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Kyle K, Peters J, Jonker B, Barnett Y, Maamary J, Barnett M, Maller J, Wang C, Tisch S. Magnetic Resonance-Guided Focused Ultrasound for Treatment of Essential Tremor: Ventral Intermediate Nucleus Ablation Alone or Additional Posterior Subthalamic Area Lesioning? Mov Disord Clin Pract 2024; 11:504-514. [PMID: 38469997 PMCID: PMC11078489 DOI: 10.1002/mdc3.14005] [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: 07/31/2023] [Revised: 12/18/2023] [Accepted: 01/24/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND Magnetic resonance-guided focused ultrasound (MRgFUS) for treatment of essential tremor (ET) traditionally targets the ventral intermediate (Vim) nucleus. Recent strategies include a secondary lesion to the posterior subthalamic area (PSA). OBJECTIVE The aim was to compare lesion characteristics, tremor improvement, and adverse events (AE) between patients in whom satisfactory tremor suppression was achieved with lesioning of the Vim alone and patients who required additional lesioning of the PSA. METHODS Retrospective analysis of data collected from ET patients treated with MRgFUS at St Vincent's Hospital Sydney was performed. Clinical Rating Scale for Tremor (CRST), hand tremor score (HTS), and Quality of Life in Essential Tremor Questionnaire (QUEST) were collected pre- and posttreatment in addition to the prevalence of AEs. The lesion coordinates and overlap with the dentatorubrothalamic tract (DRTT) were evaluated using magnetic resonance imaging. RESULTS Twenty-one patients were treated in Vim only, and 14 were treated with dual Vim-PSA lesions. Clinical data were available for 29 of the 35 patients (19 single target and 10 dual target). At follow-up (mean: 18.80 months) HTS, CRST, and QUEST in single-target patients improved by 57.97% (P < 0.001), 36.71% (P < 0.001), and 58.26% (P < 0.001), whereas dual-target patients improved by 68.34% (P < 0.001), 35.37% (P < 0.003), and 46.97% (P < 0.005), respectively. The Vim lesion of dual-target patients was further anterior relative to the posterior commissure (PC) (7.84 mm), compared with single-target patients (6.92 mm), with less DRTT involvement (14.85% vs. 23.21%). Dual-target patients exhibited a greater proportion of patients with acute motor AEs (100% vs. 58%); however, motor AE prevalence was similar in both groups at long-term follow-up (33% vs. 38%). CONCLUSION Posterior placement of lesions targeting the Vim may confer greater tremor suppression. The addition of a PSA lesion, in patients with inadequate tremor control despite Vim lesioning, had a trend toward better long-term tremor suppression; however, this approach was associated with greater prevalence of gait disturbance in the short term.
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Affiliation(s)
- Kain Kyle
- Faculty of Medicine and Health Translational Research CollectiveThe University of SydneyCamperdownNew South WalesAustralia
- Brain and Mind CentreThe University of SydneySydneyNew South WalesAustralia
- Sydney Neuroimaging Analysis CentreCamperdownNew South WalesAustralia
| | - James Peters
- Department of NeurologySt Vincent's HospitalDarlinghurstNew South WalesAustralia
- School of MedicineUniversity of New South WalesSydneyNew South WalesAustralia
| | - Benjamin Jonker
- Department of NeurosurgerySt Vincent's HospitalDarlinghurstNew South WalesAustralia
- Royal Prince Alfred Institute of Academic SurgeryUniversity of SydneyCamperdownNew South WalesAustralia
| | - Yael Barnett
- Department of NeurologySt Vincent's HospitalDarlinghurstNew South WalesAustralia
- Department of Medical ImagingSt Vincent's HospitalDarlinghurstNew South WalesAustralia
| | - Joel Maamary
- Department of NeurologySt Vincent's HospitalDarlinghurstNew South WalesAustralia
- School of MedicineUniversity of New South WalesSydneyNew South WalesAustralia
| | - Michael Barnett
- Faculty of Medicine and Health Translational Research CollectiveThe University of SydneyCamperdownNew South WalesAustralia
- Brain and Mind CentreThe University of SydneySydneyNew South WalesAustralia
- Sydney Neuroimaging Analysis CentreCamperdownNew South WalesAustralia
- Department of NeurologyRoyal Prince Alfred HospitalCamperdownNew South WalesAustralia
| | | | - Chenyu Wang
- Faculty of Medicine and Health Translational Research CollectiveThe University of SydneyCamperdownNew South WalesAustralia
- Brain and Mind CentreThe University of SydneySydneyNew South WalesAustralia
- Sydney Neuroimaging Analysis CentreCamperdownNew South WalesAustralia
| | - Stephen Tisch
- Department of NeurologySt Vincent's HospitalDarlinghurstNew South WalesAustralia
- School of MedicineUniversity of New South WalesSydneyNew South WalesAustralia
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Richter CG, Li CM, Turnbull A, Haft SL, Schneider D, Luo J, Lima DP, Lin FV, Davidson RJ, Hoeft F. Brain imaging studies of emotional well-being: a scoping review. Front Psychol 2024; 14:1328523. [PMID: 38250108 PMCID: PMC10799564 DOI: 10.3389/fpsyg.2023.1328523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 12/06/2023] [Indexed: 01/23/2024] Open
Abstract
This scoping review provides an overview of previous empirical studies that used brain imaging techniques to investigate the neural correlates of emotional well-being (EWB). We compiled evidence on this topic into one accessible and usable document as a foundation for future research into the relationship between EWB and the brain. PRISMA 2020 guidelines were followed. We located relevant articles by searching five electronic databases with 95 studies meeting our inclusion criteria. We explored EWB measures, brain imaging modalities, research designs, populations studied, and approaches that are currently in use to characterize and understand EWB across the literature. Of the key concepts related to EWB, the vast majority of studies investigated positive affect and life satisfaction, followed by sense of meaning, goal pursuit, and quality of life. The majority of studies used functional MRI, followed by EEG and event-related potential-based EEG to study the neural basis of EWB (predominantly experienced affect, affective perception, reward, and emotion regulation). It is notable that positive affect and life satisfaction have been studied significantly more often than the other three aspects of EWB (i.e., sense of meaning, goal pursuit, and quality of life). Our findings suggest that future studies should investigate EWB in more diverse samples, especially in children, individuals with clinical disorders, and individuals from various geographic locations. Future directions and theoretical implications are discussed, including the need for more longitudinal studies with ecologically valid measures that incorporate multi-level approaches allowing researchers to better investigate and evaluate the relationships among behavioral, environmental, and neural factors. Systematic review registration https://osf.io/t9cf6/.
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Affiliation(s)
- Caroline G. Richter
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, United States
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, United States
| | - Celine Mylx Li
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, United States
- Department of Psychology, University of California, Berkeley, Berkeley, CA, United States
| | - Adam Turnbull
- Department of Brain and Cognitive Sciences, University of Rochester, Rochester, NY, United States
- CogT Lab, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, United States
| | - Stephanie L. Haft
- Department of Psychology, University of California, Berkeley, Berkeley, CA, United States
| | - Deborah Schneider
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, United States
| | - Jie Luo
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, United States
| | - Denise Pinheiro Lima
- Intensive Care Pediatrician, Pediatric Intensive Care Unit, Hospital Moinhos de Vento, Porto Alegre, Brazil
| | - Feng Vankee Lin
- CogT Lab, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, United States
| | - Richard J. Davidson
- Center for Healthy Minds, University of Wisconsin, Madison, WI, United States
- Department of Psychology, University of Wisconsin, Madison, WI, United States
- Waisman Laboratory for Brain Imaging and Behavior, University of Wisconsin, Madison, WI, United States
- Department of Psychiatry, University of Wisconsin, Madison, WI, United States
| | - Fumiko Hoeft
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, United States
- Haskins Laboratories, New Haven, CT, United States
- Brain Imaging Research Center (BIRC), University of Connecticut, Storrs, CT, United States
- Department of Psychiatry and Behavioral Sciences, and Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, United States
- Department of Neuropsychiatry, Keio University School of Medicine, Shinanomachi Shinjuku Tokyo, Tokyo, Japan
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Blitz SE, Chua MMJ, Ng P, Segar DJ, Jha R, McDannold NJ, DeSalvo MN, Rolston JD, Cosgrove GR. Longitudinal MR imaging after unilateral MR-guided focused ultrasound thalamotomy: clinical and radiological correlation. Front Neurol 2023; 14:1272425. [PMID: 37869137 PMCID: PMC10587555 DOI: 10.3389/fneur.2023.1272425] [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: 08/04/2023] [Accepted: 09/22/2023] [Indexed: 10/24/2023] Open
Abstract
Introduction Magnetic-resonance-guided focused ultrasound (MRgFUS) thalamotomy uses multiple converging high-energy ultrasonic beams to produce thermal lesions in the thalamus. Early postoperative MR imaging demonstrates the location and extent of the lesion, but there is no consensus on the utility or frequency of postoperative imaging. We aimed to evaluate the evolution of MRgFUS lesions and describe the incidence, predictors, and clinical effects of lesion persistence in a large patient cohort. Methods A total of 215 unilateral MRgFUS thalamotomy procedures for essential tremor (ET) by a single surgeon were retrospectively analyzed. All patients had MR imaging 1 day postoperatively; 106 had imaging at 3 months and 32 had imaging at 1 year. Thin cut (2 mm) axial and coronal T2-weighted MRIs at these timepoints were analyzed visually on a binary scale for lesion presence and when visible, lesion volumes were measured. SWI and DWI sequences were also analyzed when available. Clinical outcomes including tremor scores and side effects were recorded at these same time points. We analyzed if patient characteristics (age, skull density ratio), preoperative tremor score, and sonication parameters influenced lesion evolution and if imaging characteristics correlated with clinical outcomes. Results Visible lesions were present in all patients 1 day post- MRgFUS and measured 307.4 ± 128.7 mm3. At 3 months, residual lesions (excluding patients where lesions were not visible) were 83.6% smaller and detectable in only 54.7% of patients (n = 58). At 1 year, residual lesions were detected in 50.0% of patients (n = 16) and were 90.7% smaller than 24 h and 46.5% smaller than 3 months. Lesions were more frequently visible on SWI (100%, n = 17), DWI (n = 38, 97.4%) and ADC (n = 36, 92.3%). At 3 months, fewer treatment sonications, higher maximum power, and greater distance between individual sonications led to larger lesion volumes. Volume at 24 h did not predict if a lesion was visible later. Lesion visibility at 3 months predicted sensory side effects but was not correlated with tremor outcomes. Discussion Overall, lesions are visible on T2-weighted MRI in about half of patients at both 3 months and 1 year post-MRgFUS thalamotomy. Certain sonication parameters significantly predicted persistent volume, but residual lesions did not correlate with tremor outcomes.
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Affiliation(s)
| | - Melissa M. J. Chua
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Patrick Ng
- Harvard Medical School, Boston, MA, United States
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - David J. Segar
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Rohan Jha
- Harvard Medical School, Boston, MA, United States
| | - Nathan J. McDannold
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Matthew N. DeSalvo
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - John D. Rolston
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - G. Rees Cosgrove
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
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Kyle K, Maller J, Barnett Y, Jonker B, Barnett M, D’Souza A, Calamante F, Maamary J, Peters J, Wang C, Tisch S. Tremor suppression following treatment with MRgFUS: skull density ratio consistency and degree of posterior dentatorubrothalamic tract lesioning predicts long-term clinical outcomes in essential tremor. Front Neurol 2023; 14:1129430. [PMID: 37181561 PMCID: PMC10166854 DOI: 10.3389/fneur.2023.1129430] [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: 12/22/2022] [Accepted: 03/27/2023] [Indexed: 05/16/2023] Open
Abstract
Objectives Magnetic resonance-guided focussed ultrasound (MRgFUS) is an incisionless ablative procedure, widely used for treatment of Parkinsonian and Essential Tremor (ET). Enhanced understanding of the patient- and treatment-specific factors that influence sustained long-term tremor suppression could help clinicians achieve superior outcomes via improved patient screening and treatment strategy. Methods We retrospectively analysed data from 31 subjects with ET, treated with MRgFUS at a single centre. Tremor severity was assessed with parts A, B and C of the Clinical Rating Scale for Tremor (CRST) as well as the combined CRST. Tremor in the dominant and non-dominant hand was assessed with Hand Tremor Scores (HTS), derived from the CRST. Pre- and post-treatment imaging data were analysed to determine ablation volume overlap with automated thalamic segmentations, and the dentatorubrothalamic tract (DRTT) and compared with percentage change in CRST and HTS following treatment. Results Tremor symptoms were significantly reduced following treatment. Combined pre-treatment CRST (mean: 60.7 ± 17.3) and HTS (mean: 19.2 ± 5.7) improved by an average of 45.5 and 62.6%, respectively. Percentage change in CRST was found to be significantly negatively associated with age (β = -0.375, p = 0.015), and SDR standard deviation (SDRSD; β = -0.324, p = 0.006), and positively associated with ablation overlap with the posterior DRTT (β = 0.535, p < 0.001). Percentage HTS improvement in the dominant hand decreased significantly with older age (β = -0.576, p < 0.01). Conclusion Our results suggest that increased lesioning of the posterior region of the DRTT could result in greater improvements in combined CRST and non-dominant hand HTS, and that subjects with lower SDR standard deviation tended to experience greater improvement in combined CRST.
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Affiliation(s)
- Kain Kyle
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
- Sydney Neuroimaging Analysis Centre, Camperdown, NSW, Australia
| | | | - Yael Barnett
- Department of Medical Imaging, and Neurology, St Vincent’s Hospital, Darlinghurst, NSW, Australia
- Department of Neurology, St Vincent’s Hospital, Darlinghurst, NSW, Australia
| | - Benjamin Jonker
- Department of Neurosurgery, St Vincent’s Hospital, Darlinghurst, NSW, Australia
- Royal Prince Alfred Institute of Academic Surgery, University of Sydney, Camperdown, NSW, Australia
| | - Michael Barnett
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
- Sydney Neuroimaging Analysis Centre, Camperdown, NSW, Australia
- Department of Neurology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Arkiev D’Souza
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | - Fernando Calamante
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
- School of Biomedical Engineering, The University of Sydney, Sydney, NSW, Australia
- Sydney Imaging, The University of Sydney, Sydney, NSW, Australia
| | - Joel Maamary
- Department of Neurology, St Vincent’s Hospital, Darlinghurst, NSW, Australia
- School of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - James Peters
- Department of Neurology, St Vincent’s Hospital, Darlinghurst, NSW, Australia
| | - Chenyu Wang
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
- Sydney Neuroimaging Analysis Centre, Camperdown, NSW, Australia
| | - Stephen Tisch
- Department of Neurology, St Vincent’s Hospital, Darlinghurst, NSW, Australia
- School of Medicine, University of New South Wales, Sydney, NSW, Australia
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