L’Aquila, Italy
| | - Pierfrancesco Badini
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Antonio Innocenzi
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Gennaro Saporito
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Alessia Catalucci
- Neuroradiology and Interventional Radiology, San Salvatore Hospital, L’Aquila, Italy
| | | | - Antonio Barile
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Ernesto Di Cesare
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | | | - Francesca Pistoia
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
- Neurology, San Salvatore Hospital, L’Aquila, Italy
| | - Alessandra Splendiani
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
- Neuroradiology and Interventional Radiology, San Salvatore Hospital, L’Aquila, Italy
| |
Collapse
|
2
|
Fenoy AJ, Chu ZD, Ritter RJ, Conner CR, Kralik SF. Evaluating functional connectivity differences between DBS ON/OFF states in essential tremor. Neurotherapeutics 2024:e00375. [PMID: 38824101 DOI: 10.1016/j.neurot.2024.e00375] [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: 10/29/2023] [Revised: 05/05/2024] [Accepted: 05/13/2024] [Indexed: 06/03/2024] Open
Abstract
Deep brain stimulation (DBS) targeting the ventral intermediate (Vim) nucleus of the thalamus is an effective treatment for essential tremor (ET). We studied 15 ET patients undergoing DBS to a major input/output tract of the Vim, the dentato-rubro-thalamic tract (DRTt), using resting state functional MRI (rsfMRI) to evaluate connectivity differences between DBS ON and OFF and elucidate significant regions most influential in impacting tremor control and/or concomitant gait ataxia. Anatomical/functional 1.5T MRIs were acquired and replicated for each DBS state. Tremor severity and gait ataxia severity were scored with DBS ON at optimal stimulation parameters and immediately upon DBS OFF. Whole brain analysis was performed using dual regression analysis followed by randomized permutation testing for multiple correction comparison. Regions of interest (ROI) analysis was also performed. All 15 patients had tremor improvement between DBS ON/OFF (p < 0.001). Whole brain analysis revealed significant connectivity changes between states in the left pre-central gyrus and left supplemental motor area. Group analysis of ROIs revealed that, with threshold p < 0.05, in DBS ON vs. OFF both tremor duration and tremor improvement were significantly correlated to changes in connectivity. A sub-group analysis of patients with greater ataxia had significantly decreased functional connectivity between multiple ROIs in the cortex and cerebellum when DBS was ON compared to OFF. Stimulation of the DRTt and concordant improvement of tremor resulted in connectivity changes seen in multiple regions outside the motor network; when combined with both structural and electrophysiologic connectivity, this may help to serve as a biomarker to improve DBS targeting and possibly predict outcome.
Collapse
Affiliation(s)
- Albert J Fenoy
- Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA; Departments of Neurosurgery and Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
| | - Zili D Chu
- Edward B. Singleton Department of Radiology, Baylor College of Medicine at Texas Children's Hospital, Houston, TX, USA
| | - Robert J Ritter
- Department of Neurosurgery, McGovern School of Medicine, UTHealth Houston, Houston, TX, USA
| | - Christopher R Conner
- Division of Neurosurgery, Dept. of Surgery, University of Connecticut, Hartford, CT, USA
| | - Stephen F Kralik
- Edward B. Singleton Department of Radiology, Baylor College of Medicine at Texas Children's Hospital, Houston, TX, USA
| |
Collapse
|
3
|
Lin J, Kang X, Zhou J, Zhang D, Hu J, Lu H, Pan L, Lou X. Profiling functional networks identify activation of corticostriatal connectivity in ET patients after MRgFUS thalamotomy. Neuroimage Clin 2024; 42:103605. [PMID: 38640802 PMCID: PMC11053244 DOI: 10.1016/j.nicl.2024.103605] [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] [Received: 01/10/2024] [Revised: 03/22/2024] [Accepted: 04/13/2024] [Indexed: 04/21/2024]
Abstract
BACKGROUND MR-guided focused ultrasound (MRgFUS) thalamotomy is a novel and effective treatment for medication-refractory tremor in essential tremor (ET), but how the brain responds to this deliberate lesion is not clear. OBJECTIVE The current study aimed to evaluate the immediate and longitudinal alterations of functional networks after MRgFUS thalamotomy. METHODS We retrospectively obtained preoperative and postoperative 30-day, 90-day, and 180-day data of 31 ET patients subjected with MRgFUS thalamotomy from 2018 to 2020. Their archived resting-state functional MRI data were used for functional network comparison as well as graph-theory metrics analysis. Both partial least squares (PLS) regression and linear regression were conducted to associate functional features to tremor symptoms. RESULTS MRgFUS thalamotomy dramatically abolished tremors, while global functional network only sustained immediate fluctuation within one week after the surgery. Network-based statistics have identified a long-term enhanced corticostriatal subnetwork by comparison between 180-day and preoperative data (P = 0.019). Within this subnetwork, network degree, global efficiency and transitivity were significantly recovered in ET patients right after MRgFUS thalamotomy compared to the pre-operative timepoint (P < 0.05), as well as hemisphere lateralization (P < 0.001). The PLS main component significantly accounted for 33.68 % and 34.16 % of the total variances of hand tremor score and clinical rating scale for tremor (CRST)-total score (P = 0.037 and 0.027). Network transitivity of this subnetwork could serve as a reliable biomarker for hand tremor score control prediction at 180-day after the surgery (β = 2.94, P = 0.03). CONCLUSION MRgFUS thalamotomy promoted corticostriatal connectivity activation correlated with tremor improvement in ET patient after MRgFUS thalamotomy.
Collapse
Affiliation(s)
- Jiaji Lin
- Department of Radiology, Chinese PLA General Hospital/Medical School of Chinese PLA, No.28 Fuxing Road, Beijing, 100853, China; Department of Neurology, The Second Affiliated Hospital of Air Force Medical University, Xi'an, 710038, China
| | - Xiaopeng Kang
- School of Artificial Intelligence, University of Chinese Academy of Sciences, No.19A Yuquan Road, Beijing, 100876, China
| | - Jiayou Zhou
- Department of Neurosurgery, Chinese PLA General Hospital/Medical School of Chinese PLA, No.28 Fuxing Road, Beijing, 100853, China
| | - Dekang Zhang
- Department of Radiology, Chinese PLA General Hospital/Medical School of Chinese PLA, No.28 Fuxing Road, Beijing, 100853, China
| | - Jianxing Hu
- Department of Radiology, Chinese PLA General Hospital/Medical School of Chinese PLA, No.28 Fuxing Road, Beijing, 100853, China
| | - Haoxuan Lu
- Department of Radiology, Chinese PLA General Hospital/Medical School of Chinese PLA, No.28 Fuxing Road, Beijing, 100853, China
| | - Longsheng Pan
- Department of Neurosurgery, Chinese PLA General Hospital/Medical School of Chinese PLA, No.28 Fuxing Road, Beijing, 100853, China.
| | - Xin Lou
- Department of Radiology, Chinese PLA General Hospital/Medical School of Chinese PLA, No.28 Fuxing Road, Beijing, 100853, China.
| |
Collapse
|
4
|
Dahmani L, Bai Y, Zhang W, Ren J, Li S, Hu Q, Fu X, Ma J, Wei W, Wang M, Liu H, Wang D. Individualized functional connectivity markers associated with motor and mood symptoms of Parkinson's disease. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.01.31.578238. [PMID: 38352322 PMCID: PMC10862849 DOI: 10.1101/2024.01.31.578238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
Parkinson's disease (PD) is a complex neurological disorder characterized by many motor and non-motor symptoms. While most studies focus on the motor symptoms of the disease, it is important to identify markers that underlie different facets of the disease. In this case-control study, we sought to discover reliable, individualized functional connectivity markers associated with both motor and mood symptoms of PD. Using functional MRI, we extensively sampled 166 patients with PD (64 women, 102 men; mean age=61.8 years, SD=7.81) and 51 healthy control participants (32 women, 19 men; mean age=55.68 years, SD=7.62). We found that a model consisting of 44 functional connections predicted both motor (UPDRS-III: Pearson r=0.21, FDR-adjusted p=0.006) and mood symptoms (HAMD: Pearson r=0.23, FDR-adjusted p=0.006; HAMA: Pearson r=0.21, FDR-adjusted p=0.006). Two sets of connections contributed differentially to these predictions. Between-network connections, mainly connecting the sensorimotor and visual large-scale functional networks, substantially contributed to the prediction of motor measures, while within-network connections in the insula and sensorimotor network contributed more so to mood prediction. The middle to posterior insula region played a particularly important role in predicting depression and anxiety scores. We successfully replicated and generalized our findings in two independent PD datasets. Taken together, our findings indicate that sensorimotor and visual network markers are indicative of PD brain pathology, and that distinct subsets of markers are associated with motor and mood symptoms of PD.
Collapse
Affiliation(s)
- Louisa Dahmani
- Department of Medical Imaging, Henan Provincial People’s Hospital, Zhengzhou, Henan, China
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA, 02129
| | - Yan Bai
- Department of Medical Imaging, Henan Provincial People’s Hospital, Zhengzhou, Henan, China
| | - Wei Zhang
- Changping Laboratory, Beijing, China
| | | | - Shiyi Li
- Changping Laboratory, Beijing, China
| | - Qingyu Hu
- Changping Laboratory, Beijing, China
| | | | - Jianjun Ma
- Department of Neurology, Henan Provincial People’s Hospital, Zhengzhou, Henan, China
| | - Wei Wei
- Department of Medical Imaging, Henan Provincial People’s Hospital, Zhengzhou, Henan, China
| | - Meiyun Wang
- Department of Medical Imaging, Henan Provincial People’s Hospital, Zhengzhou, Henan, China
| | - Hesheng Liu
- Changping Laboratory, Beijing, China
- Biomedical Pioneering Innovation Center, Peking University, Beijing, China
| | - Danhong Wang
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA, 02129
| |
Collapse
|
5
|
Tian X, Hu R, He P, Ye J. Efficacy and safety of magnetic resonance-guided focused ultrasound for Parkinson's disease: a systematic review and meta-analysis. Front Neurol 2023; 14:1301240. [PMID: 38146437 PMCID: PMC10749343 DOI: 10.3389/fneur.2023.1301240] [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: 09/24/2023] [Accepted: 11/24/2023] [Indexed: 12/27/2023] Open
Abstract
Objective Magnetic resonance imaging-guided focused ultrasound (MRgFUS) is a novel noninvasive treatment for drug-resistant Parkinson's disease (PD) related tremor. This study aims to evaluate MRgFUS's efficacy and safety in PD through a systematic review and meta-analysis, examining pre-and post-treatment MDS-UPDRSIII and/or CRST scores and associated adverse events. Materials and methods We conducted an extensive literature search across PubMed, Embase, Web of Science, and Cochrane Library databases, screening studies based on set criteria and analyzing MDS-UPDRSIII, CRST, and adverse events pre- and post-MRgFUS treatment. Results Out of 468 retrieved articles, 20 studies involving 258 patients, spanning 2014-2023, were included.17 studies indicated significant MDS-UPDRSIII score reductions post-MRgFUS treatment, while 3 showed significant CRST score declines. In the "on" medication state, pooled MDS-UPDRSIII scores at 1, 3, 6, and 12 months were 12.18 (95% CI: 5.83-18.52), 12.10 (95% CI: 8.22-15.97), 14.85 (95% CI: 9.28-20.41), and 20.65 (95% CI: 12.15-29.14) respectively. In the "off" state, scores were 11.45 (95% CI: -3.50-26.40), 14.71 (95% CI: 4.95-24.46), 21.52 (95% CI: 19.28-23.75), and 22.28 (95% CI: 15.26-29.30). Adverse events were typically mild and transient, with speech disturbances, ataxia, and sensory abnormalities being common post-operative neurological complications. Conclusion MRgFUS offers an effective and relatively safe treatment option for patients with drug-resistant PD-related tremor. Systematic review registration https://www.crd.york.ac.uk/prospero/, No. CRD42023428332.
Collapse
Affiliation(s)
- Xiaona Tian
- Eighth Clinical School, Guangzhou University of Chinese Medicine, Foshan, China
| | - Rongrui Hu
- Eighth Clinical School, Guangzhou University of Chinese Medicine, Foshan, China
| | - Peicong He
- Eighth Clinical School, Guangzhou University of Chinese Medicine, Foshan, China
| | - Jianhong Ye
- Endocrinology Department, Foshan Hospital of Traditional Chinese Medicine, Foshan, China
| |
Collapse
|