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Nili MHHK, Esfahan SM, Bagheri Y, Vahabie AH, Sanayei M, Ertiaei A, Shirani M, Dehaqani MRA, Rezayat E. The variation of functional connectivity and activity before and after thalamotomy surgery (review). Front Hum Neurosci 2023; 17:1108888. [PMID: 37187943 PMCID: PMC10175682 DOI: 10.3389/fnhum.2023.1108888] [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: 11/26/2022] [Accepted: 04/06/2023] [Indexed: 05/17/2023] Open
Abstract
Ablation surgeries are utilized to treat certain brain disorders. Recently, these surgeries have become more prevalent using techniques such as magnetic resonance guided focused ultrasound (MRgFUS) ablation and Gamma knife thalamotomy (GKT). However, as the thalamus plays a critical role in cognitive functions, the potential impact of these surgeries on functional connectivity and cognition is a matter of concern. Various approaches have been developed to locate the target for ablation and also investigate changes in functional connectivity before and after surgery. Functional magnetic resonance imaging (fMRI) and electroencephalogram (EEG) are widely used methods for assessing changes in functional connectivity and activity in clinical research. In this Review, we summarize the use of fMRI and EEG in thalamotomy surgeries. Our analysis shows that thalamotomy surgery can result in changes in functional connectivity in motor-related, visuomotor, and default-mode networks, as detected by fMRI. EEG data also indicate a reduction in over-activities observed in the preoperative state.
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Affiliation(s)
- Mohammad-Hossein H. K. Nili
- School of Electrical and Computer Engineering, College of Engineering, University of Tehran, Tehran, Iran
- Department of Psychology, Faculty of Psychology and Education, University of Tehran, Tehran, Iran
- School of Cognitive Sciences, Institute for Research in Fundamental Sciences (IPM), Tehran, Iran
| | | | - Yamin Bagheri
- Department of Psychology, Faculty of Psychology and Education, University of Tehran, Tehran, Iran
- School of Cognitive Sciences, Institute for Research in Fundamental Sciences (IPM), Tehran, Iran
| | - Abdol-Hossein Vahabie
- School of Electrical and Computer Engineering, College of Engineering, University of Tehran, Tehran, Iran
- Department of Psychology, Faculty of Psychology and Education, University of Tehran, Tehran, Iran
| | - Mehdi Sanayei
- School of Cognitive Sciences, Institute for Research in Fundamental Sciences (IPM), Tehran, Iran
| | - Abolhassan Ertiaei
- Department of Neurosurgery, Sina Hospital, Tehran University of Medical Science, Tehran, Iran
| | - Mohammad Shirani
- Department of Neurosurgery, Sina Hospital, Tehran University of Medical Science, Tehran, Iran
| | - Mohammad-Reza A. Dehaqani
- School of Electrical and Computer Engineering, College of Engineering, University of Tehran, Tehran, Iran
- School of Cognitive Sciences, Institute for Research in Fundamental Sciences (IPM), Tehran, Iran
| | - Ehsan Rezayat
- Department of Psychology, Faculty of Psychology and Education, University of Tehran, Tehran, Iran
- *Correspondence: Ehsan Rezayat,
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Lu H, Lin J, Xiong Y, Deng L, Wang X, Zhang D, Bian X, Zhou J, Pan L, Lou X. Assessing the impact of MR-guided focused ultrasound thalamotomy on brain activity and connectivity in patients with essential tremor. Neurosurg Focus 2022; 53:E5. [PMID: 36455269 DOI: 10.3171/2022.9.focus22228] [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: 04/17/2022] [Accepted: 09/20/2022] [Indexed: 12/04/2022]
Abstract
OBJECTIVE Although magnetic resonance-guided focused ultrasound (MRgFUS) at the ventral intermediate (VIM) thalamic nucleus is a novel and effective treatment for medication-refractory essential tremor (ET), it is unclear how the ablation lesion affects functional activity. The current study sought to evaluate the functional impact of MRgFUS thalamotomy in patients with ET, as well as to investigate the relationship between neuronal activity changes and tremor control. METHODS This study included 30 patients with ET who underwent MRgFUS thalamotomy with a 6-month follow-up involving MRI and clinical tremor rating. Additional sex- and age-matched healthy people were recruited for the healthy control group. The fractional amplitude of low-frequency fluctuation (fALFF) and regional homogeneity were used to identify functional alteration regions of interest (ROIs). To investigate changes after treatment, ROI- and seed-based functional connectivity (FC) analyses were performed. RESULTS Patients with ET had significantly increased fALFF in the right postcentral gyrus (PoCG; ROI 1), regional homogeneity in the left PoCG (ROI 2), and regional homogeneity in the right PoCG (ROI 3, cluster-level p value family-wise error [pFWE] < 0.05), which were recovered and normalized at 6 months after MRgFUS thalamotomy. FCs between ROI 2 and the right supramarginal gyrus, ROI 2 and the right superior parietal gyrus, and ROI 3 and the left precentral gyrus were also found to be increased after treatment (cluster-level pFWE < 0.05). Furthermore, changes in fALFF, regional homogeneity, and FC values were significantly correlated with tremor relief (p < 0.05). Preoperative FC strengths were found to be inversely related to the postoperative tremor control ratio (p < 0.05). CONCLUSIONS In patients with ET, the VIM lesion of MRgFUS thalamotomy resulted in symptom-related regional functional recovery associated with sensorimotor and attention networks. Preoperative FC strengths may reflect the postoperative tremor control ratio, implying that this metric could be a useful neuroimaging biomarker for predicting symptom relief in patients with ET following thalamotomy.
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Affiliation(s)
| | | | | | | | | | | | | | - Jiayou Zhou
- 2Neurosurgery, Chinese PLA General Hospital/Chinese PLA Medical School, Beijing, China
| | - Longsheng Pan
- 2Neurosurgery, Chinese PLA General Hospital/Chinese PLA Medical School, Beijing, China
| | - Xin Lou
- Departments of1Radiology and
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Xiong Y, Lin J, Pan L, Zong R, Bian X, Duan C, Zhang D, Lou X. Pretherapeutic functional connectivity of tractography-based targeting of the ventral intermediate nucleus for predicting tremor response in patients with Parkinson's disease after thalamotomy with MRI-guided focused ultrasound. J Neurosurg 2022; 137:1135-1144. [PMID: 35180696 DOI: 10.3171/2022.1.jns212449] [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: 10/20/2021] [Accepted: 01/03/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Tractography-based direct targeting of the ventral intermediate nucleus (T-VIM) is a novel method that provides patient-specific VIM coordinates. This study aimed to explore the accuracy and predictive value of using T-VIM in combination with tractography and resting-state functional connectivity techniques to perform magnetic resonance imaging-guided focused ultrasound (MRgFUS) thalamotomy as a treatment of Parkinson's disease (PD). METHODS PD patients underwent MRgFUS thalamotomy and were recruited for functional MRI scanning. A subscore of the Clinical Rating Scale for Tremor was used to evaluate tremor improvement. T-VIM and surgical VIM (S-VIM) were defined on preoperative diffusion tensor MRI and 24-hour postoperative T1-weighted imaging, respectively. The overlapping volume and center distance between S-VIM and T-VIM were measured to determine their correlations with 12-month postoperative tremor improvement. Moreover, pretherapeutic functional connectivity of T-VIM or S-VIM, based on region-of-interest connectivity and whole-brain seed-to-voxel connectivity, was measured with the resting-state functional connectivity technique to investigate their correlations with tremor improvement. RESULTS All patients had excellent tremor improvement (mean [range] tremor improvement 74.82% [50.00%-94.44%]). The authors found that both overlapping volume and center distance between T-VIM and S-VIM were significantly correlated with tremor improvement (r = 0.788 and p = 0.012 for overlapping volume; r = -0.696 and p = 0.037 for center distance). Pretherapeutic functional connectivity of T-VIM with the ipsilateral sensorimotor cortex (r = 0.876 and p = 0.002), subthalamic nucleus (r = 0.700 and p = 0.036), and visual area (r = 0.911 and p = 0.001) was significantly and positively correlated with tremor improvement. CONCLUSIONS T-VIM may improve the clinical application of MRgFUS thalamotomy as a treatment of PD. Pretherapeutic functional connectivity of T-VIM with the ipsilateral sensorimotor cortex, subthalamic nucleus, and visual area may predict PD tremor responses after MRgFUS thalamotomy.
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Affiliation(s)
- Yongqin Xiong
- 1Department of Radiology, Chinese PLA General Hospital/Chinese PLA Medical School, Beijing, China; and
| | - Jiaji Lin
- 1Department of Radiology, Chinese PLA General Hospital/Chinese PLA Medical School, Beijing, China; and
| | - Longsheng Pan
- 2Department of Neurosurgery, Chinese PLA General Hospital/Chinese PLA Medical School, Beijing, China
| | - Rui Zong
- 2Department of Neurosurgery, Chinese PLA General Hospital/Chinese PLA Medical School, Beijing, China
| | - Xiangbing Bian
- 1Department of Radiology, Chinese PLA General Hospital/Chinese PLA Medical School, Beijing, China; and
| | - Caohui Duan
- 1Department of Radiology, Chinese PLA General Hospital/Chinese PLA Medical School, Beijing, China; and
| | - Dekang Zhang
- 1Department of Radiology, Chinese PLA General Hospital/Chinese PLA Medical School, Beijing, China; and
| | - Xin Lou
- 1Department of Radiology, Chinese PLA General Hospital/Chinese PLA Medical School, Beijing, China; and
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Contarino MF, Groot PFC, van der Meer JN, Bour LJ, Speelman JD, Nederveen AJ, van den Munckhof P, Tijssen MAJ, Schuurman PR, van Rootselaar AF. Is there a role for combined EMG-fMRI in exploring the pathophysiology of essential tremor and improving functional neurosurgery? PLoS One 2012; 7:e46234. [PMID: 23049695 PMCID: PMC3462183 DOI: 10.1371/journal.pone.0046234] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Accepted: 08/29/2012] [Indexed: 11/30/2022] Open
Abstract
Background Functional MRI combined with electromyography (EMG-fMRI) is a new technique to investigate the functional association of movement to brain activations. Thalamic stereotactic surgery is effective in reducing tremor. However, while some patients have satisfying benefit, others have only partial or temporary relief. This could be due to suboptimal targeting in some cases. By identifying tremor-related areas, EMG-fMRI could provide more insight into the pathophysiology of tremor and be potentially useful in refining surgical targeting. Objective Aim of the study was to evaluate whether EMG-fMRI could detect blood oxygen level dependent brain activations associated with tremor in patients with Essential Tremor. Second, we explored whether EMG-fMRI could improve the delineation of targets for stereotactic surgery. Methods Simultaneous EMG-fMRI was performed in six Essential Tremor patients with unilateral thalamotomy. EMG was recorded from the trembling arm (non-operated side) and from the contralateral arm (operated side). Protocols were designed to study brain activations related to voluntary muscle contractions and postural tremor. Results Analysis with the EMG regressor was able to show the association of voluntary movements with activity in the contralateral motor cortex and supplementary motor area, and ipsilateral cerebellum. The EMG tremor frequency regressor showed an association between tremor and activity in the ipsilateral cerebellum and contralateral thalamus. The activation spot in the thalamus varied across patients and did not correspond to the thalamic nucleus ventralis intermedius. Conclusion EMG-fMRI is potentially useful in detecting brain activations associated with tremor in patients with Essential Tremor. The technique must be further developed before being useful in supporting targeting for stereotactic surgery.
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Affiliation(s)
- Maria Fiorella Contarino
- Department of Neurology/Clinical Neurophysiology, Academic Medical Center, Amsterdam, The Netherlands
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Sedrak M, Gorgulho A, Frew A, Behnke E, DeSalles A, Pouratian N. Diffusion Tensor Imaging and Colored Fractional Anisotropy Mapping of the Ventralis Intermedius Nucleus of the Thalamus. Neurosurgery 2011; 69:1124-9; discussion 1129-30. [DOI: 10.1227/neu.0b013e3182296a42] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND
The ventralis intermedius (VIM) nucleus of the thalamus is the primary surgical target for treatment of tremor. Most centers rely on indirect targeting based on atlas-defined coordinates rather than patient-specific anatomy, making intraoperative physiological mapping critical. Detailed identification of this target based on patient-specific anatomic features can help optimize the surgical treatment of tremor.
OBJECTIVE
To study colored fractional anisotropic images and diffusion tensor imaging (DTI) tractography to identify characteristic magnetic resonance appearances of the VIM nucleus.
METHODS
Four patients undergoing stereotactic surgery for essential tremor (ET) were retrospectively studied with analysis of magnetic resonance imaging-based colored fractional anisotropy (FA) images and fiber tractography. All were scanned with a 1.5-T magnetic resonance imaging unit, and all sequences were obtained before frame placement. Because the goal of this study was to identify the DTI characteristics of physiologically defined VIM nucleus, we selected and studied patients who had undergone DTI and had efficacious tremor control with intraoperative microlesioning effect and tremor reduction with less than 2.0-V stimulation.
RESULTS
Analysis of color FA maps, which graphically illustrate fiber directionality, revealed consistent anatomic patterns. The region of the VIM nucleus can be seen as an intermediate region where there is a characteristic transition of color. Presumptive VIM nucleus interconnectivity with sensorimotor cortex and cerebellum was identified via the internal capsule and the superior cerebellar peduncle, respectively. FA maps could also be used to distinguish segments of gray matter, white matter, and gray-white matter boundaries.
CONCLUSION
Analysis of DTI and FA maps on widely available 1.5-T magnetic resonance imaging yields clear identification of various structures key to neurosurgical targeting. Prospective evaluation of integrating DTI into neurosurgical planning may be warranted.
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Affiliation(s)
- Mark Sedrak
- The Permanente Medical Group, Inc., Redwood City, California
- Departments of Neurosurgery, David Geffen School of Medicine, UCLA, Los Angeles, California
| | - Alessandra Gorgulho
- Departments of Neurosurgery, David Geffen School of Medicine, UCLA, Los Angeles, California
| | - Andrew Frew
- Departments of Neurology, David Geffen School of Medicine, UCLA, Los Angeles, California
| | - Eric Behnke
- Departments of Neurosurgery, David Geffen School of Medicine, UCLA, Los Angeles, California
| | - Antonio DeSalles
- Departments of Neurosurgery, David Geffen School of Medicine, UCLA, Los Angeles, California
| | - Nader Pouratian
- Departments of Neurosurgery, David Geffen School of Medicine, UCLA, Los Angeles, California
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Lu MK, Jung P, Bliem B, Shih HT, Hseu YT, Yang YW, Ziemann U, Tsai CH. The Bereitschaftspotential in essential tremor. Clin Neurophysiol 2010; 121:622-30. [PMID: 20097128 DOI: 10.1016/j.clinph.2009.12.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2009] [Revised: 12/01/2009] [Accepted: 12/14/2009] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Essential tremor (ET) is an involuntary postural oscillation. It is unclear to which extent motor cortical activity in preparation of volitional movement is abnormal in ET. We measured the Bereitschaftspotential (BP) to address this question. METHODS Given the known influence of the cerebello-dentato-thalamo-cortical projection in the generation of the BP, patients were divided into two groups, defined by purely postural tremor (ET(PT)) or additional presence of intention tremor (ET(IT)) and compared to healthy controls. BP was recorded during self-paced rapid wrist extension movements. RESULTS The late BP (500-0 ms before movement onset) was increased over the mid-frontal area in ET(PT), whereas it was reduced over the mid-parietal area in ET(IT) when compared to healthy controls. In addition, the late BP was reduced over a widespread centro-parietal area in ET(IT) compared to ET(PT). CONCLUSIONS Findings suggest that presence vs. absence of cerebellar signs (intention tremor) in ET results in differential affection of volitional preparatory motor cortical activity. The BP increase in ET(PT) may indicate compensatory activity, whereas the widespread centro-parietal BP reduction in ET(IT) suggests dysfunction of the cerebello-dentato-thalamo-cortical projection. SIGNIFICANCE Reduction of the late BP amplitude may serve as a surrogate marker for dysfunction of the cerebello-dentato-thalamo-cortical projection in ET.
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Affiliation(s)
- Ming-Kuei Lu
- Neuroscience Laboratory, Department of Neurology, China Medical University Hospital, Taiwan
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