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Hoch MJ, Shepherd TM. MRI-Visible Anatomy of the Basal Ganglia and Thalamus. Neuroimaging Clin N Am 2022; 32:529-541. [PMID: 35843660 DOI: 10.1016/j.nic.2022.05.003] [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: 11/18/2022]
Abstract
Conventional MR imaging does not discriminate basal ganglia and thalamic internal anatomy well. Radiology reports describe anatomic locations but not specific functional structures. Functional neurosurgery uses indirect targeting based on commissural coordinates or atlases that do not fully account for individual variability. We describe innovative MR imaging sequences that improve the visualization of normal anatomy in this complex brain region and may increase our understanding of basal ganglia and thalamic function. Better visualization also may improve treatments for movement disorders and other emerging functional neurosurgery targets. We aim to provide an accessible review of the most clinically-relevant neuroanatomy within the thalamus and basal ganglia.
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Affiliation(s)
- Michael J Hoch
- Department of Radiology, University of Pennsylvania, 3400 Spruce Street, Suite 130, Philadelphia, PA 19104, USA. https://twiter.com/@RVUhound
| | - Timothy M Shepherd
- Department of Radiology, New York University Langone School of Medicine, 660 First Avenue, Room 226, New York, NY 10016, USA.
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Eguchi K, Shirai S, Matsushima M, Kano T, Yamazaki K, Hamauchi S, Sasamori T, Seki T, Hirata K, Kitagawa M, Otsuki M, Shiga T, Houkin K, Sasaki H, Yabe I. Correlation of active contact location with weight gain after subthalamic nucleus deep brain stimulation: a case series. BMC Neurol 2021; 21:351. [PMID: 34517835 PMCID: PMC8436541 DOI: 10.1186/s12883-021-02383-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 09/01/2021] [Indexed: 12/16/2022] Open
Abstract
Background Weight gain (WG) is a frequently reported side effect of subthalamic deep brain stimulation; however, the underlying mechanisms remain unclear. The active contact locations influence the clinical outcomes of subthalamic deep brain stimulation, but it is unclear whether WG is directly associated with the active contact locations. We aimed to determine whether WG is associated with the subthalamic deep brain stimulation active contact locations. Methods We enrolled 14 patients with Parkinson’s disease who underwent bilateral subthalamic deep brain stimulation between 2013 and 2019. Bodyweight and body mass index were measured before and one year following the surgery. The Lead-DBS Matlab toolbox was used to determine the active contact locations based on magnetic resonance imaging and computed tomography. We also created sweet spot maps for WG using voxel-wise statistics, based on volume of tissue activation and the WG of each patient. Fluorodeoxyglucose-positron emission tomography data were also acquired before and one year following surgery, and statistical parametric mapping was used to evaluate changes in brain metabolism. We examined which brain regions’ metabolism fluctuation significantly correlated with increased body mass index scores and positron emission tomography data. Results One year after surgery, the body mass index increase was 2.03 kg/m2. The sweet spots for WG were bilateral, mainly located dorsally outside of the subthalamic nucleus (STN). Furthermore, WG was correlated with increased metabolism in the left limbic and associative regions, including the middle temporal gyrus, inferior frontal gyrus, and orbital gyrus. Conclusions Although the mechanisms underlying WG following subthalamic deep brain stimulation are possibly multifactorial, our findings suggest that dorsal stimulation outside of STN may lead to WG. The metabolic changes in limbic and associative cortical regions after STN-DBS may also be one of the mechanisms underlying WG. Further studies are warranted to confirm whether dorsal stimulation outside of STN changes the activities of these cortical regions.
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Affiliation(s)
- Katsuki Eguchi
- Department of Neurology, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-ku, 060-8638, Sapporo, Japan.
| | - Shinichi Shirai
- Department of Neurology, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-ku, 060-8638, Sapporo, Japan
| | - Masaaki Matsushima
- Department of Neurology, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-ku, 060-8638, Sapporo, Japan
| | - Takahiro Kano
- Department of Neurology, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-ku, 060-8638, Sapporo, Japan
| | - Kazuyoshi Yamazaki
- Department of Neurosurgery, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-ku, 060-8638, Sapporo, Japan
| | - Shuji Hamauchi
- Department of Neurosurgery, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-ku, 060-8638, Sapporo, Japan
| | - Toru Sasamori
- Department of Neurosurgery, Sapporo Azabu Neurosurgical Hospital, Kita 22, Higashi 1, Higashi-ku, 065-0022, Sapporo, Japan
| | - Toshitaka Seki
- Department of Neurosurgery, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-ku, 060-8638, Sapporo, Japan
| | - Kenji Hirata
- Department of Diagnostic Imaging, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-ku, 060-8638, Sapporo, Japan
| | - Mayumi Kitagawa
- Sapporo Teishinkai Hospital, Kita 33, Higashi 1, Higashi-ku, 065-0033, Sapporo, Japan
| | - Mika Otsuki
- Faculty of Health Sciences, Graduate School of Health Sciences, Hokkaido University, Kita 15, Nishi 7, Kita-ku, 060-8638, Sapporo, Japan
| | - Tohru Shiga
- Department of Nuclear Medicine, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-ku, 060-8638, Sapporo, Japan
| | - Kiyohiro Houkin
- Department of Neurosurgery, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-ku, 060-8638, Sapporo, Japan
| | - Hidenao Sasaki
- Department of Neurology, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-ku, 060-8638, Sapporo, Japan
| | - Ichiro Yabe
- Department of Neurology, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-ku, 060-8638, Sapporo, Japan
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Internal States Influence the Representation and Modulation of Food Intake by Subthalamic Neurons. Neurosci Bull 2020; 36:1355-1368. [PMID: 32567027 DOI: 10.1007/s12264-020-00533-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 02/16/2020] [Indexed: 01/02/2023] Open
Abstract
Deep brain stimulation of the subthalamic nucleus (STN) is an effective therapy for motor deficits in Parkinson's disease (PD), but commonly causes weight gain in late-phase PD patients probably by increasing feeding motivation. It is unclear how STN neurons represent and modulate feeding behavior in different internal states. In the present study, we found that feeding caused a robust activation of STN neurons in mice (GCaMP6 signal increased by 48.4% ± 7.2%, n = 9, P = 0.0003), and the extent varied with the size, valence, and palatability of food, but not with the repetition of feeding. Interestingly, energy deprivation increased the spontaneous firing rate (8.5 ± 1.5 Hz, n = 17, versus 4.7 ± 0.7 Hz, n = 18, P = 0.03) and the depolarization-induced spikes in STN neurons, as well as enhanced the STN responses to feeding. Optogenetic experiments revealed that stimulation and inhibition of STN neurons respectively reduced (by 11% ± 6%, n = 6, P = 0.02) and enhanced (by 36% ± 15%, n = 7, P = 0.03) food intake only in the dark phase. In conclusion, our results support the hypothesis that STN neurons are activated by feeding behavior, depending on energy homeostatic status and the palatability of food, and modulation of these neurons is sufficient to regulate food intake.
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Bellini G, Best LA, Brechany U, Mills R, Pavese N. Clinical Impact of Deep Brain Stimulation on the Autonomic System in Patients with Parkinson's Disease. Mov Disord Clin Pract 2020; 7:373-382. [PMID: 32373653 DOI: 10.1002/mdc3.12938] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 02/26/2020] [Accepted: 03/08/2020] [Indexed: 12/14/2022] Open
Abstract
Background The role of deep brain stimulation (DBS) in the management of motor symptoms in patients with Parkinson's disease is well defined. However, it is becoming increasingly clear that DBS can either improve or worsen a number of non-motor phenomena. Objectives We examined the published literature to better understand the effects on autonomic symptoms following DBS of the subthalamic nucleus and the globus pallidus interna. Methods We conducted a PubMed search of studies regarding the effects of DBS on the autonomic system published from January 2001. We searched for the following terms and their combinations: Parkinson's disease, deep brain stimulation, subthalamic nucleus, globus pallidus interna, autonomic dysfunction. Results Most studies reported in the literature focus on DBS targeting the subthalamic nucleus, with particular emphasis on favorable outcomes regarding gastrointestinal function and bladder control. However, the emergence or worsening of autonomic symptoms in subgroups of patients has also been documented. More controversial is the effect of stimulation on the cardiovascular, pulmonary, and thermo-regulatory systems as well as sexual functioning. Data regarding the influence of DBS on the autonomic system when the target is the globus pallidus interna is less forthcoming, with target selection varying according to centre and clinical indication. Conclusions DBS appears to affect the autonomic nervous system, with varying degrees of influence, which may or may not be clinically beneficial for the patient. A better understanding of these effects could help personalize stimulation for individual patients with autonomic disorders and/or avoid autonomic symptoms in susceptible patients.
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Affiliation(s)
- Gabriele Bellini
- Clinical Ageing Research Centre Newcastle University Newcastle Upon Tyne United Kingdom
| | - Laura A Best
- Clinical Ageing Research Centre Newcastle University Newcastle Upon Tyne United Kingdom
| | - Una Brechany
- Newcastle Upon Tyne Hospitals NHS Foundation Trust Newcastle Upon Tyne United Kingdom
| | - Russell Mills
- Newcastle Upon Tyne Hospitals NHS Foundation Trust Newcastle Upon Tyne United Kingdom
| | - Nicola Pavese
- Clinical Ageing Research Centre Newcastle University Newcastle Upon Tyne United Kingdom.,Department of Nuclear Medicine and PET Centre Aarhus University Hospital Aarhus Denmark
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Baydin S, Baran O, Gungor A, Kuruoglu E, Tanriover N. Vascularization of the Subthalamic Nucleus: Highlighting the Significance of the Premamillary Artery. World Neurosurg 2019; 135:e562-e566. [PMID: 31863894 DOI: 10.1016/j.wneu.2019.12.062] [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: 09/01/2019] [Revised: 12/10/2019] [Accepted: 12/11/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND The need for a better understanding of the subthalamic nucleus (STN)'s vascular anatomy is still evident because revealing its vascular supply may increase insight in the pathogenesis of related disorders, such as STN ischemia. The mechanisms under motor, behavioral, and cognitive changes following deep brain stimulation treatment may also be explained by its pattern of vascularization. The primary goal of this study was to delineate the vascularization of the STN and highlight the predominant perforating arteries supplying its territory. METHODS Fiber dissections were performed with the modified Klingler technique under 6-40× magnification by preserving all vascular structures. RESULTS The thalamic and subthalamic regions were dissected from medial to lateral in silicone-injected cadavers. The STN was revealed as a biconvex-shaped structure surrounded by dense inferolateral bundles of myelinated fibers, the zona incerta, bordering the superolateral portion of the red nucleus. The ventral limit of the STN was the substantia nigra, and the internal capsule traversed from its inferior to anterolateral side. The premamillary artery, a large perforator arising from the posterior communicating artery, constantly supplied the STN and was followed proximally along the anterior third ventricular floor toward its origin. The premamillary artery was found to be one of the posterior perforators of the posterior communicating artery in all hemispheres. CONCLUSIONS The 3-dimensional microsurgical anatomy of the deep-seated STN region is complex, and the additional knowledge on its vascularization should improve our understanding of its surgical anatomy.
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Affiliation(s)
- Serhat Baydin
- Department of Neurosurgery, Medical Faculty, Ondokuz Mayis University, Samsun, Turkey
| | - Oguz Baran
- Haseki Research and Training Hospital, Neurosurgery Clinic, Istanbul, Turkey
| | - Abuzer Gungor
- Department of Neurosurgery, Medical Faculty, Acibadem University, Istanbul, Turkey
| | - Enis Kuruoglu
- Department of Neurosurgery, Medical Faculty, Ondokuz Mayis University, Samsun, Turkey
| | - Necmettin Tanriover
- Department of Neurosurgery, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey.
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Hoch MJ, Bruno MT, Faustin A, Cruz N, Mogilner AY, Crandall L, Wisniewski T, Devinsky O, Shepherd TM. 3T MRI Whole-Brain Microscopy Discrimination of Subcortical Anatomy, Part 2: Basal Forebrain. AJNR Am J Neuroradiol 2019; 40:1095-1105. [PMID: 31196861 DOI: 10.3174/ajnr.a6088] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Accepted: 04/22/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND PURPOSE The basal forebrain contains multiple structures of great interest to emerging functional neurosurgery applications, yet many neuroradiologists are unfamiliar with this neuroanatomy because it is not resolved with current clinical MR imaging. MATERIALS AND METHODS We applied an optimized TSE T2 sequence to washed whole postmortem brain samples (n = 13) to demonstrate and characterize the detailed anatomy of the basal forebrain using a clinical 3T MR imaging scanner. We measured the size of selected internal myelinated pathways and measured subthalamic nucleus size, oblique orientation, and position relative to the intercommissural point. RESULTS We identified most basal ganglia and diencephalon structures using serial axial, coronal, and sagittal planes relative to the intercommissural plane. Specific oblique image orientations demonstrated the positions and anatomic relationships for selected structures of interest to functional neurosurgery. We observed only 0.2- to 0.3-mm right-left differences in the anteroposterior and superoinferior length of the subthalamic nucleus (P = .084 and .047, respectively). Individual variability for the subthalamic nucleus was greatest for angulation within the sagittal plane (range, 15°-37°), transverse dimension (range, 2-6.7 mm), and most inferior border (range, 4-7 mm below the intercommissural plane). CONCLUSIONS Direct identification of basal forebrain structures in multiple planes using the TSE T2 sequence makes this challenging neuroanatomy more accessible to practicing neuroradiologists. This protocol can be used to better define individual variations relevant to functional neurosurgical targeting and validate/complement advanced MR imaging methods being developed for direct visualization of these structures in living patients.
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Affiliation(s)
- M J Hoch
- From the Department of Radiology and Imaging Sciences, (M.J.H.), Emory University, Atlanta, Georgia
| | - M T Bruno
- Departments of Radiology (M.T.B., N.C., T.M.S.)
| | | | - N Cruz
- Departments of Radiology (M.T.B., N.C., T.M.S.)
| | | | - L Crandall
- Neurology (L.C., T.W., O.D.).,SUDC Foundation (L.C., O.D.), New York, New York
| | - T Wisniewski
- Pathology (A.F., T.W.).,Neurology (L.C., T.W., O.D.).,Psychiatry (T.W.), New York University, New York, New York
| | - O Devinsky
- Neurology (L.C., T.W., O.D.).,SUDC Foundation (L.C., O.D.), New York, New York
| | - T M Shepherd
- Departments of Radiology (M.T.B., N.C., T.M.S.) .,Center for Advanced Imaging Innovation and Research (T.M.S.), New York, New York
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Tambasco N, Romoli M, Calabresi P. Selective basal ganglia vulnerability to energy deprivation: Experimental and clinical evidences. Prog Neurobiol 2018; 169:55-75. [DOI: 10.1016/j.pneurobio.2018.07.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 07/24/2018] [Accepted: 07/27/2018] [Indexed: 02/07/2023]
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Choi BS, Shen G, Nan G, Kim JM, Jung KY, Jeon B. Dramatic psychiatric and behavioral symptoms following a subthalamic lesion. J Clin Neurosci 2018; 47:154-156. [DOI: 10.1016/j.jocn.2017.10.051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Accepted: 10/22/2017] [Indexed: 11/26/2022]
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Fine morphological evaluation of hypothalamus in patients with hyperphagia. Acta Neurochir (Wien) 2017; 159:865-871. [PMID: 28224319 DOI: 10.1007/s00701-017-3112-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 02/01/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND Various metabolic diseases induced by eating disorders are some of the most serious and difficult problems for modern public healthcare. However, little is known about hyperphagia, partly because of the lack of a clear definition. Several basic studies have analyzed eating habits using endocrinological or neurophysiological approaches, which have suggested a controlled balance between the hunger and satiety centers in the central nervous system. However, more detailed neuro-radiologic evaluations have not been achieved for the hypothalamus, and evaluations were limited only to the floor of the third ventricles. METHODS Fine structures of hypothalamic morphology were investigated using high-resolution magnetic resonance imaging in seven patients with hypothalamo-pituitary tumors, who suffered from preoperative hyperphagia-induced severe obesity and metabolic disorders. Body mass index (BMI) varied from 22.4 to 40.5 kg/m2 (mean 32.8 kg/m2). Clinical data were compared with the data of nine patients without hyperphagia and seven healthy volunteers. RESULTS Morphological evaluation was possible in all patients and control subjects, and patients with hyperphagia had significantly shortened maximum distances between the ependymal layers of the lateral wall of the third ventricle and fornixes (hyperphagia group right side 0.30 mm, left side 0.23 mm vs. patients without hyperphagia group right side 1.60, left side 1.53 vs. healthy group right side 1.73 mm, left side 1.85 mm) (p < 0.01). Two patients achieved postoperative improvement in both clinical and neuro-radiological findings. CONCLUSION Eating and metabolic disorders are related to strong dysfunction of the medial nuclei of the hypothalamus in patients with hypothalamo-pituitary tumors. We report the first case of dynamic improvement from hyperphagia, with both symptomatic and neuro-radiological findings.
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Aiello M, Eleopra R, Foroni F, Rinaldo S, Rumiati RI. Weight gain after STN-DBS: The role of reward sensitivity and impulsivity. Cortex 2017; 92:150-161. [PMID: 28494345 DOI: 10.1016/j.cortex.2017.04.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 02/15/2017] [Accepted: 04/08/2017] [Indexed: 12/23/2022]
Abstract
Weight gain has been reported after deep brain stimulation of the subthalamic nucleus (STN-DBS), a widely used treatment for Parkinson's disease (PD). This nucleus has been repeatedly found to be linked both to reward and to inhibitory control, two key aspects in the control of food intake. In this study, we assessed whether weight gain experienced by patients with PD after STN-DBS, might be due to an alteration of reward and inhibitory functions. Eighteen patients with PD were compared to eighteen healthy controls and tested three times: before surgery, in ON medication and after surgery, respectively five days after the implantation in ON medication/OFF stimulation and at least three months after surgery in ON medication/ON stimulation. All participants were assessed for depression (Beck Depression Inventory), anhedonia (Snaith-Hamilton Pleasure Scale) and impulsiveness (Barratt Impulsiveness Scale). They performed a battery of tests assessing food reward sensitivity (Liking, Wanting and Preference) and a food go/no-go task. Results showed that body weight significantly increased after STN-DBS. A few days after surgery, patients were slower and more impulsive in the go/no-go task, showed a higher preference for high calorie (HC) foods and rated foods as less tasty. Months after subthalamic stimulation, the performance on the go/no-go task improved while no differences were observed in reward sensitivity. Interestingly, weight gain resulted greater in patients with higher levels of attentional impulsiveness pre-surgery, higher wanting for low calorie (LC) foods and impulsivity in the go/no-go task in ON medication/ON stimulation. However, only wanting and attentional impulsivity significantly predicted weight change. Furthermore, weight gain resulted associated with the reduction of l-Dopa after surgery and disease's duration. In conclusion, our findings are consistent with the view that weight gain in PD after STN-DBS has a multifactorial nature, which reflects the complex functional organization of the STN.
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Affiliation(s)
| | - Roberto Eleopra
- S.O.C. Neurologia, Azienda Ospedaliero Universitaria "Santa Maria Della Misericordia", Piazzale Santa Maria Della Misericordia, Udine, UD, Italy
| | | | - Sara Rinaldo
- S.O.C. Neurologia, Azienda Ospedaliero Universitaria "Santa Maria Della Misericordia", Piazzale Santa Maria Della Misericordia, Udine, UD, Italy
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Bosemani T, Anghelescu C, Boltshauser E, Hoon AH, Pearl PL, Craiu D, Johnston MV, Huisman TAGM, Poretti A. Subthalamic nucleus involvement in children: a neuroimaging pattern-recognition approach. Eur J Paediatr Neurol 2014; 18:249-56. [PMID: 24149100 DOI: 10.1016/j.ejpn.2013.09.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Revised: 09/17/2013] [Accepted: 09/30/2013] [Indexed: 12/28/2022]
Abstract
A neuroimaging-based pattern-recognition approach has been shown to be very helpful in the diagnosis of a wide range of pediatric central nervous system diseases. Few disorders may selectively affect the subthalamic nucleus in children including Leigh syndrome, succinic semialdehyde dehydrogenase deficiency, kernicterus, chronic end-stage liver failure and near total hypoxic-ischemic injury in the full-term neonates. The consideration of the constellation of clinical history and findings as well as additional neuroimaging findings should allow planning the appropriate diagnostic tests to make the correct diagnosis in children with involvement of the subthalamic nucleus.
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Affiliation(s)
- Thangamadhan Bosemani
- Section of Pediatric Neuroradiology, Division of Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Eugen Boltshauser
- Department of Pediatric Neurology, University Children's Hospital, Zurich, Switzerland
| | - Alexander H Hoon
- Kennedy Krieger Institute, Baltimore, MD, USA; Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Phillip L Pearl
- Division of Neurology, Children's National Medical Center, Washington, DC, USA
| | - Dana Craiu
- Pediatric Neurology Clinic, Alexandru Obregia Hospital, Bucharest, Romania; Department of Neurology, Pediatric Neurology, Neurosurgery, Psychiatry, "Carol Davila" University of Medicine, Bucharest, Romania
| | - Michael V Johnston
- Kennedy Krieger Institute, Baltimore, MD, USA; Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Thierry A G M Huisman
- Section of Pediatric Neuroradiology, Division of Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Andrea Poretti
- Section of Pediatric Neuroradiology, Division of Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Pediatric Neurology, University Children's Hospital, Zurich, Switzerland.
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Jourdain VA, Schechtmann G, Di Paolo T. Subthalamotomy in the treatment of Parkinson's disease: clinical aspects and mechanisms of action. J Neurosurg 2014; 120:140-51. [DOI: 10.3171/2013.10.jns13332] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Parkinson's disease (PD) is a neurodegenerative condition that can be pharmacologically treated with levodopa. However, important motor and nonmotor symptoms appear with its long-term use. The subthalamic nucleus (STN) is known to be involved in the pathophysiology of PD and to contribute to levodopa-induced complications. Surgery is considered in patients who have advanced PD that is refractory to pharmacotherapy and who display disabling dyskinesia. Deep brain stimulation of the STN is currently the main surgical procedure for PD, but lesioning is still performed. This review covers the clinical aspects and complications of subthalamotomy as one of the lesion-based options for PD patients with levodopa-induced dyskinesias. Moreover, the authors discuss the possible effects of subthalamic lesioning.
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Affiliation(s)
- Vincent A. Jourdain
- 1Neurosciences Research Center, Centre de Recherche du CHU de Québec
- 2Faculty of Pharmacy, Laval University, Quebec City, Quebec, Canada, and
| | - Gastón Schechtmann
- 3Department of Neurosurgery and Clinical Neuroscience, Karolinska Institutet and University Hospital, Stockholm, Sweden
| | - Thérèse Di Paolo
- 1Neurosciences Research Center, Centre de Recherche du CHU de Québec
- 2Faculty of Pharmacy, Laval University, Quebec City, Quebec, Canada, and
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