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Luo Y, Liu H, Zhong L, Weng A, Yang Z, Zhang Y, Zhang J, He X, Ou Z, Yan Z, Cheng Q, Fan X, Zhang X, Zhang W, Hu Q, Peng K, Liu G, Xu J. Regional structural abnormalities in thalamus in idiopathic cervical dystonia. BMC Neurol 2024; 24:174. [PMID: 38789945 PMCID: PMC11127434 DOI: 10.1186/s12883-024-03680-6] [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: 02/29/2024] [Accepted: 05/17/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND The thalamus has a central role in the pathophysiology of idiopathic cervical dystonia (iCD); however, the nature of alterations occurring within this structure remain largely elusive. Using a structural magnetic resonance imaging (MRI) approach, we examined whether abnormalities differ across thalamic subregions/nuclei in patients with iCD. METHODS Structural MRI data were collected from 37 patients with iCD and 37 healthy controls (HCs). Automatic parcellation of 25 thalamic nuclei in each hemisphere was performed based on the FreeSurfer program. Differences in thalamic nuclei volumes between groups and their relationships with clinical information were analysed in patients with iCD. RESULTS Compared to HCs, a significant reduction in thalamic nuclei volume primarily in central medial, centromedian, lateral geniculate, medial geniculate, medial ventral, paracentral, parafascicular, paratenial, and ventromedial nuclei was found in patients with iCD (P < 0.05, false discovery rate corrected). However, no statistically significant correlations were observed between altered thalamic nuclei volumes and clinical characteristics in iCD group. CONCLUSION This study highlights the neurobiological mechanisms of iCD related to thalamic volume changes.
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Grants
- 62006220, 81771137, 82271300, and 81971103 National Natural Science Foundation of China
- 62006220, 81771137, 82271300, and 81971103 National Natural Science Foundation of China
- 62006220, 81771137, 82271300, and 81971103 National Natural Science Foundation of China
- 2023A1515012739, 2016A030310132, and 2021A1515010600 Natural Science Foundation of Guangdong Province
- 2023A1515012739, 2016A030310132, and 2021A1515010600 Natural Science Foundation of Guangdong Province
- 2023B03J0466 Science and Technology Program of Guangzhou
- 2020B1212060017 Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases
- 2018B030335001, 2023A1515012739 Guangdong Key Project
- 2015B050501003 and 2020A0505020004 Southern China International Cooperation Base for Early Intervention and Functional Rehabilitation of Neurological Diseases
- JCYJ20200109114816594 Shenzhen Science and Technology Research Program
- 202007030002 Guangzhou Key Project
- Guangdong Provincial Engineering Center for Major Neurological Disease Treatment
- Guangdong Provincial Translational Medicine Innovation Platform for Diagnosis and Treatment of Major Neurological Disease
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Affiliation(s)
- Yuhan Luo
- Department of Neurology, Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China
| | - Huiming Liu
- Department of Medical Imaging, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China
| | - Linchang Zhong
- Department of Medical Imaging, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China
| | - Ai Weng
- Department of Neurology, Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China
| | - Zhengkun Yang
- Department of Neurology, Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China
| | - Yue Zhang
- Department of Neurology, Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China
| | - Jiana Zhang
- Department of Neurology, Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China
| | - Xiuye He
- Department of Neurology, Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China
| | - Zilin Ou
- Department of Neurology, Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China
| | - Zhicong Yan
- Department of Neurology, Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China
| | - Qinxiu Cheng
- Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, China
| | - Xinxin Fan
- Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, China
| | - Xiaodong Zhang
- Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, China
| | - Weixi Zhang
- Department of Neurology, Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China
| | - Qingmao Hu
- Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, China
| | - Kangqiang Peng
- Department of Medical Imaging, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China
| | - Gang Liu
- Department of Neurology, Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China.
| | - Jinping Xu
- Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, China.
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Neudorfer C, Kultas-Ilinsky K, Ilinsky I, Paschen S, Helmers AK, Cosgrove GR, Richardson RM, Horn A, Deuschl G. The role of the motor thalamus in deep brain stimulation for essential tremor. Neurotherapeutics 2024; 21:e00313. [PMID: 38195310 PMCID: PMC11103222 DOI: 10.1016/j.neurot.2023.e00313] [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: 10/09/2023] [Revised: 12/10/2023] [Accepted: 12/27/2023] [Indexed: 01/11/2024] Open
Abstract
The advent of next-generation technology has significantly advanced the implementation and delivery of Deep Brain Stimulation (DBS) for Essential Tremor (ET), yet controversies persist regarding optimal targets and networks responsible for tremor genesis and suppression. This review consolidates key insights from anatomy, neurology, electrophysiology, and radiology to summarize the current state-of-the-art in DBS for ET. We explore the role of the thalamus in motor function and describe how differences in parcellations and nomenclature have shaped our understanding of the neuroanatomical substrates associated with optimal outcomes. Subsequently, we discuss how seminal studies have propagated the ventral intermediate nucleus (Vim)-centric view of DBS effects and shaped the ongoing debate over thalamic DBS versus stimulation in the posterior subthalamic area (PSA) in ET. We then describe probabilistic- and network-mapping studies instrumental in identifying the local and network substrates subserving tremor control, which suggest that the PSA is the optimal DBS target for tremor suppression in ET. Taken together, DBS offers promising outcomes for ET, with the PSA emerging as a better target for suppression of tremor symptoms. While advanced imaging techniques have substantially improved the identification of anatomical targets within this region, uncertainties persist regarding the distinct anatomical substrates involved in optimal tremor control. Inconsistent subdivisions and nomenclature of motor areas and other subdivisions in the thalamus further obfuscate the interpretation of stimulation results. While loss of benefit and habituation to DBS remain challenging in some patients, refined DBS techniques and closed-loop paradigms may eventually overcome these limitations.
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Affiliation(s)
- Clemens Neudorfer
- Brain Modulation Lab, Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, 02114, USA; Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Center for Brain Circuit Therapeutics Department of Neurology Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA; Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité -Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
| | | | - Igor Ilinsky
- Department of Anatomy and Cell Biology, The University of Iowa, Iowa City, IA, USA
| | - Steffen Paschen
- Department of Neurology, Christian-Albrechts-University, Kiel, Germany
| | | | - G Rees Cosgrove
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - R Mark Richardson
- Brain Modulation Lab, Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, 02114, USA; Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Andreas Horn
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Center for Brain Circuit Therapeutics Department of Neurology Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA; Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité -Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Günther Deuschl
- Department of Neurology, Christian-Albrechts-University, Kiel, Germany
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Malaga KA, Houshmand L, Costello JT, Chandrasekaran J, Chou KL, Patil PG. Thalamic Segmentation and Neural Activation Modeling Based on Individual Tissue Microstructure in Deep Brain Stimulation for Essential Tremor. Neuromodulation 2023; 26:1689-1698. [PMID: 36470728 DOI: 10.1016/j.neurom.2022.09.013] [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: 06/23/2022] [Revised: 08/08/2022] [Accepted: 09/13/2022] [Indexed: 12/05/2022]
Abstract
OBJECTIVE Thalamic deep brain stimulation (DBS) is the primary surgical therapy for essential tremor (ET). Thalamic DBS traditionally uses an atlas-based targeting approach, which, although nominally accurate, may obscure individual anatomic differences from population norms. The objective of this study was to compare this traditional atlas-based approach with a novel quantitative modeling methodology grounded in individual tissue microstructure (N-of-1 approach). MATERIALS AND METHODS The N-of-1 approach uses individual patient diffusion tensor imaging (DTI) data to perform thalamic segmentation and volume of tissue activation (VTA) modeling. For each patient, the thalamus was individually segmented into 13 nuclei using DTI-based k-means clustering. DBS-induced VTAs associated with tremor suppression and side effects were then computed for each patient with finite-element electric-field models incorporating DTI microstructural data. Results from N-of-1 and traditional atlas-based modeling were compared for a large cohort of patients with ET treated with thalamic DBS. RESULTS The size and shape of individual N-of-1 thalamic nuclei and VTAs varied considerably across patients (N = 22). For both methods, tremor-improving therapeutic VTAs showed similar overlap with motor thalamic nuclei and greater motor than sensory nucleus overlap. For VTAs producing undesirable sustained paresthesia, 94% of VTAs overlapped with N-of-1 sensory thalamus estimates, whereas 74% of atlas-based segmentations overlapped. For VTAs producing dysarthria/motor contraction, the N-of-1 approach predicted greater spread beyond the thalamus into the internal capsule and adjacent structures than the atlas-based method. CONCLUSIONS Thalamic segmentation and VTA modeling based on individual tissue microstructure explain therapeutic stimulation equally well and side effects better than a traditional atlas-based method in DBS for ET. The N-of-1 approach may be useful in DBS targeting and programming, particularly when patient neuroanatomy deviates from population norms.
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Affiliation(s)
- Karlo A Malaga
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Layla Houshmand
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Joseph T Costello
- Department of Electrical Engineering, University of Michigan, Ann Arbor, MI, USA
| | | | - Kelvin L Chou
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA; Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA
| | - Parag G Patil
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA; Department of Neurology, University of Michigan, Ann Arbor, MI, USA; Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA.
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Ding X, Li Q, Tang YY. The thalamic clustering coefficient moderates the vigor-sleep quality relationship. Sleep Biol Rhythms 2023; 21:369-375. [PMID: 38476314 PMCID: PMC10899908 DOI: 10.1007/s41105-023-00456-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 03/06/2023] [Indexed: 03/28/2023]
Abstract
Sleep disorders affect more than one-quarter of the world's population, resulting in reduced daytime productivity, impaired immune function, and an increased risk of cardiovascular disease. It is important to identify the physiological and psychological factors related to sleep for the prevention and treatment of sleep disorders. In this study, we correlated measurements of emotional state, sleep quality, and some brain neural activity parameters to better understand the brain and psychological factors related to sleep. Resting-state functional magnetic resonance imaging (rs-fMRI) of 116 healthy undergraduates were analyzed using graph theory to assess regional topological characteristics. Among these, the left thalamic cluster coefficient proved to be the ablest to reflect the characteristics of the sleep neural graph index. The Profile of Mood States (POMS) was used to measure vigor, and the Pittsburgh Sleep Quality Index (PSQI) to assess sleep quality. The results showed that the left thalamic clustering coefficient was negatively correlated with sleep quality and vigor. Further, the left thalamic clustering coefficient moderated the relationship between vigor and sleep quality. When the left thalamic clustering coefficient was very low, there was a significant positive correlation between vigor and sleep quality. However, when the left thalamic clustering coefficient was high, the correlation between vigor and sleep quality became insignificant. The relationship between vigor and sleep quality is heterogeneous. Analyzing the function of the left thalamic neural network could help understand the variation in the relationship between vigor and sleep quality in different populations. Such observations may help in the development of personalized interventions for sleep disorders.
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Affiliation(s)
- Xiaoqian Ding
- College of Psychology, Liaoning Normal University, Dalian, 116029 China
| | - Qingmin Li
- College of Psychology, Liaoning Normal University, Dalian, 116029 China
| | - Yi-Yuan Tang
- College of Health Solutions, Arizona State University, Tempe, AZ 85281 USA
- College of Health Solutions, Arizona State University, Phoenix, AZ 85004 USA
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5
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Ko TH, Lee YH, Chan L, Tsai KWK, Hong CT, Lo WL. Magnetic Resonance-Guided focused ultrasound surgery for Parkinson's disease: A mini-review and comparison between deep brain stimulation. Parkinsonism Relat Disord 2023:105431. [PMID: 37164870 DOI: 10.1016/j.parkreldis.2023.105431] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 04/24/2023] [Accepted: 04/28/2023] [Indexed: 05/12/2023]
Abstract
Magnetic resonance-guided focused ultrasound (MRgFUS) is a new surgical treatment for Parkinson's disease (PD). Previous experience with radiofrequency lesionectomy and deep brain stimulation (DBS) has identified several candidate targets for MRgFUS intended to alleviate the motor symptoms of PD. The main advantage of MRgFUS is that it is incisionless. MRgFUS has certain limitations and is associated with adverse effects. The present study reviews the literature on conventional surgical interventions for PD, discusses recent studies on MRgFUS, and the comparison between DBS and MRgFUS for PD. The reviews aims to provide an essential reference for neurologists to select the appropriate treatments for patients with PD.
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Affiliation(s)
- Tzu-Hsiang Ko
- Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan; Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Taipei Neuroscience Institute, Taipei Medical University, Taipei, Taiwan
| | - Yu-Hsuan Lee
- Taipei Neuroscience Institute, Taipei Medical University, Taipei, Taiwan; Department of Neurosurgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Lung Chan
- Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan; Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Taipei Neuroscience Institute, Taipei Medical University, Taipei, Taiwan
| | | | - Chien-Tai Hong
- Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan; Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Taipei Neuroscience Institute, Taipei Medical University, Taipei, Taiwan.
| | - Wei-Lun Lo
- Taipei Neuroscience Institute, Taipei Medical University, Taipei, Taiwan; Department of Neurosurgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan; Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
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6
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Pérez-Santos I, García-Cabezas MÁ, Cavada C. Mapping the primate thalamus: systematic approach to analyze the distribution of subcortical neuromodulatory afferents. Brain Struct Funct 2023:10.1007/s00429-023-02619-w. [PMID: 36890350 DOI: 10.1007/s00429-023-02619-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: 09/12/2022] [Accepted: 02/09/2023] [Indexed: 03/10/2023]
Abstract
Neuromodulatory afferents to thalamic nuclei are key for information transmission and thus play critical roles in sensory, motor, and limbic processes. Over the course of the last decades, diverse attempts have been made to map and describe subcortical neuromodulatory afferents to the primate thalamus, including axons using acetylcholine, serotonin, dopamine, noradrenaline, adrenaline, and histamine. Our group has been actively involved in this endeavor. The published descriptions on neuromodulatory afferents to the primate thalamus have been made in different laboratories and are not fully comparable due to methodological divergences (for example, fixation procedures, planes of cutting, techniques used to detect the afferents, different criteria for identification of thalamic nuclei…). Such variation affects the results obtained. Therefore, systematic methodological and analytical approaches are much needed. The present article proposes reproducible methodological and terminological frameworks for primate thalamic mapping. We suggest the use of standard stereotaxic planes to produce and present maps of the primate thalamus, as well as the use of the Anglo-American school terminology (vs. the German school terminology) for identification of thalamic nuclei. Finally, a public repository of the data collected under agreed-on frameworks would be a useful tool for looking up and comparing data on the structure and connections of primate thalamic nuclei. Important and agreed-on efforts are required to create, manage, and fund a unified and homogeneous resource of data on the primate thalamus. Likewise, a firm commitment of the institutions to preserve experimental brain material is much needed because neuroscience work with non-human primates is becoming increasingly rare, making earlier material still more valuable.
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Affiliation(s)
- Isabel Pérez-Santos
- Department of Anatomy, Histology and Neuroscience, School of Medicine, Facultad de Medicina, Universidad Autónoma de Madrid, Calle Arzobispo Morcillo 4, 28029, Madrid, Spain.,PhD Program in Neuroscience, Universidad Autónoma de Madrid-Cajal, Madrid, Spain
| | - Miguel Ángel García-Cabezas
- Department of Anatomy, Histology and Neuroscience, School of Medicine, Facultad de Medicina, Universidad Autónoma de Madrid, Calle Arzobispo Morcillo 4, 28029, Madrid, Spain.,PhD Program in Neuroscience, Universidad Autónoma de Madrid-Cajal, Madrid, Spain.,Neural Systems Laboratory, Department of Health Sciences, Boston University, Boston, MA, USA
| | - Carmen Cavada
- Department of Anatomy, Histology and Neuroscience, School of Medicine, Facultad de Medicina, Universidad Autónoma de Madrid, Calle Arzobispo Morcillo 4, 28029, Madrid, Spain. .,PhD Program in Neuroscience, Universidad Autónoma de Madrid-Cajal, Madrid, Spain.
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7
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Avecillas-Chasin JM, Levinson S, Kuhn T, Omidbeigi M, Langevin JP, Pouratian N, Bari A. Connectivity-based parcellation of the amygdala and identification of its main white matter connections. Sci Rep 2023; 13:1305. [PMID: 36693904 PMCID: PMC9873600 DOI: 10.1038/s41598-023-28100-6] [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: 04/01/2022] [Accepted: 01/12/2023] [Indexed: 01/25/2023] Open
Abstract
The amygdala plays a role in emotion, learning, and memory and has been implicated in behavioral disorders. Better understanding of the amygdala circuitry is crucial to develop new therapies for these disorders. We used data from 200 healthy-subjects from the human connectome project. Using probabilistic tractography, we created population statistical maps of amygdala connectivity to brain regions involved in limbic, associative, memory, and reward circuits. Based on the amygdala connectivity with these regions, we applied k-means clustering to parcellate the amygdala into three clusters. The resultant clusters were averaged across all subjects and the main white-matter pathways of the amygdala from each averaged cluster were generated. Amygdala parcellation into three clusters showed a medial-to-lateral pattern. The medial cluster corresponded with the centromedial and cortical nuclei, the basal cluster with the basal nuclei and the lateral cluster with the lateral nuclei. The connectivity analysis revealed different white-matter pathways consistent with the anatomy of the amygdala circuit. This in vivo connectivity-based parcellation of the amygdala delineates three clusters of the amygdala in a mediolateral pattern based on its connectivity with brain areas involved in cognition, memory, emotion, and reward. The human amygdala circuit presented in this work provides the first step for personalized amygdala circuit mapping for patients with behavioral disorders.
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Affiliation(s)
- Josue M Avecillas-Chasin
- Department of Neurosurgery, University of Nebraska Medical Center, 988437 Nebraska Medical Center, Omaha, NE, 68198-8437, USA. .,Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
| | - Simon Levinson
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Taylor Kuhn
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA, USA
| | - Mahmoud Omidbeigi
- Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Jean-Philippe Langevin
- Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.,Neurosurgery Service, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Nader Pouratian
- Department of Neurological Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | - Ausaf Bari
- Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
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Pagano RL, Dale CS, Campos ACP, Hamani C. Translational aspects of deep brain stimulation for chronic pain. FRONTIERS IN PAIN RESEARCH (LAUSANNE, SWITZERLAND) 2023; 3:1084701. [PMID: 36713643 PMCID: PMC9874335 DOI: 10.3389/fpain.2022.1084701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 12/22/2022] [Indexed: 01/13/2023]
Abstract
The use of deep brain stimulation (DBS) for the treatment of chronic pain was one of the first applications of this technique in functional neurosurgery. Established brain targets in the clinic include the periaqueductal (PAG)/periventricular gray matter (PVG) and sensory thalamic nuclei. More recently, the anterior cingulum (ACC) and the ventral striatum/anterior limb of the internal capsule (VS/ALIC) have been investigated for the treatment of emotional components of pain. In the clinic, most studies showed a response in 20%-70% of patients. In various applications of DBS, animal models either provided the rationale for the development of clinical trials or were utilized as a tool to study potential mechanisms of stimulation responses. Despite the complex nature of pain and the fact that animal models cannot reliably reflect the subjective nature of this condition, multiple preparations have emerged over the years. Overall, DBS was shown to produce an antinociceptive effect in rodents when delivered to targets known to induce analgesic effects in humans, suggesting a good predictive validity. Compared to the relatively high number of clinical trials in the field, however, the number of animal studies has been somewhat limited. Additional investigation using modern neuroscience techniques could unravel the mechanisms and neurocircuitry involved in the analgesic effects of DBS and help to optimize this therapy.
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Affiliation(s)
- Rosana L. Pagano
- Laboratory of Neuroscience, Hospital Sírio-Libanês, São Paulo, Brazil
| | - Camila S. Dale
- Laboratory of Neuromodulation and Experimental Pain, Department of Anatomy, University of São Paulo, São Paulo, Brazil
| | | | - Clement Hamani
- Sunnybrook Research Institute, Hurvitz Brain Sciences Centre, Toronto, ON, Canada,Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto, ON, Canada,Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada,Correspondence: Clement Hamani
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9
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Ferroli P, Restelli F, Bertolini G, Monti E, Falco J, Bonomo G, Tramacere I, Pollo B, Calatozzolo C, Patanè M, Schiavolin S, Broggi M, Acerbi F, Erbetta A, Esposito S, Mazzapicchi E, La Corte E, Vetrano IG, Broggi G, Schiariti M. Are Thalamic Intrinsic Lesions Operable? No-Man's Land Revisited by the Analysis of a Large Retrospective, Mono-Institutional, Cohort. Cancers (Basel) 2023; 15:cancers15020361. [PMID: 36672311 PMCID: PMC9856718 DOI: 10.3390/cancers15020361] [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: 11/29/2022] [Revised: 12/30/2022] [Accepted: 01/04/2023] [Indexed: 01/09/2023] Open
Abstract
Thalamic gliomas represent a heterogeneous subset of deep-seated lesions for which surgical removal is advocated, although clear prognostic factors linked to advantages in performance status or overall survival are still lacking. We reviewed our Institutional Cancer Registry, identifying patients who underwent surgery for thalamic gliomas between 2006 and 2020. Associations between possible prognostic factors such as tumor volume, grade, the extent of resection and performance status (PS), and overall survival (OS) were evaluated using univariate and multivariate survival analyses. We found 56 patients: 31 underwent surgery, and 25 underwent biopsy. Compared to biopsy, surgery resulted positively associated with an increase in the OS (hazard ratio, HR, at multivariate analysis 0.30, 95% confidence interval, CI, 0.12-0.75). Considering the extent of resection (EOR), obtaining GTR/STR appeared to offer an OS advantage in high-grade gliomas (HGG) patients submitted to surgical resection if compared to biopsy, although we did not find statistical significance at multivariate analysis (HR 0.53, 95% CI 0.17-1.59). Patients with a stable 3-month KPS after surgery demonstrated to have a better prognosis in terms of OS if compared to biopsy (multivariate HR 0.17, 95% CI, 0.05-0.59). Age and histological grades were found to be prognostic factors for this condition (p = 0.04 and p = 0.004, respectively, chi-square test). Considering the entire cohort, p53 positivity (univariate HR 2.21, 95% CI 1.01-4.82) and ATRX positivity (univariate HR 2.69, 95% CI 0.92-7.83) resulted associated with a worse prognosis in terms of OS. In this work, we demonstrated that surgery aimed at tumor resection might offer a stronger survival advantage when a stable 3-month KPS after surgery is achieved.
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Affiliation(s)
- Paolo Ferroli
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Francesco Restelli
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
- Correspondence: ; Tel.: +39-02-2394-2309; Fax: +39-02-7063-5017
| | - Giacomo Bertolini
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Emanuele Monti
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Jacopo Falco
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Giulio Bonomo
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
- Department of Neurological Surgery, Policlinico “G. Rodolico–S. Marco”, University Hospital, 95123 Catania, Italy
| | - Irene Tramacere
- Department of Research and Clinical Development, Scientific Directorate, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Bianca Pollo
- Unit of Neuropathology, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Chiara Calatozzolo
- Unit of Neuropathology, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Monica Patanè
- Unit of Neuropathology, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Silvia Schiavolin
- Public Health and Disability Unit–Scientific Directorate, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Morgan Broggi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Francesco Acerbi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Alessandra Erbetta
- Unit of Neuroradiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Silvia Esposito
- Department of Paediatric Neuroscience, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Elio Mazzapicchi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Emanuele La Corte
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
- Department of Neurosurgery, Alma Mater Studiorum, University of Bologna, 40126 Bologna, Italy
| | - Ignazio Gaspare Vetrano
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, 20133 Milan, Italy
| | - Giovanni Broggi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
- IEN Foundation, 20100 Milan, Italy
| | - Marco Schiariti
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
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10
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Hosp JA, Dressing A, Engesser A, Glauche V, Kümmerer D, Vaidelyte EB, Musso M, Rijntjes M, Weiller C. The Role of Ascending Ventral-Tegmental Fibers for Recovery after Stroke. Ann Neurol 2022; 93:922-933. [PMID: 36585896 DOI: 10.1002/ana.26595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 12/29/2022] [Accepted: 12/30/2022] [Indexed: 01/01/2023]
Abstract
OBJECTIVES The integrity of cortical motor networks and their descending effector pathway (the corticospinal tract [CST]) is a major determinant motor recovery after stroke. However, this view neglects the importance of ascending tracts and their modulatory effects on cortical physiology. Here, we explore the role of such a tract that connects dopaminergic ventral tegmental midbrain nuclei to the motor cortex (the VTMC tract) for post-stroke recovery. METHODS Lesion data and diffusivity parameters (fractional anisotropy) of the ipsi- and contralesional VTMC tract and CST were obtained from 133 patients (63.9 ± 13.4 years, 45 women) during the acute and chronic stage after the first ever ischemic stroke in the middle cerebral artery territory. Degeneration of VTMC tract and CST was quantified and related to clinical outcome parameters (National Institute of Health Stroke Scale with motor and cortical symptom subscores; modified Fugl-Meyer upper extremity score; modified Ranking Scale [mRS]). RESULTS A significant post-stroke degeneration occurred in both tracts, but only VTMC degeneration was associated with lesion size. Using multiple regression models, we dissected the impact of particular tracts on recovery: Changes in VTMC tract integrity were stronger associated with independence in daily activities (mRS), upper limb motor impairment (modified Fugl-Meyer upper extremity score) and cortical symptoms (aphasia, neglect) captured by National Institute of Health Stroke Scale compared to CST. Changes in CST integrity merely were associated with the degree of hemiparesis (National Institute of Health Stroke Scale motor subscale). INTERPRETATION Post-stroke outcome is influenced by ascending (VTMC) and descending (CST) fiber tracts. Favorable outcome regarding independence (modified Ranking Scale), upper limb motor function (modified Fugl-Meyer upper extremity score), and cortical symptoms (aphasia, neglect) was more strongly related to the ascending than descending tract. ANN NEUROL 2023.
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Affiliation(s)
- Jonas A Hosp
- Department of Neurology and Clinical Neuroscience, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, Germany
| | - Andrea Dressing
- Department of Neurology and Clinical Neuroscience, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, Germany.,Freiburg Brain Imaging Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Anika Engesser
- Department of Neurology and Clinical Neuroscience, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, Germany
| | - Volkmar Glauche
- Department of Neurology and Clinical Neuroscience, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, Germany.,Freiburg Brain Imaging Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Dorothee Kümmerer
- Department of Neurology and Clinical Neuroscience, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, Germany.,Freiburg Brain Imaging Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ema B Vaidelyte
- Department of Neurology and Clinical Neuroscience, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, Germany
| | - Mariachristina Musso
- Department of Neurology and Clinical Neuroscience, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, Germany.,Freiburg Brain Imaging Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Michel Rijntjes
- Department of Neurology and Clinical Neuroscience, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, Germany.,Freiburg Brain Imaging Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Cornelius Weiller
- Department of Neurology and Clinical Neuroscience, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, Germany.,Freiburg Brain Imaging Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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11
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Patterned Stimulation of the Chrimson Opsin in Glutamatergic Motor Thalamus Neurons Improves Forelimb Akinesia in Parkinsonian Rats. Neuroscience 2022; 507:64-78. [PMID: 36343721 DOI: 10.1016/j.neuroscience.2022.10.026] [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: 06/07/2022] [Revised: 09/20/2022] [Accepted: 10/30/2022] [Indexed: 11/06/2022]
Abstract
Parkinson's disease (PD) is a motor disorder charactertised by altered neural activity throughout the basal ganglia-thalamocortical circuit. Electrical deep brain stimulation (DBS) is efficacious in alleviating motor symptoms, but has several notable side-effects, most likely reflecting the non-specific nature of electrical stimulation and/or the brain regions targeted. We determined whether specific optogenetic activation of glutamatergic motor thalamus (Mthal) neurons alleviated forelimb akinesia in a chronic rat model of PD. Parkinsonian rats (unilateral 6-hydroxydopamine injection) were injected with an adeno-associated viral vector (AAV5-CaMKII-Chrimson-GFP) to transduce glutamatergic Mthal neurons with the red-shifted Chrimson opsin. Optogenetic stimulation with orange light at 15 Hz tonic and a physiological pattern, previously recorded from a Mthal neuron in a control rat, significantly increased forelimb use in the reaching test (p < 0.01). Orange light theta burst stimulation, 15 Hz and control reaching patterns significantly reduced akinesia (p < 0.0001) assessed by the step test. In contrast, forelimb use in the cylinder test was unaffected by orange light stimulation with any pattern. Blue light (control) stimulation failed to alter behaviours. Activation of Chrimson using complex patterns in the Mthal may be an alternative treatment to recover movement in PD. These vector and opsin changes are important steps towards translating optogenetic stimulation to humans.
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12
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Gray Matter Abnormalities in Patients with Complex Regional Pain Syndrome: A Systematic Review and Meta-Analysis of Voxel-Based Morphometry Studies. Brain Sci 2022; 12:brainsci12081115. [PMID: 36009176 PMCID: PMC9405829 DOI: 10.3390/brainsci12081115] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 08/10/2022] [Accepted: 08/17/2022] [Indexed: 11/17/2022] Open
Abstract
Current findings on brain structural alterations in complex regional pain syndrome (CRPS) are heterogenous and controversial. This study aimed to perform a systematic review and meta-analysis to explore the significant gray matter volume (GMV) abnormalities between patients with CRPS and healthy controls (HCs). A systematic search of the PubMed, Web of Science, and MEDLINE databases was performed, updated through 27 January 2022. A total of five studies (93 CRPS patients and 106 HCs) were included. Peak coordinates and effect sizes were extracted and meta-analyzed by anisotropic effect size-signed differential mapping (AES-SDM). Heterogeneity, sensitivity, and publication bias of the main results were checked by the Q test, jackknife analysis, and the Egger test, respectively. Meta-regression analysis was performed to explore the potential impact of risk factors on GMV alterations in patients with CRPS. The main analysis exhibited that patients with CRPS had increased GMV in the left medial superior frontal gyrus (SFGmedial.L), left striatum, and an undefined area (2, 0, -8) that may be in hypothalamus, as well as decreased GMV in the corpus callosum (CC) (extending to right supplementary motor area (SMA.R), right median cingulate/paracingulate gyri (MCC.R)), and an undefined area (extending to the right caudate nucleus (CAU.R), and right thalamus (THA.R)). Meta-regression analysis showed a negative relationship between increased GMV in the SFGmedial.L and disease duration, and the percentage of female patients with CRPS. Brain structure abnormalities in the sensorimotor regions (e.g., SFGmedial.L, SMA.R, CAU.R, MCC.R, and THA.R) may be susceptible in patients with CRPS. Additionally, sex differences and disease duration may have a negative effect on the increased GMV in SFGmedial.L.
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13
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Savas A, Bayatli E, Eroglu U, Akbostanci MC. Combined Unilateral Radiofrequency Lesioning of the Motor Thalamus, Field of Forel, and Zona Incerta: A Series of Cases With Dystonia. Neurosurgery 2022; 90:313-321. [PMID: 35049526 DOI: 10.1227/neu.0000000000001819] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 10/03/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Dystonia is a group of disorders characterized by involuntary slow repetitive twisting movements and/or abnormal posture. Surgical options such as neuromodulation through deep brain stimulation and neuroablative procedures are available for patients who do not respond to conservative treatment. OBJECTIVE To present our series of patients with dystonia who were treated with stereotactic combined unilateral radiofrequency lesioning of the motor thalamus, field of Forel, and zona incerta. METHODS Medical records of 50 patients with dystonia who were treated with unilateral combined lesions were reviewed. Outcomes of the surgical procedure were evaluated using the Burke-Fahn-Marsden Dystonia Rating Scale (with movement and disability subscales) and Unified Parkinson's Disease Rating Scale-tremor items. RESULTS Based on the symptoms, patients were categorized as having generalized dystonia (34%), hemidystonia (30%), and dystonic tremor (DT) (36%). Primary/idiopathic dystonia, primary genetic/hereditary dystonia, and secondary dystonia accounted for 16%, 4%, and 80% of patients, respectively. The mean follow-up duration was 156.2 ± 88.9 mo. The overall improvement in the Burke-Fahn-Marsden Dystonia Rating Scale scores (movement and disability, respectively) was 57.8% and 36.4% in generalized dystonia, 60.0% and 45.8% in hemidystonia, and 65.6% and 56.8% in DT. Patients with DT showed an 83.3% improvement in mean Unified Parkinson's Disease Rating Scale tremor score. Patients with cerebral palsy showed mean improvements of 66.7% in movement scores and 50.8% in disability scores. No mortality or major morbidity was observed postoperatively. CONCLUSION Stereotactic radiofrequency unilateral combined thalamotomy, campotomy, and zona incerta lesions may be an effective surgical alternative for patients with dystonia, especially those with secondary dystonia resistant to deep brain stimulation.
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Affiliation(s)
- Ali Savas
- Department of Neurosurgery, Ankara University, Ankara, Turkey
| | - Eyup Bayatli
- Department of Neurosurgery, Ankara University, Ankara, Turkey
| | - Umit Eroglu
- Department of Neurosurgery, Ankara University, Ankara, Turkey
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14
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Mensah-Brown KG, Yang AI, Hitti FL, Henry L, Heman-Ackah SM, Chaibainou H, Baltuch GH. Magnetic Resonance-Guided Focused Ultrasound Thalamotomy for Essential Tremor Under General Anesthesia: Technical Note. Oper Neurosurg (Hagerstown) 2022; 22:255-260. [PMID: 35147587 DOI: 10.1227/ons.0000000000000119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 11/03/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Magnetic resonance-guided focused ultrasound (MRgFUS) thalamotomy is an incisionless therapy for the treatment of medication-resistant essential tremor. Although its safety and efficacy has been demonstrated, MRgFUS is typically performed with the patient awake, with intraprocedural neurological assessments to guide lesioning. OBJECTIVE To report the first case of MRgFUS thalamotomy under general anesthesia in a patient whose medical comorbidities prohibit him from being in a supine position without a secured airway. METHODS The dentatorubrothalamic tract was directly targeted. Two sonications reaching lesional temperatures (≥54°C) were delivered without any complications. RESULTS Lesioning was confirmed on intraoperative magnetic resonance imaging, and the patient experienced 89% improvement in his tremor postoperatively. CONCLUSION This demonstrates the safety and feasibility of MRgFUS thalamotomy under general anesthesia without the benefit of intraprocedural neurological assessments.
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Affiliation(s)
- Kobina G Mensah-Brown
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Andrew I Yang
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Frederick L Hitti
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Sabrina M Heman-Ackah
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Hanane Chaibainou
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Gordon H Baltuch
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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15
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Stanziano M, Golfrè Andreasi N, Messina G, Rinaldo S, Palermo S, Verri M, Demichelis G, Medina JP, Ghielmetti F, Bonvegna S, Nigri A, Frazzetta G, D'Incerti L, Tringali G, DiMeco F, Eleopra R, Bruzzone MG. Resting State Functional Connectivity Signatures of MRgFUS Vim Thalamotomy in Parkinson's Disease: A Preliminary Study. Front Neurol 2022; 12:786734. [PMID: 35095731 PMCID: PMC8791196 DOI: 10.3389/fneur.2021.786734] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 12/02/2021] [Indexed: 12/03/2022] Open
Abstract
Magnetic Resonance-guided high-intensity Focused Ultrasound (MRgFUS) of the thalamic ventral intermediate nucleus (Vim) for tremor has increasingly gained interest as a new non-invasive alternative to standard neurosurgery. Resting state functional connectivity (rs-FC) correlates of MRgFUS have not been extensively investigated yet. A region of interest (ROI)-to-ROI rs-FC MRI “connectomic” analysis focusing on brain regions relevant for tremor was conducted on 15 tremor-dominant patients with Parkinson's disease who underwent MRgFUS. We tested whether rs-FC between tremor-related areas was modulated by MRgFUS at 1 and 3 months post-operatively, and whether such changes correlated with individual clinical outcomes assessed by the MDS-UPDRS-III sub items for tremor. Significant increase in FC was detected within bilateral primary motor (M1) cortices, as well as between bilateral M1 and crossed primary somatosensory cortices, and also between pallidum and the dentate nucleus of the untreated hemisphere. Correlation between disease duration and FC increase at 3 months was found between the putamen of both cerebral hemispheres and the Lobe VI of both cerebellar hemispheres, as well as between the Lobe VI of untreated cerebellar hemisphere with bilateral supplementary motor area (SMA). Drop-points value of MDS-UPDRS at 3 months correlated with post-treatment decrease in FC, between the anterior cingulate cortex and bilateral SMA, as well as between the Lobe VI of treated cerebellar hemisphere and the interpositus nucleus of untreated cerebellum. Tremor improvement at 3 months, expressed as percentage of intra-subject MDS-UPDRS changes, correlated with FC decrease between bilateral occipital fusiform gyrus and crossed Lobe VI and Vermis VI. Good responders (≥50% of baseline tremor improvement) showed reduced FC between bilateral SMA, between the interpositus nucleus of untreated cerebellum and the Lobe VI of treated cerebellum, as well as between the untreated SMA and the contralateral putamen. Good responders were characterized at baseline by crossed hypoconnectivity between bilateral putamen and M1, as well as between the putamen of the treated hemisphere and the contralateral SMA. We conclude that MRgFUS can effectively modulate brain FC within the tremor network. Such changes are associated with clinical outcome. The shifting mode of integration among the constituents of this network is, therefore, susceptible to external redirection despite the chronic nature of PD.
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Affiliation(s)
- Mario Stanziano
- Neuroradiology Unit, Diagnostic and Technology Department, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Neurologico Carlo Besta, Milan, Italy.,Neurosciences Department "Rita Levi Montalcini, " University of Turin, Turin, Italy
| | - Nico Golfrè Andreasi
- Parkinson and Movement Disorders Unit, Clinical Neurosciences Department, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Neurologico Carlo Besta, Milan, Italy
| | - Giuseppe Messina
- Functional Neurosurgery Unit, Neurosurgery Department, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Neurologico Carlo Besta, Milan, Italy
| | - Sara Rinaldo
- Parkinson and Movement Disorders Unit, Clinical Neurosciences Department, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Neurologico Carlo Besta, Milan, Italy
| | - Sara Palermo
- Neuroradiology Unit, Diagnostic and Technology Department, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Neurologico Carlo Besta, Milan, Italy.,European Innovation Partnership on Active and Healthy Ageing, Brussels, Belgium
| | - Mattia Verri
- Neuroradiology Unit, Diagnostic and Technology Department, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Neurologico Carlo Besta, Milan, Italy
| | - Greta Demichelis
- Neuroradiology Unit, Diagnostic and Technology Department, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Neurologico Carlo Besta, Milan, Italy
| | - Jean Paul Medina
- Neuroradiology Unit, Diagnostic and Technology Department, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Neurologico Carlo Besta, Milan, Italy
| | - Francesco Ghielmetti
- Health Department, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Neurologico Carlo Besta, Milan, Italy
| | - Salvatore Bonvegna
- Parkinson and Movement Disorders Unit, Clinical Neurosciences Department, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Neurologico Carlo Besta, Milan, Italy
| | - Anna Nigri
- Neuroradiology Unit, Diagnostic and Technology Department, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Neurologico Carlo Besta, Milan, Italy
| | | | - Ludovico D'Incerti
- Neuroradiology Unit, Diagnostic and Technology Department, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Neurologico Carlo Besta, Milan, Italy
| | - Giovanni Tringali
- Functional Neurosurgery Unit, Neurosurgery Department, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Neurologico Carlo Besta, Milan, Italy
| | - Francesco DiMeco
- Neurosurgery Department, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Neurologico Carlo Besta, Milan, Italy.,Pathophysiology and Transplantation Department, University of Milan, Milan, Italy.,Neurological Surgery Department, Johns Hopkins Medical School, Baltimore, MD, United States
| | - Roberto Eleopra
- Parkinson and Movement Disorders Unit, Clinical Neurosciences Department, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Neurologico Carlo Besta, Milan, Italy
| | - Maria Grazia Bruzzone
- Neuroradiology Unit, Diagnostic and Technology Department, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Neurologico Carlo Besta, Milan, Italy
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16
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Engelhardt J, Cuny E, Guehl D, Burbaud P, Damon-Perrière N, Dallies-Labourdette C, Thomas J, Branchard O, Schmitt LA, Gassa N, Zemzemi N. Prediction of Clinical Deep Brain Stimulation Target for Essential Tremor From 1.5 Tesla MRI Anatomical Landmarks. Front Neurol 2021; 12:620360. [PMID: 34777189 PMCID: PMC8579860 DOI: 10.3389/fneur.2021.620360] [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: 11/04/2020] [Accepted: 09/13/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Deep brain stimulation is an efficacious treatment for refractory essential tremor, though targeting the intra-thalamic nuclei remains challenging. Objectives: We sought to develop an inverse approach to retrieve the position of the leads in a cohort of patients operated on with optimal clinical outcomes from anatomical landmarks identifiable by 1.5 Tesla magnetic resonance imaging. Methods: The learning database included clinical outcomes and post-operative imaging from which the coordinates of the active contacts and those of anatomical landmarks were extracted. We used machine learning regression methods to build three different prediction models. External validation was performed according to a leave-one-out cross-validation. Results: Fifteen patients (29 leads) were included, with a median tremor improvement of 72% on the Fahn-Tolosa-Marin scale. Kernel ridge regression, deep neural networks, and support vector regression (SVR) were used. SVR gave the best results with a mean error of 1.33 ± 1.64 mm between the predicted target and the active contact position. Conclusion: We report an original method for the targeting in deep brain stimulation for essential tremor based on patients' radio-anatomical features. This approach will be tested in a prospective clinical trial.
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Affiliation(s)
- Julien Engelhardt
- Department of Neurosurgery, University Hospital of Bordeaux, Bordeaux, France.,Institute for Neurodegenerative Disorders, CNRS-University of Bordeaux, Bordeaux, France
| | - Emmanuel Cuny
- Department of Neurosurgery, University Hospital of Bordeaux, Bordeaux, France.,Institute for Neurodegenerative Disorders, CNRS-University of Bordeaux, Bordeaux, France
| | - Dominique Guehl
- Institute for Neurodegenerative Disorders, CNRS-University of Bordeaux, Bordeaux, France.,Department of Neurology, University Hospital of Bordeaux, Bordeaux, France
| | - Pierre Burbaud
- Institute for Neurodegenerative Disorders, CNRS-University of Bordeaux, Bordeaux, France.,Department of Neurology, University Hospital of Bordeaux, Bordeaux, France
| | - Nathalie Damon-Perrière
- Institute for Neurodegenerative Disorders, CNRS-University of Bordeaux, Bordeaux, France.,Department of Neurology, University Hospital of Bordeaux, Bordeaux, France
| | - Camille Dallies-Labourdette
- Institute for Neurodegenerative Disorders, CNRS-University of Bordeaux, Bordeaux, France.,Department of Neurology, University Hospital of Bordeaux, Bordeaux, France
| | - Juliette Thomas
- Institute for Neurodegenerative Disorders, CNRS-University of Bordeaux, Bordeaux, France.,Department of Neurology, University Hospital of Bordeaux, Bordeaux, France
| | - Olivier Branchard
- Department of Neurosurgery, University Hospital of Bordeaux, Bordeaux, France
| | | | - Narimane Gassa
- INRIA Bordeaux Sud-Ouest Research Centre, Talence, France
| | - Nejib Zemzemi
- INRIA Bordeaux Sud-Ouest Research Centre, Talence, France.,Mathematical Institute of Bordeaux, University of Bordeaux, Bordeaux, France
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17
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Thaker AA, Reddy KM, Thompson JA, Gerecht PD, Brown MS, Abosch A, Ojemann SG, Kern DS. Coronal Gradient Echo MRI to Visualize the Zona Incerta for Deep Brain Stimulation Targeting in Parkinson's Disease. Stereotact Funct Neurosurg 2021; 99:443-450. [PMID: 33902054 DOI: 10.1159/000515772] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 03/10/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Deep brain stimulation of the zona incerta is effective at treating tremor and other forms of parkinsonism. However, the structure is not well visualized with standard MRI protocols making direct surgical targeting unfeasible and contributing to inconsistent clinical outcomes. In this study, we applied coronal gradient echo MRI to directly visualize the rostral zona incerta in Parkinson's disease patients to improve targeting for deep brain stimulation. METHODS We conducted a prospective study to optimize and evaluate an MRI sequence to visualize the rostral zona incerta in patients with Parkinson's disease (n = 31) and other movement disorders (n = 13). We performed a contrast-to-noise ratio analysis of specific regions of interest to quantitatively assess visual discrimination of relevant deep brain structures in the optimized MRI sequence. Regions of interest were independently assessed by 2 neuroradiologists, and interrater reliability was assessed. RESULTS Rostral zona incerta and subthalamic nucleus were well delineated in our 5.5-min MRI sequence, indicated by excellent interrater agreement between neuroradiologists for region-of-interest measurements (>0.90 intraclass coefficient). Mean contrast-to-noise ratio was high for both rostral zona incerta (6.39 ± 3.37) and subthalamic nucleus (17.27 ± 5.61) relative to adjacent white matter. There was no significant difference between mean signal intensities or contrast-to-noise ratio for Parkinson's and non-Parkinson's patients for either structure. DISCUSSION/CONCLUSION Our optimized coronal gradient echo MRI sequence delineates subcortical structures relevant to traditional and novel deep brain stimulation targets, including the zona incerta, with high contrast-to-noise. Future studies will prospectively apply this sequence to surgical planning and postimplantation outcomes.
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Affiliation(s)
- Ashesh A Thaker
- Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Kartik M Reddy
- Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - John A Thompson
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.,Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Pamela David Gerecht
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Mark S Brown
- Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Aviva Abosch
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.,Department of Neurosurgery, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Steven G Ojemann
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Drew S Kern
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.,Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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18
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Kapadia AN, Elias GJB, Boutet A, Germann J, Pancholi A, Chu P, Zhong J, Fasano A, Munhoz R, Chow C, Kucharczyk W, Schwartz ML, Hodaie M, Lozano AM. Multimodal MRI for MRgFUS in essential tremor: post-treatment radiological markers of clinical outcome. J Neurol Neurosurg Psychiatry 2020; 91:921-927. [PMID: 32651242 DOI: 10.1136/jnnp-2020-322745] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 04/22/2020] [Accepted: 06/11/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND MRI-guided focused ultrasound (MRgFUS) thalamotomy is a promising non-invasive treatment option for medication-resistant essential tremor. However, it has been associated with variable efficacy and a relatively high incidence of adverse effects. OBJECTIVES To assess the evolution of radiological findings after MRgFUS thalamotomy and to evaluate their significance for clinical outcomes. METHODS Ninety-four patients who underwent MRgFUS between 2012 and 2017 were retrospectively evaluated. Lesion characteristics were assessed on routine MRI sequences, as well as with tractography. Relationships between imaging appearance, extent of white matter tract lesioning (59/94, on a 4-point scale) and clinical outcome were investigated. Recurrence was defined as >33% loss of tremor suppression at 3 months relative to day 7. RESULTS Acute lesions demonstrated blood products, surrounding oedema and peripheral diffusion restriction. The extent of dentatorubrothalamic tract (DRTT) lesioning was significantly associated with clinical improvement at 1 year (t=4.32, p=0.001). Lesion size decreased over time (180.8±91.5 mm3 at day 1 vs 19.5±19.3 mm3 at 1-year post-treatment). Higher post-treatment oedema (t=3.59, p<0.001) was associated with larger lesions at 3 months. Patients with larger lesions at day 1 demonstrated reduced rates of tremor recurrence (t=2.67, p=0.019); however, lesions over 170 mm3 trended towards greater incidence of adverse effects (sensitivity=0.60, specificity=0.63). Lesion encroachment on the medial lemniscus (Sn=1.00, Sp=0.32) and pyramidal tract (Sn=1.00, Sp=0.12) were also associated with increased adverse effects incidence. CONCLUSION Lesion size at day 1 predicts symptom recurrence, with fewer recurrences seen with larger lesions. Greater DRTT lesioning is associated with treatment efficacy. These findings may have implications for lesion targeting and extent. TRIAL REGISTRATION NUMBER NCT02252380.
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Affiliation(s)
- Anish N Kapadia
- Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Gavin J B Elias
- Division of Neurosurgery, University Health Network, Toronto, Ontario, Canada
| | - Alexandre Boutet
- Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada.,Division of Neurosurgery, University Health Network, Toronto, Ontario, Canada
| | - Jürgen Germann
- Division of Neurosurgery, University Health Network, Toronto, Ontario, Canada
| | - Aditiya Pancholi
- Division of Neurosurgery, University Health Network, Toronto, Ontario, Canada
| | - Powell Chu
- Division of Neurosurgery, University Health Network, Toronto, Ontario, Canada
| | - Jidan Zhong
- Division of Neurosurgery, University Health Network, Toronto, Ontario, Canada
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Division of Neurology, University Health Network, Toronto, Ontario, Canada
| | - Renato Munhoz
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Division of Neurology, University Health Network, Toronto, Ontario, Canada
| | - Clement Chow
- Division of Neurosurgery, University Health Network, Toronto, Ontario, Canada
| | - Walter Kucharczyk
- Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada.,Division of Neurosurgery, University Health Network, Toronto, Ontario, Canada
| | - Michael L Schwartz
- Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Mojgan Hodaie
- Division of Neurosurgery, University Health Network, Toronto, Ontario, Canada
| | - Andres M Lozano
- Division of Neurosurgery, University Health Network, Toronto, Ontario, Canada
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19
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Pelzer EA, Pauls KAM, Braun N, Tittgemeyer M, Timmermann L. Probabilistic tractography in the ventrolateral thalamic nucleus: cerebellar and pallidal connections. Brain Struct Funct 2020; 225:1685-1689. [PMID: 32363531 PMCID: PMC7286851 DOI: 10.1007/s00429-020-02076-9] [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: 09/28/2019] [Accepted: 04/18/2020] [Indexed: 12/26/2022]
Abstract
The ventrolateral thalamic nucleus (VL), as part of the 'motor thalamus', is main relay station of cerebellar and pallidal projections. It comprises anterior (VLa) and posterior (VLpd and VLpv) subnuclei. Though the fibre architecture of cerebellar and pallidal projections to of the VL nucleus has already been focus in a numerous amount of in vitro studies mainly in animals, probabilistic tractography now offers the possibility of an in vivo comparison in healthy humans. In this study we performed a (a) qualitative and (b) quantitative examination of VL-cerebellar and VL-pallidal pathways and compared the probability distributions between both projection fields in the VL after an (I) atlas-based and (II) manual-based segmentation procedure. Both procedures led to high congruent results of cerebellar and pallidal connectivity distributions: the maximum of pallidal projections was located in anterior and medial parts of the VL nucleus, whereas cerebellar connectivity was more located in lateral and posterior parts. The median connectivity for cerebellar connections in both approaches (manual and atlas-based segmentation) was VLa > VLpv > VLpd, whereas the pallidal median connectivity was VLa ~ VLpv > VLpd in the atlas-based approach and VLpv > VLa > VLpd in the manual approach.
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Affiliation(s)
- Esther A Pelzer
- Department of Neurology, University Hospital Cologne, Cologne, Germany. .,Max-Planck Institute for Metabolism Research, Gleulerstr. 50, 50931, Cologne, Germany.
| | - K Amande M Pauls
- Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland.,Department of Clinical Neurosciences (Neurology), University of Helsinki, Helsinki, Finland.,BioMag Laboratory, HUS Medical Imaging Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Nina Braun
- Department of Neurology, University Hospital Cologne, Cologne, Germany
| | - Marc Tittgemeyer
- Max-Planck Institute for Metabolism Research, Gleulerstr. 50, 50931, Cologne, Germany
| | - Lars Timmermann
- Department of Neurology, University Hospital Cologne, Cologne, Germany.,Department of Neurology, University Hospital Marburg, Marburg, Germany
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20
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Coenen VA, Sajonz B, Prokop T, Reisert M, Piroth T, Urbach H, Jenkner C, Reinacher PC. The dentato-rubro-thalamic tract as the potential common deep brain stimulation target for tremor of various origin: an observational case series. Acta Neurochir (Wien) 2020; 162:1053-1066. [PMID: 31997069 PMCID: PMC7156360 DOI: 10.1007/s00701-020-04248-2] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 01/23/2020] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Deep brain stimulation alleviates tremor of various origins. The dentato-rubro-thalamic tract (DRT) has been suspected as a common tremor-reducing structure. Statistical evidence has not been obtained. We here report the results of an uncontrolled case series of patients with refractory tremor who underwent deep brain stimulation under tractographic assistance. METHODS A total of 36 patients were enrolled (essential tremor (17), Parkinson's tremor (8), multiple sclerosis (7), dystonic head tremor (3), tardive dystonia (1)) and received 62 DBS electrodes (26 bilateral; 10 unilateral). Preoperatively, diffusion tensor magnetic resonance imaging sequences were acquired together with high-resolution anatomical T1W and T2W sequences. The DRT was individually tracked and used as a direct thalamic or subthalamic target. Intraoperative tremor reduction was graded on a 4-point scale (0 = no tremor reduction to 3 = full tremor control) and recorded together with the current amplitude, respectively. Stimulation point coordinates were recorded and compared to DRT. The relation of the current amplitude needed to reduce tremor was expressed as TiCR (tremor improvement per current ratio). RESULTS Stimulation points of 241 were available for analysis. A total of 68 trajectories were tested (62 dB leads, 1.1 trajectories tested per implanted lead). Tremor improvement was significantly decreasing (p < 0.01) if the distance to both the border and the center of the DRT was increasing. On the initial trajectory, 56 leads (90.3%) were finally placed. Long-term outcomes were not part of this analysis. DISCUSSION Tremor of various origins was acutely alleviated at different points along the DRT fiber tract (above and below the MCP plane) despite different tremor diseases. DRT is potentially a common tremor-reducing structure. Individual targeting helps to reduce brain penetrating tracts. TiCR characterizes stimulation efficacy and might help to identify an optimal stimulation point.
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Affiliation(s)
- Volker Arnd Coenen
- Department of Stereotactic and Functional Neurosurgery, Freiburg University Medical Center, Freiburg (i.Br.), Germany.
- Faculty of Medicine, Freiburg University, Freiburg (i.Br.), Germany.
- Brain Links/Brain Tools Cluster of Excellence, Freiburg University, Freiburg (i.Br.), Germany.
- NeuroModul Basics (Center for Basics in NeuroModulation), Freiburg University, Freiburg (i.Br.), Germany.
| | - Bastian Sajonz
- Department of Stereotactic and Functional Neurosurgery, Freiburg University Medical Center, Freiburg (i.Br.), Germany
- Faculty of Medicine, Freiburg University, Freiburg (i.Br.), Germany
| | - Thomas Prokop
- Department of Stereotactic and Functional Neurosurgery, Freiburg University Medical Center, Freiburg (i.Br.), Germany
- Faculty of Medicine, Freiburg University, Freiburg (i.Br.), Germany
| | - Marco Reisert
- Department of Stereotactic and Functional Neurosurgery, Freiburg University Medical Center, Freiburg (i.Br.), Germany
- Faculty of Medicine, Freiburg University, Freiburg (i.Br.), Germany
| | - Tobias Piroth
- Faculty of Medicine, Freiburg University, Freiburg (i.Br.), Germany
- Brain Links/Brain Tools Cluster of Excellence, Freiburg University, Freiburg (i.Br.), Germany
- Department of Neurology and Neurophysiology, Freiburg University Medical Center, Freiburg (i.Br.), Germany
| | - Horst Urbach
- Faculty of Medicine, Freiburg University, Freiburg (i.Br.), Germany
- Department of Neuroradiology, Freiburg University Medical Center, Freiburg (i.Br.), Germany
| | - Carolin Jenkner
- Faculty of Medicine, Freiburg University, Freiburg (i.Br.), Germany
- Clinical Trials Unit, Freiburg University Medical Center, Freiburg, Germany
| | - Peter Christoph Reinacher
- Department of Stereotactic and Functional Neurosurgery, Freiburg University Medical Center, Freiburg (i.Br.), Germany
- Faculty of Medicine, Freiburg University, Freiburg (i.Br.), Germany
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21
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Krishna V, Sammartino F, Agrawal P, Changizi BK, Bourekas E, Knopp MV, Rezai A. Prospective Tractography-Based Targeting for Improved Safety of Focused Ultrasound Thalamotomy. Neurosurgery 2020; 84:160-168. [PMID: 29579287 DOI: 10.1093/neuros/nyy020] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 01/19/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Focused ultrasound thalamotomy (FUS-T) was recently approved for the treatment of refractory essential tremor (ET). Despite its noninvasive approach, FUS-T reinitiated concerns about the adverse effects and long-term efficacy after lesioning. OBJECTIVE To prospectively assess the outcomes of FUS-T in 10 ET patients using tractography-based targeting of the ventral intermediate nucleus (VIM). METHODS VIM was identified at the intercommissural plane based on its neighboring tracts: the pyramidal tract and medial lemniscus. FUS-T was performed at the center of tractography-defined VIM. Tremor outcomes, at baseline and 3 mo, were assessed independently by the Tremor Research Group. We analyzed targeting coordinates, clinical outcomes, and adverse events. The FUS-T lesion location was analyzed in relation to unbiased thalamic parcellation using probabilisitic tractography. Quantitative diffusion-weighted imaging changes were also studied in fiber tracts of interest. RESULTS The tractography coordinates were more anterior than the standard. Intraoperatively, therapeutic sonications at the tractography target improved tremor (>50% improvement) without motor or sensory side effects. Sustained improvement in tremor was observed at 3 mo (tremor score: 18.3 ± 6.9 vs 8.1 ± 4.4, P = .001). No motor weakness and sensory deficits after FUS-T were observed during 6-mo follow-up. Ataxia was observed in 3 patients. FUS-T lesions overlapped with the VIM parcellated with probablisitic tractography. Significant microstructural changes were observed in the white matter connecting VIM with cerebellum and motor cortex. CONCLUSION This is the first report of prospective VIM targeting with tractography for FUS-T. These results suggest that tractography-guided targeting is safe and has satisfactory short-term clinical outcomes.
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Affiliation(s)
- Vibhor Krishna
- Center for Neuromodulation, The Ohio State University, Columbus, Ohio
| | | | - Punit Agrawal
- Center for Neuromodulation, The Ohio State University, Columbus, Ohio
| | | | - Eric Bourekas
- De-partment of Radiology, The Ohio State University, Columbus, Ohio
| | - Michael V Knopp
- De-partment of Radiology, The Ohio State University, Columbus, Ohio
| | - Ali Rezai
- Center for Neuromodulation, The Ohio State University, Columbus, Ohio
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22
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Essential Tremor: Lesions. Stereotact Funct Neurosurg 2020. [DOI: 10.1007/978-3-030-34906-6_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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23
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van Nuland AJM, den Ouden HEM, Zach H, Dirkx MFM, van Asten JJA, Scheenen TWJ, Toni I, Cools R, Helmich RC. GABAergic changes in the thalamocortical circuit in Parkinson's disease. Hum Brain Mapp 2019; 41:1017-1029. [PMID: 31721369 PMCID: PMC7267977 DOI: 10.1002/hbm.24857] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 08/31/2019] [Accepted: 10/22/2019] [Indexed: 12/29/2022] Open
Abstract
Parkinson's disease is characterized by bradykinesia, rigidity, and tremor. These symptoms have been related to an increased gamma‐aminobutyric acid (GABA)ergic inhibitory drive from globus pallidus onto the thalamus. However, in vivo empirical evidence for the role of GABA in Parkinson's disease is limited. Some discrepancies in the literature may be explained by the presence or absence of tremor. Specifically, recent functional magnetic resonance imaging (fMRI) findings suggest that Parkinson's tremor is associated with reduced, dopamine‐dependent thalamic inhibition. Here, we tested the hypothesis that GABA in the thalamocortical motor circuit is increased in Parkinson's disease, and we explored differences between clinical phenotypes. We included 60 Parkinson patients with dopamine‐resistant tremor (n = 17), dopamine‐responsive tremor (n = 23), or no tremor (n = 20), and healthy controls (n = 22). Using magnetic resonance spectroscopy, we measured GABA‐to‐total‐creatine ratio in motor cortex, thalamus, and a control region (visual cortex) on two separate days (ON and OFF dopaminergic medication). GABA levels were unaltered by Parkinson's disease, clinical phenotype, or medication. However, motor cortex GABA levels were inversely correlated with disease severity, particularly rigidity and tremor, both ON and OFF medication. We conclude that cortical GABA plays a beneficial rather than a detrimental role in Parkinson's disease, and that GABA depletion may contribute to increased motor symptom expression.
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Affiliation(s)
- Annelies J M van Nuland
- Radboud University Nijmegen, Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Nijmegen, The Netherlands
| | - Hanneke E M den Ouden
- Radboud University Nijmegen, Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Nijmegen, The Netherlands
| | - Heidemarie Zach
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, The Netherlands.,Medical University of Vienna, Department of Neurology, Vienna, Austria
| | - Michiel F M Dirkx
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, The Netherlands
| | - Jack J A van Asten
- Radboud University Medical Centre, Department of Radiology and Nuclear Medicine, Nijmegen, The Netherlands
| | - Tom W J Scheenen
- Radboud University Medical Centre, Department of Radiology and Nuclear Medicine, Nijmegen, The Netherlands
| | - Ivan Toni
- Radboud University Nijmegen, Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Nijmegen, The Netherlands
| | - Roshan Cools
- Radboud University Nijmegen, Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Nijmegen, The Netherlands
| | - Rick C Helmich
- Radboud University Nijmegen, Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Nijmegen, The Netherlands.,Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, The Netherlands
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24
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Hosp JA, Coenen VA, Rijntjes M, Egger K, Urbach H, Weiller C, Reisert M. Ventral tegmental area connections to motor and sensory cortical fields in humans. Brain Struct Funct 2019; 224:2839-2855. [PMID: 31440906 PMCID: PMC6778584 DOI: 10.1007/s00429-019-01939-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Accepted: 08/10/2019] [Indexed: 12/13/2022]
Abstract
In humans, sensorimotor cortical areas receive relevant dopaminergic innervation—although an anatomic description of the underlying fiber projections is lacking so far. In general, dopaminergic projections towards the cortex originate within the ventral tegmental area (VTA) and are organized in a meso-cortico-limbic system. Using a DTI-based global tractography approach, we recently characterized the superolateral branch of the medial forebrain bundle (slMFB), a prominent pathway providing dopaminergic (and other transmitters) innervation for the pre-frontal cortex (Coenen et al., NeuroImage Clin 18:770–783, 2018). To define the connections between VTA and sensory–motor cortical fields that should contain dopaminergic fibers, we use the slMFB as a key structure to lead our fiber selection procedure: using a similar tracking-seed and tractography algorithm, we describe a dorsal extension of this slMFB that covers sensorimotor fields that are dorsally appended to pre-frontal cortical areas. This “motorMFB”, that connects the VTA to sensorimotor cortical fields, can be further segregated into three sub-bundles with a seed-based fiber-selection strategy: A PFC bundle that is attendant to the pre-frontal cortex, passes the lateral VTA, runs through the border zone between the posterior and lateral ventral thalamic nucleus, and involves the pre- and postcentral gyrus. An MB bundle that is attendant to the mammillary bodies runs directly through the medial VTA, passes the lateral ventral thalamic nucleus, and involves the pre- and postcentral gyrus as well as the supplementary motor area (SMA) and the dorsal premotor cortex (dPMC). Finally, a BC bundle that is attendant to the brainstem and cerebellum runs through the lateral VTA, passes the anterior ventral thalamic nucleus, and covers the SMA, pre-SMA, and the dPMC. We, furthermore, included a fiber tracking of the well-defined dentato-rubro-thalamic tract (DRT) that is known to lie in close proximity with respect to fiber orientation and projection areas. As expected, the tract is characterized by a decussation at the ponto-mesencephal level and a projection covering the superior-frontal and precentral cortex. In addition to the physiological role of these particular bundles, the physiological and pathophysiological impact of dopaminergic signaling within sensorimotor cortical fields becomes discussed. However, some limitations have to be taken into account in consequence of the method: the transmitter content, the directionality, and the occurrence of interposed synaptic contacts cannot be specified.
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Affiliation(s)
- Jonas A Hosp
- Department of Neurology and Neuroscience, Freiburg University Medical Center, Breisacher Str. 64, 79106, Freiburg, Germany. .,Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - V A Coenen
- Department of Stereotactic and Functional Neurosurgery, Freiburg University Medical Center, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Center for Basics in Neuromodulation, University of Freiburg, Freiburg, Germany
| | - M Rijntjes
- Department of Neurology and Neuroscience, Freiburg University Medical Center, Breisacher Str. 64, 79106, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - K Egger
- Department of Neuroradiology, Freiburg University Medical Center, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - H Urbach
- Department of Neuroradiology, Freiburg University Medical Center, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - C Weiller
- Department of Neurology and Neuroscience, Freiburg University Medical Center, Breisacher Str. 64, 79106, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - M Reisert
- Department of Stereotactic and Functional Neurosurgery, Freiburg University Medical Center, Freiburg, Germany.,Department of Medical Physics, Freiburg University Medical Center, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
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25
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Pedrosa DJ, Brown P, Cagnan H, Visser-Vandewalle V, Wirths J, Timmermann L, Brittain JS. A functional micro-electrode mapping of ventral thalamus in essential tremor. Brain 2019; 141:2644-2654. [PMID: 30052807 PMCID: PMC6113647 DOI: 10.1093/brain/awy192] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 06/04/2018] [Indexed: 11/23/2022] Open
Abstract
Deep brain stimulation enables the delivery of therapeutic interventions to otherwise inaccessible areas of the brain while, at the same time, offering the unique opportunity to record from these same regions in awake patients. The posterior ventrolateral thalamus has become a reliable deep brain stimulation target for medically-refractory patients suffering from essential tremor. However, the contribution of the thalamus in essential tremor, and even whether posterior ventrolateral thalamus is the optimal target, remains a matter of ongoing debate. There are several lines of evidence supporting clusters of activity within the posterior ventrolateral thalamus that are important for tremor emergence. In this study we sought to map the functional properties of these clusters through microelectrode recordings during deep brain stimulation surgery. Data were obtained from 10 severely affected patients with essential tremor (12 hemispheres) undergoing deep brain stimulation surgery. Our results demonstrate power and coherence maxima located in the inferior posterior ventrolateral thalamus and immediate ventral region. Moreover, we identified distinct yet overlapping clusters of predominantly efferent (driving) and afferent (feedback) activity, with a preference for more efferent contributors, consistent with a net role in the driving of tremor output. Finally, we demonstrate that resolvable thalamic spiking activity directly relates to background activity and that the strength of tremor may be dictated by phase relationships between efferent and afferent pockets in the posterior ventrolateral thalamus. Taken together, these results provide important evidence for the role of the inferior posterior ventrolateral thalamus and its border region in essential tremor pathophysiology. Such results progress our mechanistic understanding and promote the adoption of next-generation therapies such as high resolution segregated deep brain stimulation electrodes.
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Affiliation(s)
- David J Pedrosa
- Department of Neurology, University Hospital of Marburg and Gießen, Marburg, Germany.,Nuffield Department of Clinical Neurosciences and MRC Brain Network Dynamics Unit, University of Oxford, Oxford, UK.,Department of Psychiatry, University Hospital of Marburg and Gießen, Marburg, Germany
| | - Peter Brown
- Nuffield Department of Clinical Neurosciences and MRC Brain Network Dynamics Unit, University of Oxford, Oxford, UK
| | - Hayriye Cagnan
- Nuffield Department of Clinical Neurosciences and MRC Brain Network Dynamics Unit, University of Oxford, Oxford, UK
| | - Veerle Visser-Vandewalle
- Department of Stereotactic and Functional Neurosurgery, University Hospital Cologne, Cologne, Germany
| | - Jochen Wirths
- Department of Stereotactic and Functional Neurosurgery, University Hospital Cologne, Cologne, Germany
| | - Lars Timmermann
- Department of Neurology, University Hospital of Marburg and Gießen, Marburg, Germany.,Department of Neurology, University Hospital Cologne, Cologne, Germany
| | - John-Stuart Brittain
- Nuffield Department of Clinical Neurosciences and MRC Brain Network Dynamics Unit, University of Oxford, Oxford, UK.,School of Psychology, University of Birmingham, Birmingham, UK
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26
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Kern DS, Picillo M, Thompson JA, Sammartino F, di Biase L, Munhoz RP, Fasano A. Interleaving Stimulation in Parkinson's Disease, Tremor, and Dystonia. Stereotact Funct Neurosurg 2019; 96:379-391. [PMID: 30654368 DOI: 10.1159/000494983] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 10/24/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS Interleaving stimulation (ILS) in deep brain stimulation (DBS) provides individualized stimulation of 2 contacts delivered in alternating order. Currently, limited information on the utility of ILS exists. The aims of this study were to determine the practical applications and outcomes of ILS DBS in Parkinson's disease (PD), tremor, and dystonia. METHODS We performed a single-center, unblinded, retrospective chart review of all patients with DBS attempted on ILS at our referral center assessing for rationale and outcomes. RESULTS Fifty patients (PD, n = 27; tremor, n = 7; dystonia, n = 16 patients) tried ILS for 2 rationales: management of adverse effects (n = 29) and to improve clinical efficacy (n = 21). A total of 19 patients demonstrated improvement with ILS for adverse effect management predominately for the treatment of dyskinesias (n = 12). In the vast majority of dyskinetic patients, a contact added into the rostral zona incerta with ILS was performed. Nine out of 21 patients demonstrated improved clinical efficacy with ILS with all 6 PD patients who tried ILS for this rationale demonstrating benefit. CONCLUSIONS In PD, ILS provided benefits for dyskinesias and parkinsonism, with minimal improvement of other adverse effects. In tremor and dystonia, marginal effects in terms of mitigation of adverse effects and improvement of clinical outcomes were evident.
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Affiliation(s)
- Drew S Kern
- Movement Disorders Center, Department of Neurology, University of Colorado, Denver, Colorado, USA, .,Movement Disorders Center, Department of Neurosurgery, University of Colorado, Denver, Colorado, USA,
| | - Marina Picillo
- Center for Neurodegenerative Diseases (CEMAND), Department of Medicine and Surgery, Neuroscience Section, University of Salerno, Salerno, Italy
| | - John A Thompson
- Movement Disorders Center, Department of Neurosurgery, University of Colorado, Denver, Colorado, USA
| | - Francesco Sammartino
- Division of Neurosurgery, University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Lazzaro di Biase
- Neurology Unit, Campus Bio-Medico University, Rome, Italy.,Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Renato P Munhoz
- Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Division of Neurology, University of Toronto, Toronto, Ontario, Canada.,Krembil Research Institute, Toronto, Ontario, Canada
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27
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Human Motor Thalamus Reconstructed in 3D from Continuous Sagittal Sections with Identified Subcortical Afferent Territories. eNeuro 2018; 5:eN-NWR-0060-18. [PMID: 30023427 PMCID: PMC6049607 DOI: 10.1523/eneuro.0060-18.2018] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 04/02/2018] [Accepted: 05/03/2018] [Indexed: 11/21/2022] Open
Abstract
Classification and delineation of the motor-related nuclei in the human thalamus have been the focus of numerous discussions for a long time. Difficulties in finding consensus have for the most part been caused by paucity of direct experimental data on connections of individual nuclear entities. Kultas-Ilinsky et al. (2011) showed that distribution of glutamic acid decarboxylase isoform 65 (GAD65), the enzyme that synthesizes inhibitory neurotransmitter γ-aminobutyric acid, is a reliable marker that allows to delineate connectionally distinct nuclei in the human motor thalamus, namely the territories innervated by nigral, pallidal, and cerebellar afferents. We compared those immunocytochemical staining patterns with underlying cytoarchitecture and used the latter to outline the three afferent territories in a continuous series of sagittal Nissl-stained sections of the human thalamus. The 3D volume reconstructed from the outlines was placed in the Talairach stereotactic coordinate system relative to the intercommissural line and sectioned in three stereotactic planes to produce color-coded nuclear maps. This 3D coordinate-based atlas was coregistered to the Montreal Neurological Institute (MNI-152) space. The current report proposes a simplified nomenclature of the motor-related thalamic nuclei, presents images of selected histological sections and stereotactic maps illustrating topographic relationships of these nuclei as well as their relationship with adjacent somatosensory afferent region. The data are useful in different applications such as functional MRI and diffusion tractography. The 3D dataset is publicly available under an open license and can also be applicable in clinical interventions in the thalamus.
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Deep brain stimulation induces sparse distributions of locally modulated neuronal activity. Sci Rep 2018; 8:2062. [PMID: 29391468 PMCID: PMC5794783 DOI: 10.1038/s41598-018-20428-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 01/18/2018] [Indexed: 12/17/2022] Open
Abstract
Deep brain stimulation (DBS) therapy is a potent tool for treating a range of brain disorders. High frequency stimulation (HFS) patterns used in DBS therapy are known to modulate neuronal spike rates and patterns in the stimulated nucleus; however, the spatial distribution of these modulated responses are not well understood. Computational models suggest that HFS modulates a volume of tissue spatially concentrated around the active electrode. Here, we tested this theory by investigating modulation of spike rates and patterns in non-human primate motor thalamus while stimulating the cerebellar-receiving area of motor thalamus, the primary DBS target for treating Essential Tremor. HFS inhibited spike activity in the majority of recorded cells, but increasing stimulation amplitude also shifted the response to a greater degree of spike pattern modulation. Modulated responses in both categories exhibited a sparse and long-range spatial distribution within motor thalamus, suggesting that stimulation preferentially affects afferent and efferent axonal processes traversing near the active electrode and that the resulting modulated volume strongly depends on the local connectome of these axonal processes. Such findings have important implications for current clinical efforts building predictive computational models of DBS therapy, developing directional DBS lead technology, and formulating closed-loop DBS strategies.
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Devetiarov D, Semenova U, Usova S, Tomskiy A, Tyurnikov V, Nizametdinova D, Gushcha A, Belova E, Sedov A. Neuronal activity patterns in the ventral thalamus: Comparison between Parkinson's disease and cervical dystonia. Clin Neurophysiol 2017; 128:2482-2490. [PMID: 29100066 DOI: 10.1016/j.clinph.2017.09.110] [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: 03/24/2017] [Revised: 08/16/2017] [Accepted: 09/17/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The aim of this study was to distinguish neuronal activity patterns in the human ventral thalamus and reveal common and disease-specific features in patients with Parkinson's disease (PD) and cervical dystonia (CD). METHODS Single unit activity of neurons was recorded during microelectrode-guided thalamotomies. We classified neurons of surgical target and surrounding area into patterns and compared their characteristics and responsiveness to voluntary movement between PD and CD patients. RESULTS We distinguished five patterns of neuronal activity: single, LTS burst, mixed, non-LTS burst and longburst patterns. The burst and mixed patterns showed significant differences in several basic and burst characteristics. We showed that there were no disease-specific patterns or significant differences in pattern distribution between studied patients. However, burst patterns had an unbalanced distribution between disease conditions. In addition, we found difference in LTS burst characteristics between surgical targets and surrounding nuclei. All identified patterns, except the long burst pattern, were reactive to the motor tasks and to contraction of the pathological muscles. CONCLUSIONS The ventral thalamus was characterised by common neuronal activity patterns which differed in characteristics between PD and CD. SIGNIFICANCE Our findings highlight patterns of neuronal activity of the human ventral thalamus and specific pathological features.
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Affiliation(s)
- Dmitriy Devetiarov
- Semenov Institute of Chemical Physics, Russian Academy of Sciences, Moscow, Russia
| | - Ulia Semenova
- Semenov Institute of Chemical Physics, Russian Academy of Sciences, Moscow, Russia.
| | - Svetlana Usova
- Semenov Institute of Chemical Physics, Russian Academy of Sciences, Moscow, Russia
| | - Alexey Tomskiy
- Burdenko Neurosurgery Institute, Functional Neurosurgery, Moscow, Russia
| | | | | | - Artem Gushcha
- Research Center of Neurology, Functional Neurosurgery, Moscow, Russia
| | - Elena Belova
- Semenov Institute of Chemical Physics, Russian Academy of Sciences, Moscow, Russia
| | - Alexey Sedov
- Semenov Institute of Chemical Physics, Russian Academy of Sciences, Moscow, Russia; Moscow Institute of Physics and Technology, Moscow, Russia
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Anatomic Targeting of the Optimal Location for Thalamic Deep Brain Stimulation in Patients with Essential Tremor. World Neurosurg 2017; 107:168-174. [DOI: 10.1016/j.wneu.2017.07.136] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 07/22/2017] [Accepted: 07/24/2017] [Indexed: 11/23/2022]
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Circuit changes in motor cortex during motor skill learning. Neuroscience 2017; 368:283-297. [PMID: 28918262 DOI: 10.1016/j.neuroscience.2017.09.010] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 09/05/2017] [Accepted: 09/05/2017] [Indexed: 01/08/2023]
Abstract
Motor cortex is important for motor skill learning, particularly the dexterous skills necessary for our favorite sports and careers. We are especially interested in understanding how plasticity in motor cortex contributes to skill learning. Although human studies have been helpful in understanding the importance of motor cortex in learning skilled tasks, animal models are necessary for achieving a detailed understanding of the circuitry underlying these behaviors and the changes that occur during training. We review data from these models to try to identify sites of plasticity in motor cortex, focusing on rodents asa model system. Rodent neocortex contains well-differentiated motor and sensory regions, as well as neurons expressing similar genetic markers to many of the same circuit components in human cortex. Furthermore, rodents have circuit mapping tools for labeling, targeting, and manipulating these cell types as circuit nodes. Crucially, the projection from rodent primary somatosensory cortex to primary motor cortex is a well-studied corticocortical projection and a model of sensorimotor integration. We first summarize some of the descending pathways involved in making dexterous movements, including reaching. We then describe local and long-range circuitry in mouse motor cortex, summarizing structural and functional changes associated with motor skill acquisition. We then address which specific connections might be responsible for plasticity. For insight into the range of plasticity mechanisms employed by cortex, we review plasticity in sensory systems. The similarities and differences between motor cortex plasticity and critical periods of plasticity in sensory systems are discussed.
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Lozano AM, Hutchison WD, Kalia SK. What Have We Learned About Movement Disorders from Functional Neurosurgery? Annu Rev Neurosci 2017; 40:453-477. [DOI: 10.1146/annurev-neuro-070815-013906] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Andres M. Lozano
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario M5T 2S8, Canada;, ,
- Krembil Research Institute, Toronto Western Hospital, Toronto, Ontario M5T 2S8, Canada
| | - William D. Hutchison
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario M5T 2S8, Canada;, ,
- Krembil Research Institute, Toronto Western Hospital, Toronto, Ontario M5T 2S8, Canada
| | - Suneil K. Kalia
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario M5T 2S8, Canada;, ,
- Krembil Research Institute, Toronto Western Hospital, Toronto, Ontario M5T 2S8, Canada
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King NKK, Krishna V, Basha D, Elias G, Sammartino F, Hodaie M, Lozano AM, Hutchison WD. Microelectrode recording findings within the tractography-defined ventral intermediate nucleus. J Neurosurg 2017; 126:1669-1675. [DOI: 10.3171/2016.3.jns151992] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVEThe ventral intermediate nucleus (VIM) of the thalamus is not visible on structural MRI. Therefore, direct VIM targeting methods for stereotactic tremor surgery are desirable. The authors previously described a direct targeting method for visualizing the VIM and its structural connectivity using deterministic tractography. In this combined electrophysiology and imaging study, the authors investigated the electrophysiology within this tractography-defined VIM (T-VIM).METHODSThalamic neurons were classified based on their relative location to the T-VIM: dorsal, within, and ventral to the T-VIM. The authors identified the movement-responsive cells (kinesthetic and tremor cells), performed spike analysis (firing rate and burst index), and local field potential analysis (area under the curve for 13–30 Hz). Tremor efficacy in response to microstimulation along the electrode trajectory was also assessed in relation to the T-VIM.RESULTSSeventy-three cells from a total of 9 microelectrode tracks were included for this analysis. Movement-responsive cells (20 kinesthetic cells and 26 tremor cells) were identified throughout the electrode trajectories. The mean firing rate and burst index of cells (n = 27) within the T-VIM are 18.8 ± 9.8 Hz and 4.5 ± 5.4, respectively. Significant local field potential beta power was identified within the T-VIM (area under the curve for 13–30 Hz = 6.6 ± 7.7) with a trend toward higher beta power in the dorsal T-VIM. The most significant reduction in tremor was also observed in the dorsal T-VIM.CONCLUSIONSThe electrophysiological findings within the VIM thalamus defined by tractography, or T-VIM, correspond with the known microelectrode recording characteristics of the VIM in patients with tremor.
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Affiliation(s)
- Nicolas Kon Kam King
- 1Division of Neurosurgery, Department of Surgery, University of Toronto
- 2Department of Neurosurgery, National Neuroscience Institute, Singapore; and
| | - Vibhor Krishna
- 1Division of Neurosurgery, Department of Surgery, University of Toronto
- 3Center for Neuromodulation, Department of Neurosurgery, The Ohio State University, Columbus, Ohio
| | - Diellor Basha
- 5Department of Physiology, Toronto Western Hospital, University of Toronto, Ontario, Canada
| | - Gavin Elias
- 1Division of Neurosurgery, Department of Surgery, University of Toronto
| | | | - Mojgan Hodaie
- 1Division of Neurosurgery, Department of Surgery, University of Toronto
- 4Division of Brain Imaging, Behaviour Systems Neuroscience, Toronto Western Research Institute
| | - Andres M. Lozano
- 1Division of Neurosurgery, Department of Surgery, University of Toronto
| | - William D. Hutchison
- 5Department of Physiology, Toronto Western Hospital, University of Toronto, Ontario, Canada
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Orofacial proprioceptive thalamus of the rat. Brain Struct Funct 2017; 222:2655-2669. [DOI: 10.1007/s00429-016-1363-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 12/26/2016] [Indexed: 12/18/2022]
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Sammartino F, Krishna V, King NKK, Lozano AM, Schwartz ML, Huang Y, Hodaie M. Tractography-Based Ventral Intermediate Nucleus Targeting: Novel Methodology and Intraoperative Validation. Mov Disord 2016; 31:1217-25. [PMID: 27214406 PMCID: PMC5089633 DOI: 10.1002/mds.26633] [Citation(s) in RCA: 121] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 02/29/2016] [Accepted: 03/06/2016] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The ventral intermediate nucleus of the thalamus is not readily visible on structural magnetic resonance imaging. Therefore, a method for its visualization for stereotactic targeting is desirable. OBJECTIVE The objective of this study was to define a tractography-based methodology for the stereotactic targeting of the ventral intermediate nucleus. METHODS The lateral and posterior borders of the ventral intermediate nucleus were defined by tracking the pyramidal tract and medial lemniscus, respectively. A thalamic seed was then created 3 mm medial and anterior to these borders, and its structural connections were analyzed. The application of this method was assessed in an imaging cohort of 14 tremor patients and 15 healthy controls, in which we compared the tractography-based targeting to conventional targeting. In a separate surgical cohort (3 tremor and 3 tremor-dominant Parkinson's disease patients), we analyzed the accuracy of this method by correlating it with intraoperative neurophysiology. RESULTS Tractography of the thalamic seed revealed the tracts corresponding to cerebellar input and motor cortical output fibers. The tractography-based target was more lateral (12.5 [1.2] mm vs 11.5 mm for conventional targeting) and anterior (8.5 [1.1] mm vs 6.7 [0.3] mm, anterior to the posterior commissure). In the surgical cohort, the Euclidian distance between the ventral intermediate nucleus identified by tractography and the surgical target was 1.6 [1.1] mm. The locations of the sensory thalamus, lemniscus, and pyramidal tracts were concordant within <1 mm between tractography and neurophysiology. INTERPRETATION The tractography-based methodology for identification of the ventral intermediate nucleus is accurate and useful. This method may be used to improve stereotactic targeting in functional neurosurgery procedures. © 2016 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Francesco Sammartino
- Division of NeurosurgeryToronto Western Hospital and University Health NetworkTorontoCanada
- Division of Neurosurgery, Department of SurgeryUniversity of TorontoTorontoCanada
| | - Vibhor Krishna
- Division of NeurosurgeryToronto Western Hospital and University Health NetworkTorontoCanada
- Division of Neurosurgery, Department of SurgeryUniversity of TorontoTorontoCanada
| | - Nicolas Kon Kam King
- Division of NeurosurgeryToronto Western Hospital and University Health NetworkTorontoCanada
- Division of Neurosurgery, Department of SurgeryUniversity of TorontoTorontoCanada
| | - Andres M. Lozano
- Division of NeurosurgeryToronto Western Hospital and University Health NetworkTorontoCanada
- Division of Neurosurgery, Department of SurgeryUniversity of TorontoTorontoCanada
| | - Michael L. Schwartz
- Division of Neurosurgery, Department of SurgeryUniversity of TorontoTorontoCanada
- Division of NeurosurgerySunnybrook HospitalTorontoCanada
| | - Yuexi Huang
- Physical Sciences PlatformSunnybrook Research InstituteTorontoCanada
| | - Mojgan Hodaie
- Division of NeurosurgeryToronto Western Hospital and University Health NetworkTorontoCanada
- Division of Neurosurgery, Department of SurgeryUniversity of TorontoTorontoCanada
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Sammartino F, Rowland N, Hodaie M, Kalia SK, Lozano AM, Hamani C. Diffusion tensor imaging and deep brain stimulation. Expert Rev Med Devices 2016; 13:615-7. [DOI: 10.1080/17434440.2016.1195259] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
| | - Nathan Rowland
- Division of Neurosurgery, Toronto Western Hospital, Toronto, Canada
| | - Mojgan Hodaie
- Division of Neurosurgery, Toronto Western Hospital, Toronto, Canada
| | - Suneil K. Kalia
- Division of Neurosurgery, Toronto Western Hospital, Toronto, Canada
| | - Andres M. Lozano
- Division of Neurosurgery, Toronto Western Hospital, Toronto, Canada
| | - Clement Hamani
- Division of Neurosurgery, Toronto Western Hospital, Toronto, Canada
- Behavioural Neurobiology Laboratory, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
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Avecillas-Chasin JM, Rascón-Ramírez F, Barcia JA. Tractographical model of the cortico-basal ganglia and corticothalamic connections. Clin Anat 2016; 29:481-92. [DOI: 10.1002/ca.22689] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 12/16/2015] [Accepted: 01/06/2016] [Indexed: 11/08/2022]
Affiliation(s)
| | - Fernando Rascón-Ramírez
- Department of Neurosurgery; Institute of Neurosciences, Instituto De Investigación Sanitaria San Calos, Hospital Clínico San Carlos; Madrid Spain
| | - Juan A. Barcia
- Department of Neurosurgery; Institute of Neurosciences, Instituto De Investigación Sanitaria San Calos, Hospital Clínico San Carlos; Madrid Spain
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Gallay MN, Moser D, Rossi F, Pourtehrani P, Magara AE, Kowalski M, Arnold A, Jeanmonod D. Incisionless transcranial MR-guided focused ultrasound in essential tremor: cerebellothalamic tractotomy. J Ther Ultrasound 2016; 4:5. [PMID: 26877873 PMCID: PMC4752806 DOI: 10.1186/s40349-016-0049-8] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 02/08/2016] [Indexed: 11/30/2022] Open
Abstract
Background Already in the late 1960s and early 1970s, targeting of the “posterior subthalamic area (PSA)” was explored by different functional neurosurgical groups applying the radiofrequency (RF) technique to treat patients suffering from essential tremor (ET). Recent advances in magnetic resonance (MR)-guided focused ultrasound (MRgFUS) technology offer the possibility to perform thermocoagulation of the cerebellothalamic fiber tract in the PSA without brain penetration, allowing a strong reduction of the procedure-related risks and increased accuracy. We describe here the first results of the MRgFUS cerebellothalamic tractotomy (CTT). Methods Twenty-one consecutive patients suffering from chronic (mean disease duration 29.9 years), therapy-resistant ET were treated with MRgFUS CTT. Three patients received bilateral treatment with a 1-year interval. Primary relief assessment indicators were the Essential Tremor Rating Scale (Fahn, Tolosa, and Marin) (ETRS) taken at follow-up (3 months to 2 years) with accent on the hand function subscores (HF16 for treated hand and HF32 for both hands) and handwriting. The evolution of seven patients with HF32 above 28 points over 32 (group 1) differentiated itself from the others’ (group 2) and was analyzed separately. Global tremor relief estimations were provided by the patients. Lesion reconstruction and measurement of targeting accuracy were done on 2-day post-treatment MR pictures for each CTT lesion. Results The mean ETRS score for all patients was 57.6 ± 13.2 at baseline and 25.8 ± 17.6 at 1 year (n = 10). The HF16 score reduction was 92 % in group 2 at 3 months and stayed stable at 1 year (90 %). Group 1 showed only an improvement of 41 % at 3 months and 40 % at 1 year. Nevertheless, two patients of group 1 treated bilaterally had an HF16 score reduction of 75 and 88 % for the dominant hand at 1 year after the second side. The mean patient estimation of global tremor relief after CTT was 92 % at 2 days and 77 % at 1-year follow-up. Conclusions CTT with MRgFUS was shown to be an effective and safe approach for patients with therapy-refractory essential tremor, combining neurological function sparing with precise targeting and the possibility to treat patients bilaterally.
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Affiliation(s)
- Marc N Gallay
- Sonimodul, Center for Ultrasound Functional Neurosurgery, Leopoldstrasse 1, CH-4500 Solothurn, Switzerland
| | - David Moser
- Sonimodul, Center for Ultrasound Functional Neurosurgery, Leopoldstrasse 1, CH-4500 Solothurn, Switzerland
| | - Franziska Rossi
- Sonimodul, Center for Ultrasound Functional Neurosurgery, Leopoldstrasse 1, CH-4500 Solothurn, Switzerland
| | - Payam Pourtehrani
- Rodiag Diagnostics Centers, Leopoldstrasse 1, CH-4500 Solothurn, Switzerland
| | - Anouk E Magara
- Praxisgemeinschaft für Neurologie, Thunstrasse 95, CH-3006 Bern, Switzerland
| | - Milek Kowalski
- Privatklinik Obach, Leopoldstrasse 5, CH-4500 Solothurn, Switzerland
| | - Alexander Arnold
- Privatklinik Obach, Leopoldstrasse 5, CH-4500 Solothurn, Switzerland
| | - Daniel Jeanmonod
- Sonimodul, Center for Ultrasound Functional Neurosurgery, Leopoldstrasse 1, CH-4500 Solothurn, Switzerland
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Assessment of a method to determine deep brain stimulation targets using deterministic tractography in a navigation system. Neurosurg Rev 2015; 38:739-50; discussion 751. [PMID: 25962557 DOI: 10.1007/s10143-015-0643-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 02/04/2015] [Accepted: 03/14/2015] [Indexed: 01/18/2023]
Abstract
Recent advances in imaging permit radiologic identification of target structures for deep brain stimulation (DBS) for movement disorders. However, these methods cannot detect the internal subdivision and thus cannot determine the appropriate DBS target located within those subdivisions. The aim of this study is to provide a straightforward method to obtain an optimized target (OT) within DBS target nuclei using a widely available navigation system. We used T1- and T2-weighted images, fluid-attenuated inversion recovery (FLAIR) sequence, and diffusion tensor imaging (DTI) of nine patients operated for DBS in our center. Using the StealthViz® software, we segmented the targeted deep structures (subcortical targets) and the anatomically identifiable areas to which these target nuclei were connected (projection areas). We generated fiber tracts from the projection areas. By identifying their intersections with the subcortical targets, we obtained an OT within the DBS target nuclei. We computed the distances from the clinically effective electrode contacts (CEEC) to the OT obtained by our method and the targets provided by the atlas. These distances were compared using a Wilcoxon signed-rank test, with p < 0.05 considered statistically significant. We were able to identify OT coincident with the motor part of the subthalamic nucleus and the ventral intermediate nucleus. We clinically tested the results and found that the CEEC were significantly more closely related to the OT than with the targets obtained by the atlas. Our present results show that this novel method permits optimization of the stimulation site within the internal subdivisions of target nuclei for DBS.
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Abstract
Essential tremor is the most common tremor disorder and is characterized by a postural and kinetic tremor. Most commonly, the disease involves the upper extremities, although other body parts may be affected. Essential tremor is seen most often in adults and may markedly limit abilities to perform daily activities. Medications often fail to control the tremor adequately. In the past, ventral intermediate nucleus of the thalamus (VIM) thalamotomy was the surgery of choice for medication-resistant patients with disabling tremor. With technological advances, deep brain stimulation (DBS) to the VIM has replaced thalamotomy as the operation of choice for patients with essential tremor, given the heightened risk of permanent neurological deficits associated with ablative surgery. Multiple studies have demonstrated that unilateral VIM DBS has significant short- and long-term benefits for targeted tremor. Unilateral VIM DBS may also improve head and voice tremor, although most commonly bilateral stimulation is required for adequate control. However, bilateral thalamic stimulation is associated with a higher incidence of neurological deficits, particularly speech and gait problems. Investigations of DBS of other brain target areas for essential tremor, such as the posterior subthalamic area and the subthalamic nucleus, are ongoing.
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Affiliation(s)
- Jules M Nazzaro
- Department of Neurosurgery, University of Kansas Medical Center, Kansas City, KS, USA; Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA; Department of Molecular and Integrative Physiology, University of Kansas Medical Center, Kansas City, KS, USA
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Kazi JA. Nocistatin and nociceptin modulate c-Fos expression in the mice thalamus. Neurol Sci 2012; 33:1233-7. [PMID: 22240716 DOI: 10.1007/s10072-012-0933-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2011] [Accepted: 01/03/2012] [Indexed: 12/20/2022]
Abstract
Nocistatin and nociceptin/orphanin FQ (N/OFQ) are two neuropeptides which may have opposite effects in several biological functions but their neuro-anatomical sites of interaction are not fully clear. We investigated interaction between the effect of intracerebroventricular (i.c.v.) injection of nocistatin and N/OFQ, on c-Fos expression in the mouse thalamus, using c-Fos immunohistochemistry. We found that co-injection of nocistatin with N/OFQ significantly modulates c-Fos expression in the thalamus. The present study strongly suggests that "Nocistatin-Nociceptin" interaction system in the thalamus may be the promising neuromodulatory sites in the investigation of unlocking their possible therapeutic circuit in nociception, memory and anxiety.
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Affiliation(s)
- Jamil Ahsan Kazi
- Universiti Teknologi MARA (UiTM), Level 19, Tower 2, Science & Technology Complex, 40450, Shah Alam, Selangor, Malaysia.
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Kincses ZT, Szabó N, Valálik I, Kopniczky Z, Dézsi L, Klivényi P, Jenkinson M, Király A, Babos M, Vörös E, Barzó P, Vécsei L. Target identification for stereotactic thalamotomy using diffusion tractography. PLoS One 2012; 7:e29969. [PMID: 22238685 PMCID: PMC3251609 DOI: 10.1371/journal.pone.0029969] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2011] [Accepted: 12/10/2011] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Stereotactic targets for thalamotomy are usually derived from population-based coordinates. Individual anatomy is used only to scale the coordinates based on the location of some internal guide points. While on conventional MR imaging the thalamic nuclei are indistinguishable, recently it has become possible to identify individual thalamic nuclei using different connectivity profiles, as defined by MR diffusion tractography. METHODOLOGY AND PRINCIPAL FINDINGS Here we investigated the inter-individual variation of the location of target nuclei for thalamotomy: the putative ventralis oralis posterior (Vop) and the ventral intermedius (Vim) nucleus as defined by probabilistic tractography. We showed that the mean inter-individual distance of the peak Vop location is 7.33 mm and 7.42 mm for Vim. The mean overlap between individual Vop nuclei was 40.2% and it was 31.8% for Vim nuclei. As a proof of concept, we also present a patient who underwent Vop thalamotomy for untreatable tremor caused by traumatic brain injury and another patient who underwent Vim thalamotomy for essential tremor. The probabilistic tractography indicated that the successful tremor control was achieved with lesions in the Vop and Vim respectively. CONCLUSIONS Our data call attention to the need for a better appreciation of the individual anatomy when planning stereotactic functional neurosurgery.
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Affiliation(s)
- Zsigmond Tamás Kincses
- Department of Neurology, Albert Szent-György Clinical Center, University of Szeged, Szeged, Hungary.
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Solari SVH, Stoner R. Cognitive consilience: primate non-primary neuroanatomical circuits underlying cognition. Front Neuroanat 2011; 5:65. [PMID: 22194717 PMCID: PMC3243081 DOI: 10.3389/fnana.2011.00065] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Accepted: 12/01/2011] [Indexed: 11/16/2022] Open
Abstract
Interactions between the cerebral cortex, thalamus, and basal ganglia form the basis of cognitive information processing in the mammalian brain. Understanding the principles of neuroanatomical organization in these structures is critical to understanding the functions they perform and ultimately how the human brain works. We have manually distilled and synthesized hundreds of primate neuroanatomy facts into a single interactive visualization. The resulting picture represents the fundamental neuroanatomical blueprint upon which cognitive functions must be implemented. Within this framework we hypothesize and detail 7 functional circuits corresponding to psychological perspectives on the brain: consolidated long-term declarative memory, short-term declarative memory, working memory/information processing, behavioral memory selection, behavioral memory output, cognitive control, and cortical information flow regulation. Each circuit is described in terms of distinguishable neuronal groups including the cerebral isocortex (9 pyramidal neuronal groups), parahippocampal gyrus and hippocampus, thalamus (4 neuronal groups), basal ganglia (7 neuronal groups), metencephalon, basal forebrain, and other subcortical nuclei. We focus on neuroanatomy related to primate non-primary cortical systems to elucidate the basis underlying the distinct homotypical cognitive architecture. To display the breadth of this review, we introduce a novel method of integrating and presenting data in multiple independent visualizations: an interactive website (http://www.frontiersin.org/files/cognitiveconsilience/index.html) and standalone iPhone and iPad applications. With these tools we present a unique, annotated view of neuroanatomical consilience (integration of knowledge).
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Abstract
This review presents a summary of recent efforts in understanding the systems of the brain involved in motor imagery. Motor imagery likely involves many cortical regions in its generation, but in action may also involve subcortical structures. The parietal lobe seems to be particularly important, as demonstrated by brain imaging studies and patients with lesions of this region. Brain activity correlated with imagery may be related to an efference copy used to compare with peripheral sensory signals for the correction of movement. Amputees with phantom representations have also provided valuable information in this field, as they demonstrate cortical reorganization, which also alters imagery of the missing limb. The following summary explores the recent difficult and challenging studies used to tease out motor imagery in man.
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Affiliation(s)
- William S. Anderson
- The Johns Hopkins University School of Medicine, Department of Neurosurgery, 600 North Wolfe Street, Meyer 5, Baltimore, MD USA 21287, (o) +1(443)287-4561, (f) +1(443)287-6423
| | - Frederick A. Lenz
- The Johns Hopkins University School of Medicine, Department of Neurosurgery, 600 North Wolfe Street, Meyer 8-181, Baltimore, MD USA 21287, (o) +1(410)955-2257, (f) +1(443)287-8044
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Kultas-Ilinsky K, Ilinsky IA, Verney C. Glutamic acid decarboxylase isoform 65 immunoreactivity in the motor thalamus of humans and monkeys: γ-aminobutyric acidergic connections and nuclear delineations. J Comp Neurol 2011; 519:2811-37. [PMID: 21491431 DOI: 10.1002/cne.22653] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The neurotransmitter γ-aminobutyric acid (GABA) plays an important role in the motor thalamic nuclei. This report analyzes the distribution of the GABA-producing enzyme glutamic acid decarboxylase isoform 65 (GAD65), stained with monoclonal antibody, in human and rhesus monkey thalami and compares it with staining patterns of some widely used cytoskeletal and calcium binding protein markers. GAD65 immunoreactivity distinctly labeled two systems: fibers and terminals of basal ganglia thalamic afferents and local circuit neurons, revealing fine features of GABAergic circuitry in the human thalamus. Gross distribution patterns of GAD65 were identical in human and rhesus monkey thalami. The area displaying specific staining of large-caliber beaded fibers coincided with nigro- and pallidothalamic afferent territories previously identified in monkeys with anterograde tracers. Accordingly, a similarly stained region in the human thalamus was considered basal ganglia territory. Except for cytoarchitecture, no specific markers differentiating between the nigro- and pallidothalamic projection zones within this territory were found. GAD65 staining in the cerebellar afferent territory reflected organization of its local circuit neuron network, distinguishing it from adjacent nuclei. Specific GAD65 staining pattern and negative calcium binding protein immunoreactivity identify the cerebellar afferent territory in humans. It is subdivided further into ventral and dorsal regions based on the cytoskeletal protein SMI31 staining pattern. The nuclear outlines revised according to the results are compared with those of Hassler (Schaltenbrand G and Bailey P [1959] Einfuhrung in die stereotaktishen Operationen mit einem Atlas des menschlichen Gehirns, vol 3. Stuttgart: Thieme) and discussed in light of the ongoing controversy regarding delineations of the motor thalamic nuclei in humans.
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Affiliation(s)
- K Kultas-Ilinsky
- INSERM U676, Université Paris 7, Faculté de Médecine Denis Diderot, PremUP, Paris 75019, France
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Santaniello S, Fiengo G, Glielmo L, Grill WM. Closed-Loop Control of Deep Brain Stimulation: A Simulation Study. IEEE Trans Neural Syst Rehabil Eng 2011; 19:15-24. [PMID: 20889437 DOI: 10.1109/tnsre.2010.2081377] [Citation(s) in RCA: 158] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Anderson WS, Weiss N, Lawson HC, Ohara S, Rowland L, Lenz FA. Demonstration of motor imagery movement and phantom movement-related neuronal activity in human thalamus. Neuroreport 2011; 22:88-92. [PMID: 21150804 PMCID: PMC3071423 DOI: 10.1097/wnr.0b013e328342c98a] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Functional imaging studies show that motor imagery activates multiple structures in the human forebrain. We now show that phantom movements in an amputee and imagined movements in intact individuals elicit responses from neurons in several human thalamic nuclei. These include the somatic sensory nucleus receiving input from the periphery (ventral caudal), and the motor nuclei receiving input from the cerebellum [ventral intermediate (Vim)] and the basal ganglia [ventral oral posterior (Vop)]. Seven neurons in the amputee showed phantom movement-related activity (three Vim, two Vop, and two ventral caudal). In addition, seven neurons in a group of three controls showed motor imagery-related activity (four Vim and three Vop). These studies were performed during single neuron recording sessions in patients undergoing therapeutic treatment of phantom pain, tremor, and chronic pain conditions by thalamic stimulation. The activity of neurons in these sensory and motor nuclei, respectively, may encode the expected sensory consequences and the dynamics of planned movements.
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Affiliation(s)
- William S Anderson
- Department of Neurosurgery, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
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Brückner G, Morawski M, Arendt T. Aggrecan-based extracellular matrix is an integral part of the human basal ganglia circuit. Neuroscience 2008; 151:489-504. [DOI: 10.1016/j.neuroscience.2007.10.033] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2007] [Revised: 10/26/2007] [Accepted: 11/02/2007] [Indexed: 11/28/2022]
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Craig A(B. Retrograde analyses of spinothalamic projections in the macaque monkey: Input to the ventral lateral nucleus. J Comp Neurol 2008; 508:315-28. [DOI: 10.1002/cne.21672] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Miyagishima T, Takahashi A, Kikuchi S, Watanabe K, Hirato M, Saito N, Yoshimoto Y. Effect of ventralis intermedius thalamotomy on the area in the sensorimotor cortex activated by passive hand movements: fMR imaging study. Stereotact Funct Neurosurg 2007; 85:225-34. [PMID: 17534135 DOI: 10.1159/000103261] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Stereotactic ventralis intermedius (Vim) thalamotomy is effective for essential tremor (ET) of the limb, but the effect on the activity of the sensorimotor cortex is still unclear. The functional changes in this cortical area of patients with ET after Vim thalamotomy were investigated using functional magnetic resonance (fMR) imaging. Six patients underwent Vim thalamotomy for medically intractable ET, predominantly in the right hand. 1.5-tesla fMR imaging was performed using the blood oxygenation level-dependent sequence, before and after Vim thalamotomy, during passive movements with right wrist flexion and extension. Before and after images were analyzed using SPM99 software. Activation in the sensorimotor cortex and supplementary motor area evoked by wrist passive movement was observed both before and after surgery. Group analysis of changes in the blood oxygenation level-dependent response revealed a significantly smaller activated area postoperatively. Activation at the fundus of the central sulcus was characteristically decreased. All patients showed marked improvement in tremor after Vim thalamotomy. No patient experienced neurological deficits. fMR imaging showed that activation at the fundus of the central sulcus evoked by passive wrist movement was suppressed after Vim thalamotomy in ET patients, probably due to disruption of the thalamocortical pathway. The fundus of the central sulcus (Brodmann area 3a) is likely to be one of the key relays in the tremor circuit.
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Affiliation(s)
- Takaaki Miyagishima
- Department of Neurosurgery, Gunma University School of Medicine, Maebashi, Japan.
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