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Zhang D, Xiong Y, Lu H, Duan C, Huang J, Li Y, Bian X, Zhang D, Zhou J, Pan L, Lou X. Predicting tremor improvement after MRgFUS thalamotomy in essential tremor from preoperative spontaneous brain activity: A machine learning approach. Sci Bull (Beijing) 2024:S2095-9273(24)00588-7. [PMID: 39191568 DOI: 10.1016/j.scib.2024.05.049] [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: 02/19/2024] [Revised: 05/27/2024] [Accepted: 05/28/2024] [Indexed: 08/29/2024]
Abstract
Magnetic resonance-guided focused ultrasound surgery (MRgFUS) thalamotomy is an emerging technique for medication-refractory essential tremor (ET), but with variable outcomes. This study used pattern regression analysis to identify brain signatures predictive of tremor improvements. Fifty-four ET patients (mean age = 63.06 years, standard deviation (SD) = 10.55 years, 38 males) underwent unilateral MRgFUS thalamotomy and were scanned for resting-state functional magnetic resonance imaging (rs-fMRI). Seventy-four healthy controls (mean age = 58.09 years, SD = 10.30 years, 38 males) were recruited for comparison. Tremor responses at 12 months posttreatment were evaluated by the Clinical Rating Scale for Tremor. The fractional amplitude of low-frequency fluctuations (fALFF) was calculated from rs-fMRI data. Two-sample t-test was used to generate a disease-specific mask, within which Multivariate Kernel Ridge Regression analyses were conducted. Predicted and actual clinical scores were compared using Pearson's correlation coefficient (r) and normalized mean squared error (Norm. MSE). Permutation test and leave-one-out strategy were applied for results validation. KRR identified fALFF patterns that significantly predicted the hand tremor improvement (r = 0.23, P = 0.025; Norm. MSE = 0.05, P = 0.026) and the postural tremor improvement (r = 0.28, P = 0.025; Norm. MSE = 0.06, P = 0.023), but not action tremor improvement. Lobule VI of right cerebellum (Cerebelum_6_R), right superior occipital gyrus (Occipital_Sup_R) and lobule X of vermis (Vermis_10) contributed most for hand tremor prediction (normalized weights (NW): 2.77%, 2.40%, 2.34%) while Vermis_10, left supplementary motor area (Supp_Motor_Area_L) and right hippocampus (Hippocampus_R) for postural tremor prediction (NW: 2.69%, 2.12%, 2.05%). The low contributing NW of the individual brain regions suggested that the fALFF pattern as a whole is an overall predicting feature. Preoperative fALFF pattern predicts tremor benefits induced by MRgFUS thalamotomy. ClinicalTrials.gov number: NCT04570046.
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Affiliation(s)
- Dong Zhang
- Department of Radiology, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Yongqin Xiong
- Department of Radiology, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Haoxuan Lu
- Department of Radiology, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Caohui Duan
- Department of Radiology, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Jiayu Huang
- Department of Radiology, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Yan Li
- Department of Radiology, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Xiangbing Bian
- Department of Radiology, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Dekang Zhang
- Department of Radiology, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Jiayou Zhou
- Department of Neurosurgery, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Longsheng Pan
- Department of Neurosurgery, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China.
| | - Xin Lou
- Department of Radiology, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China.
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Lan Y, Yuan H, Ma X, Yin C, Liu X, Zeng X, Lyu J, Xiong Y, Zhang X, Lu H, Zhong Y, Li X, Cui Z, Lou X. Resting-state functional connectivity of the occipital cortex in different subtypes of Parkinson's disease. CNS Neurosci Ther 2024; 30:e14915. [PMID: 39187974 PMCID: PMC11347390 DOI: 10.1111/cns.14915] [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: 03/31/2024] [Revised: 04/30/2024] [Accepted: 07/29/2024] [Indexed: 08/28/2024] Open
Abstract
AIMS To examine whether functional connectivity (FC) of the occipital gyrus differs between patients with Parkinson's disease (PD) motor subtypes and healthy controls (HCs). METHODS We enrolled 30 PD patients exhibiting tremor dominance (TD), 43 PD patients with postural instability and gait disturbance (PIGD), and 42 HCs. The occipital gyrus was partitioned into six areas of interest, as seed points, via the Anatomical Automatic Labeling template to compare the FC of the three groups and analyze the relationship of FC with clinical scales. RESULTS Compared with the PIGD group, the TD group showed increased FC between the left superior occipital gyrus (SOG.L) and right median cingulate and paracingulate gyri (DCG.R)/right paracentral lobule/bilateral inferior parietal, but supramarginal and angular gyri; the left middle occipital gyrus (MOG.L) and left posterior cingulate gyrus (PCG.L); the MOG.R and SOG.L/right calcarine fissure and surrounding cortex/DCG.R/PCG.L/right cuneus; the left inferior occipital gyrus (IOG.L) and right caudate nucleus; and the IOG.R and PCG.L. CONCLUSION Differentiated FC between the occipital gyrus and other brain areas within the PD motor subtypes, which may serve as neural markers to distinguish between patients with TD and PIGD PD.
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Affiliation(s)
- Yina Lan
- Department of RadiologyThe First Medical Center of Chinese PLA General HospitalBeijingChina
| | - Hongjun Yuan
- Department of RadiologyThe Fifth Medical Center of Chinese PLA General HospitalBeijingChina
| | - Xiaoxaio Ma
- Department of RadiologyThe First Medical Center of Chinese PLA General HospitalBeijingChina
| | - ChunYu Yin
- Department of Cadres' OutpatientThe First Medical Center of Chinese PLA General HospitalBeijingChina
| | - Xinyun Liu
- Department of RadiologyThe First Medical Center of Chinese PLA General HospitalBeijingChina
| | - XiYu Zeng
- Department of RadiologyThe First Medical Center of Chinese PLA General HospitalBeijingChina
| | - Jinhao Lyu
- Department of RadiologyThe First Medical Center of Chinese PLA General HospitalBeijingChina
| | - Yongqin Xiong
- Department of RadiologyThe First Medical Center of Chinese PLA General HospitalBeijingChina
| | - Xiaobo Zhang
- Department of RadiologyThe First Medical Center of Chinese PLA General HospitalBeijingChina
| | - Haoxuan Lu
- Department of RadiologyThe First Medical Center of Chinese PLA General HospitalBeijingChina
| | - Yujue Zhong
- Department of RadiologyThe First Medical Center of Chinese PLA General HospitalBeijingChina
| | - Xuemei Li
- Department of Cadres' OutpatientThe First Medical Center of Chinese PLA General HospitalBeijingChina
| | - Zhiqiang Cui
- Department of NeurosurgeryThe First Medical Center of Chinese PLA General HospitalBeijingChina
| | - Xin Lou
- Department of RadiologyThe First Medical Center of Chinese PLA General HospitalBeijingChina
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Pellow C, Pichardo S, Pike GB. A systematic review of preclinical and clinical transcranial ultrasound neuromodulation and opportunities for functional connectomics. Brain Stimul 2024; 17:734-751. [PMID: 38880207 DOI: 10.1016/j.brs.2024.06.005] [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: 03/01/2024] [Revised: 05/21/2024] [Accepted: 06/05/2024] [Indexed: 06/18/2024] Open
Abstract
BACKGROUND Low-intensity transcranial ultrasound has surged forward as a non-invasive and disruptive tool for neuromodulation with applications in basic neuroscience research and the treatment of neurological and psychiatric conditions. OBJECTIVE To provide a comprehensive overview and update of preclinical and clinical transcranial low intensity ultrasound for neuromodulation and emphasize the emerging role of functional brain mapping to guide, better understand, and predict responses. METHODS A systematic review was conducted by searching the Web of Science and Scopus databases for studies on transcranial ultrasound neuromodulation, both in humans and animals. RESULTS 187 relevant studies were identified and reviewed, including 116 preclinical and 71 clinical reports with subjects belonging to diverse cohorts. Milestones of ultrasound neuromodulation are described within an overview of the broader landscape. General neural readouts and outcome measures are discussed, potential confounds are noted, and the emerging use of functional magnetic resonance imaging is highlighted. CONCLUSION Ultrasound neuromodulation has emerged as a powerful tool to study and treat a range of conditions and its combination with various neural readouts has significantly advanced this platform. In particular, the use of functional magnetic resonance imaging has yielded exciting inferences into ultrasound neuromodulation and has the potential to advance our understanding of brain function, neuromodulatory mechanisms, and ultimately clinical outcomes. It is anticipated that these preclinical and clinical trials are the first of many; that transcranial low intensity focused ultrasound, particularly in combination with functional magnetic resonance imaging, has the potential to enhance treatment for a spectrum of neurological conditions.
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Affiliation(s)
- Carly Pellow
- Department of Radiology, Cumming School of Medicine, University of Calgary, Alberta, T2N 1N4, Canada; Hotchkiss Brain Institute, University of Calgary, Alberta, T2N 4N1, Canada.
| | - Samuel Pichardo
- Department of Radiology, Cumming School of Medicine, University of Calgary, Alberta, T2N 1N4, Canada; Hotchkiss Brain Institute, University of Calgary, Alberta, T2N 4N1, Canada; Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Alberta, T2N 1N4, Canada
| | - G Bruce Pike
- Department of Radiology, Cumming School of Medicine, University of Calgary, Alberta, T2N 1N4, Canada; Hotchkiss Brain Institute, University of Calgary, Alberta, T2N 4N1, Canada; Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Alberta, T2N 1N4, Canada
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Lin J, Kang X, Zhou J, Zhang D, Hu J, Lu H, Pan L, Lou X. Profiling functional networks identify activation of corticostriatal connectivity in ET patients after MRgFUS thalamotomy. Neuroimage Clin 2024; 42:103605. [PMID: 38640802 PMCID: PMC11053244 DOI: 10.1016/j.nicl.2024.103605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 03/22/2024] [Accepted: 04/13/2024] [Indexed: 04/21/2024]
Abstract
BACKGROUND MR-guided focused ultrasound (MRgFUS) thalamotomy is a novel and effective treatment for medication-refractory tremor in essential tremor (ET), but how the brain responds to this deliberate lesion is not clear. OBJECTIVE The current study aimed to evaluate the immediate and longitudinal alterations of functional networks after MRgFUS thalamotomy. METHODS We retrospectively obtained preoperative and postoperative 30-day, 90-day, and 180-day data of 31 ET patients subjected with MRgFUS thalamotomy from 2018 to 2020. Their archived resting-state functional MRI data were used for functional network comparison as well as graph-theory metrics analysis. Both partial least squares (PLS) regression and linear regression were conducted to associate functional features to tremor symptoms. RESULTS MRgFUS thalamotomy dramatically abolished tremors, while global functional network only sustained immediate fluctuation within one week after the surgery. Network-based statistics have identified a long-term enhanced corticostriatal subnetwork by comparison between 180-day and preoperative data (P = 0.019). Within this subnetwork, network degree, global efficiency and transitivity were significantly recovered in ET patients right after MRgFUS thalamotomy compared to the pre-operative timepoint (P < 0.05), as well as hemisphere lateralization (P < 0.001). The PLS main component significantly accounted for 33.68 % and 34.16 % of the total variances of hand tremor score and clinical rating scale for tremor (CRST)-total score (P = 0.037 and 0.027). Network transitivity of this subnetwork could serve as a reliable biomarker for hand tremor score control prediction at 180-day after the surgery (β = 2.94, P = 0.03). CONCLUSION MRgFUS thalamotomy promoted corticostriatal connectivity activation correlated with tremor improvement in ET patient after MRgFUS thalamotomy.
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Affiliation(s)
- Jiaji Lin
- Department of Radiology, Chinese PLA General Hospital/Medical School of Chinese PLA, No.28 Fuxing Road, Beijing, 100853, China; Department of Neurology, The Second Affiliated Hospital of Air Force Medical University, Xi'an, 710038, China
| | - Xiaopeng Kang
- School of Artificial Intelligence, University of Chinese Academy of Sciences, No.19A Yuquan Road, Beijing, 100876, China
| | - Jiayou Zhou
- Department of Neurosurgery, Chinese PLA General Hospital/Medical School of Chinese PLA, No.28 Fuxing Road, Beijing, 100853, China
| | - Dekang Zhang
- Department of Radiology, Chinese PLA General Hospital/Medical School of Chinese PLA, No.28 Fuxing Road, Beijing, 100853, China
| | - Jianxing Hu
- Department of Radiology, Chinese PLA General Hospital/Medical School of Chinese PLA, No.28 Fuxing Road, Beijing, 100853, China
| | - Haoxuan Lu
- Department of Radiology, Chinese PLA General Hospital/Medical School of Chinese PLA, No.28 Fuxing Road, Beijing, 100853, China
| | - Longsheng Pan
- Department of Neurosurgery, Chinese PLA General Hospital/Medical School of Chinese PLA, No.28 Fuxing Road, Beijing, 100853, China.
| | - Xin Lou
- Department of Radiology, Chinese PLA General Hospital/Medical School of Chinese PLA, No.28 Fuxing Road, Beijing, 100853, China.
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Wang X, Lin J, Lu H, Xiong Y, Duan C, Zhang D, Huang J, Deng L, Li C, Li R, Zhang D, Bian X, Zhou J, Pan L, Lou X. Alteration of White Matter Connectivity for MR-Guided Focused Ultrasound in the Treatment of Essential Tremor. J Magn Reson Imaging 2024; 59:1358-1370. [PMID: 37491872 DOI: 10.1002/jmri.28896] [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: 02/03/2023] [Revised: 06/21/2023] [Accepted: 06/22/2023] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND Magnetic resonance-guided focused ultrasound (MRgFUS) thalamotomy has been implemented as a therapeutic alternative for the treatment of drug-refractory essential tremor (ET). However, its impact on the brain structural network is still unclear. PURPOSE To investigate both global and local alterations of the white matter (WM) connectivity network in ET after MRgFUS thalamotomy. STUDY TYPE Retrospective. SUBJECTS Twenty-seven ET patients (61 ± 11 years, 19 males) with MRgFUS thalamotomy and 28 healthy controls (HC) (61 ± 11 years, 20 males) were recruited for comparison. FIELD STRENGTH/SEQUENCE A 3 T/single shell diffusion tensor imaging by using spin-echo-based echo-planar imaging, three-dimensional T1 weighted imaging by using gradient-echo-based sequence. ASSESSMENT Patients were undergoing MRgFUS thalamotomy and their clinical data were collected from pre-operation to 6-month post-operation. Network topological metrics, including rich-club organization, small-world, and efficiency properties were calculated. Correlation between the topological metrics and tremor scores in ET groups was also calculated to assess the role of neural remodeling in the brain. STATISTICAL TESTS Two-sample independent t-tests, chi-squared test, ANOVA, Bonferroni test, and Spearman's correlation. Statistical significance was set at P < 0.05. RESULTS For ET patients, the strength of rich-club connection and clustering coefficient significantly increased vs. characteristic path length decreased at 6-month post-operation compared with pre-operation. The distribution pattern of rich-club regions was different in ET groups. Specifically, the order of the rich-club regions was changed according to the network degree value after MRgFUS thalamotomy. Moreover, the altered nodal efficiency in the right temporal pole of the superior temporal gyrus (R = 0.434-0.596) and right putamen (R = 0.413-0.436) was positively correlated with different tremor improvement. DATA CONCLUSION These findings might improve understanding of treatment-induced modulation from a network perspective and may work as an objective marker in the assessment of ET tremor control with MRgFUS thalamotomy. LEVEL OF EVIDENCE 3 TECHNICAL EFFICACY: Stage 4.
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Affiliation(s)
- Xiaoyu Wang
- School of Medicine, Nankai University, Tianjin, China
- Department of Radiology, Chinese PLA General Hospital, Beijing, China
| | - Jiaji Lin
- Department of Radiology, Chinese PLA General Hospital, Beijing, China
| | - Haoxuan Lu
- Department of Radiology, Chinese PLA General Hospital, Beijing, China
| | - Yongqin Xiong
- Department of Radiology, Chinese PLA General Hospital, Beijing, China
| | - Caohui Duan
- Department of Radiology, Chinese PLA General Hospital, Beijing, China
| | - Dong Zhang
- Department of Radiology, Chinese PLA General Hospital, Beijing, China
| | - Jiayu Huang
- Department of Radiology, Chinese PLA General Hospital, Beijing, China
| | - Linlin Deng
- Department of Radiology, Chinese PLA General Hospital, Beijing, China
| | - Chenxi Li
- Department of Radiology, Chinese PLA General Hospital, Beijing, China
| | - Runze Li
- Department of Radiology, Chinese PLA General Hospital, Beijing, China
| | - Dekang Zhang
- Department of Radiology, Chinese PLA General Hospital, Beijing, China
| | - Xiangbing Bian
- Department of Radiology, Chinese PLA General Hospital, Beijing, China
| | - Jiayou Zhou
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China
| | - Longsheng Pan
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China
| | - Xin Lou
- School of Medicine, Nankai University, Tianjin, China
- Department of Radiology, Chinese PLA General Hospital, Beijing, China
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Tian X, Hu R, He P, Ye J. Efficacy and safety of magnetic resonance-guided focused ultrasound for Parkinson's disease: a systematic review and meta-analysis. Front Neurol 2023; 14:1301240. [PMID: 38146437 PMCID: PMC10749343 DOI: 10.3389/fneur.2023.1301240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 11/24/2023] [Indexed: 12/27/2023] Open
Abstract
Objective Magnetic resonance imaging-guided focused ultrasound (MRgFUS) is a novel noninvasive treatment for drug-resistant Parkinson's disease (PD) related tremor. This study aims to evaluate MRgFUS's efficacy and safety in PD through a systematic review and meta-analysis, examining pre-and post-treatment MDS-UPDRSIII and/or CRST scores and associated adverse events. Materials and methods We conducted an extensive literature search across PubMed, Embase, Web of Science, and Cochrane Library databases, screening studies based on set criteria and analyzing MDS-UPDRSIII, CRST, and adverse events pre- and post-MRgFUS treatment. Results Out of 468 retrieved articles, 20 studies involving 258 patients, spanning 2014-2023, were included.17 studies indicated significant MDS-UPDRSIII score reductions post-MRgFUS treatment, while 3 showed significant CRST score declines. In the "on" medication state, pooled MDS-UPDRSIII scores at 1, 3, 6, and 12 months were 12.18 (95% CI: 5.83-18.52), 12.10 (95% CI: 8.22-15.97), 14.85 (95% CI: 9.28-20.41), and 20.65 (95% CI: 12.15-29.14) respectively. In the "off" state, scores were 11.45 (95% CI: -3.50-26.40), 14.71 (95% CI: 4.95-24.46), 21.52 (95% CI: 19.28-23.75), and 22.28 (95% CI: 15.26-29.30). Adverse events were typically mild and transient, with speech disturbances, ataxia, and sensory abnormalities being common post-operative neurological complications. Conclusion MRgFUS offers an effective and relatively safe treatment option for patients with drug-resistant PD-related tremor. Systematic review registration https://www.crd.york.ac.uk/prospero/, No. CRD42023428332.
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Affiliation(s)
- Xiaona Tian
- Eighth Clinical School, Guangzhou University of Chinese Medicine, Foshan, China
| | - Rongrui Hu
- Eighth Clinical School, Guangzhou University of Chinese Medicine, Foshan, China
| | - Peicong He
- Eighth Clinical School, Guangzhou University of Chinese Medicine, Foshan, China
| | - Jianhong Ye
- Endocrinology Department, Foshan Hospital of Traditional Chinese Medicine, Foshan, China
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Lin J, Kang X, Lu H, Zhang D, Bian X, Zhou J, Hu J, Zhang D, Sepulcre J, Pan L, Lou X. Magnetic Resonance-Guided Focused Ultrasound Thalamotomy Rebalances Atypical Functional Hierarchy in Patients with Essential Tremor. Neurotherapeutics 2023; 20:1755-1766. [PMID: 37843768 PMCID: PMC10684443 DOI: 10.1007/s13311-023-01442-9] [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] [Accepted: 09/12/2023] [Indexed: 10/17/2023] Open
Abstract
Magnetic resonance-guided focused ultrasound (MRgFUS) has brought thalamotomy back to the frontline for essential tremor (ET). As functional organization of human brain strictly follows hierarchical principles which are frequently deficient in neurological diseases, whether additional damage from MRgFUS thalamotomy induces further disruptions of ET functional scaffolds are still controversial. This study was to examine the alteration features of brain functional frameworks following MRgFUS thalamotomy in patients with ET. We retrospectively obtained preoperative (ETpre) and postoperative 6-month (ET6m) data of 30 ET patients underwent MRgFUS thalamotomy from 2018 to 2020. Their archived functional MR images were used to functional gradient comparison. Both supervised pattern learning and stepwise linear regression were conducted to associate gradient features to tremor symptoms with additional neuropathophysiological analysis. MRgFUS thalamotomy relieved 78.19% of hand tremor symptoms and induced vast global framework alteration (ET6m vs. ETpre: Cohen d = - 0.80, P < 0.001). Multiple robust alterations were identified especially in posterior cingulate cortex ([Formula: see text] ET6m vs. [Formula: see text] ETpre: Cohen d = 0.87, P = 0.048). Compared with matched health controls (HCs), its gradient distances to primary communities were significantly increased in [Formula: see text] ETpre patients with anomalous stepwise connectivity (P < 0.05 in ETpre vs. HCs), which were restored after MRgFUS thalamotomy. Both global and regional gradient features could be used for tremor symptom prediction and were linked to neuropathophysiological features of Parkinson disease and oxidative phosphorylation. MRgFUS thalamotomy not only suppress tremor symptoms but also rebalances atypical functional hierarchical architecture of ET patients.
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Affiliation(s)
- Jiaji Lin
- Department of Radiology, Chinese PLA General Hospital/Medical School of Chinese PLA, No.28 Fuxing Road, Beijing, 100853, China
| | - Xiaopeng Kang
- School of Artificial Intelligence, University of Chinese Academy of Sciences, No.19A Yuquan Road, Beijing, 100876, China
| | - Haoxuan Lu
- Department of Radiology, Chinese PLA General Hospital/Medical School of Chinese PLA, No.28 Fuxing Road, Beijing, 100853, China
| | - Dekang Zhang
- Department of Radiology, Chinese PLA General Hospital/Medical School of Chinese PLA, No.28 Fuxing Road, Beijing, 100853, China
| | - Xianbing Bian
- Department of Radiology, Chinese PLA General Hospital/Medical School of Chinese PLA, No.28 Fuxing Road, Beijing, 100853, China
| | - Jiayou Zhou
- Department of Neurosurgery, Chinese PLA General Hospital/Medical School of Chinese PLA, No.28 Fuxing Road, Beijing, 100853, China
| | - Jianxing Hu
- Department of Radiology, Chinese PLA General Hospital/Medical School of Chinese PLA, No.28 Fuxing Road, Beijing, 100853, China
| | - Dong Zhang
- Department of Radiology, Chinese PLA General Hospital/Medical School of Chinese PLA, No.28 Fuxing Road, Beijing, 100853, China
| | - Jorge Sepulcre
- Gordon Center for Medical Imaging, Harvard Medical School, No.55 Fruit Street, Boston, 02114, USA
| | - Longsheng Pan
- Department of Neurosurgery, Chinese PLA General Hospital/Medical School of Chinese PLA, No.28 Fuxing Road, Beijing, 100853, China.
| | - Xin Lou
- Department of Radiology, Chinese PLA General Hospital/Medical School of Chinese PLA, No.28 Fuxing Road, Beijing, 100853, China.
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Lan Y, Liu X, Yin C, Lyu J, Xiaoxaio M, Cui Z, Li X, Lou X. Resting-state functional magnetic resonance imaging study comparing tremor-dominant and postural instability/gait difficulty subtypes of Parkinson's disease. LA RADIOLOGIA MEDICA 2023; 128:1138-1147. [PMID: 37474664 DOI: 10.1007/s11547-023-01673-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 06/29/2023] [Indexed: 07/22/2023]
Abstract
PURPOSE The symptom-specific intrinsic neural mechanisms underlying Parkinson's disease (PD) subtypes (tremor dominant [TD] and postural instability gait difficulty [PIGD]) remain unclarified. We examined spontaneous brain activity patterns in TD and PIGD. MATERIAL AND METHODS We included 49 patients with PD (21 with TD/28 with PIGD) and 32 healthy controls (HCs) in this study. We conducted analysis of variance and post-hoc analyses of the amplitude of low-frequency fluctuation (ALFF) and regional homogeneity (ReHo) values of the three groups, with age, sex, and gray matter volume as covariates, and a relationship analysis of the ALFF and ReHo values with clinical variables. RESULTS In comparison with HCs, PIGD PD patients had increased ALFF values in the right middle occipital gyrus and left superior occipital gyrus and decreased values primarily in the bilateral inferior frontal gyrus (triangular part). TD PD patients had lower ALFF values in the right inferior frontal gyrus (triangular part) and left insula. In comparison to TD PD patients, PIGD PD patients had higher ALFF values in the left middle occipital gyrus and left superior occipital gyrus. In contrast to HCs, TD PD patients demonstrated a reduction of ReHo values in the left middle temporal gyrus, and PIGD patients showed a decrease of ReHo values in the left inferior temporal gyrus. CONCLUSION ALFF values increased in the occipital gyrus of the PIGD PD patients, thus providing evidence of a compensatory mechanism of altered motor function in comparison with the TD PD patients.
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Affiliation(s)
- Yina Lan
- Department of Radiology, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Xinyun Liu
- Department of Radiology, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - ChunYu Yin
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Jinhao Lyu
- Department of Radiology, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Ma Xiaoxaio
- Department of Radiology, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Zhiqiang Cui
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China
| | - Xuemei Li
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Xin Lou
- Department of Radiology, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China.
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Wu H, Hong H, Wu C, Qin J, Zhou C, Tan S, DuanMu X, Guan X, Bai X, Guo T, Wu J, Chen J, Wen J, Cao Z, Gao T, Gu L, Huang P, Xu X, Zhang B, Zhang M. Regional white matter hyperintensity volume in Parkinson's disease and associations with the motor signs. Ann Clin Transl Neurol 2023; 10:1502-1512. [PMID: 37353980 PMCID: PMC10502622 DOI: 10.1002/acn3.51839] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 06/08/2023] [Accepted: 06/09/2023] [Indexed: 06/25/2023] Open
Abstract
OBJECTIVE To determine whether white matter hyperintensity (WMH) volumes in specific regions are associated with Parkinson's disease (PD) compared to non-PD controls, and to assess their impact on motor signs through cross-sectional and longitudinal analyses. METHODS A total of 50 PD participants and 47 age- and gender-matched controls were enrolled. All PD participants were followed up for at least 2 years. To detect regions of greater WMH in the PD, the WMH volume of each region was compared with the corresponding region in the control group. Linear regression and linear mixed effects models were respectively used for cross-sectional and longitudinal analyses of the impact of increases in WMH volume on motor signs. RESULTS The PD group had greater WMH volume in the occipital region compared with the control group. Cross-sectional analyses only detected a significant correlation between occipital WMH volume and motor function in PD. Occipital WMH volume positively correlated with the severity of tremor, and gait and posture impairments, in the PD group. During the follow-up period, the participants' motor signs progressed and the WMH volumes remained stable, no longitudinal association was detected between them. The baseline occipital WMH volume cannot predict the progression of signs after adjustment for baseline disease duration and the presence of vascular risk factors. INTERPRETATION PD participants in this study were characterized by greater WMH at the occipital region, and greater occipital WMH volume had cross-sectional associations with worse motor signs, while its longitudinal impact on motor signs progression was limited.
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Affiliation(s)
- Haoting Wu
- Department of RadiologyThe Second Affiliated HospitalZhejiang University School of MedicineHangzhou310009China
| | - Hui Hong
- Department of RadiologyThe Second Affiliated HospitalZhejiang University School of MedicineHangzhou310009China
| | - Chenqing Wu
- Department of RadiologyThe Second Affiliated HospitalZhejiang University School of MedicineHangzhou310009China
| | - Jianmei Qin
- Department of RadiologyThe Second Affiliated HospitalZhejiang University School of MedicineHangzhou310009China
| | - Cheng Zhou
- Department of RadiologyThe Second Affiliated HospitalZhejiang University School of MedicineHangzhou310009China
| | - Sijia Tan
- Department of RadiologyThe Second Affiliated HospitalZhejiang University School of MedicineHangzhou310009China
| | - Xiaojie DuanMu
- Department of RadiologyThe Second Affiliated HospitalZhejiang University School of MedicineHangzhou310009China
| | - Xiaojun Guan
- Department of RadiologyThe Second Affiliated HospitalZhejiang University School of MedicineHangzhou310009China
| | - Xueqin Bai
- Department of RadiologyThe Second Affiliated HospitalZhejiang University School of MedicineHangzhou310009China
| | - Tao Guo
- Department of RadiologyThe Second Affiliated HospitalZhejiang University School of MedicineHangzhou310009China
| | - Jingjing Wu
- Department of RadiologyThe Second Affiliated HospitalZhejiang University School of MedicineHangzhou310009China
| | - Jingwen Chen
- Department of RadiologyThe Second Affiliated HospitalZhejiang University School of MedicineHangzhou310009China
| | - Jiaqi Wen
- Department of RadiologyThe Second Affiliated HospitalZhejiang University School of MedicineHangzhou310009China
| | - Zhengye Cao
- Department of RadiologyThe Second Affiliated HospitalZhejiang University School of MedicineHangzhou310009China
| | - Ting Gao
- Department of NeurologyThe Second Affiliated HospitalZhejiang University School of MedicineHangzhou310009China
| | - Luyan Gu
- Department of NeurologyThe Second Affiliated HospitalZhejiang University School of MedicineHangzhou310009China
| | - Peiyu Huang
- Department of RadiologyThe Second Affiliated HospitalZhejiang University School of MedicineHangzhou310009China
| | - Xiaojun Xu
- Department of RadiologyThe Second Affiliated HospitalZhejiang University School of MedicineHangzhou310009China
| | - Baorong Zhang
- Department of NeurologyThe Second Affiliated HospitalZhejiang University School of MedicineHangzhou310009China
| | - Minming Zhang
- Department of RadiologyThe Second Affiliated HospitalZhejiang University School of MedicineHangzhou310009China
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10
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Nili MHHK, Esfahan SM, Bagheri Y, Vahabie AH, Sanayei M, Ertiaei A, Shirani M, Dehaqani MRA, Rezayat E. The variation of functional connectivity and activity before and after thalamotomy surgery (review). Front Hum Neurosci 2023; 17:1108888. [PMID: 37187943 PMCID: PMC10175682 DOI: 10.3389/fnhum.2023.1108888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 04/06/2023] [Indexed: 05/17/2023] Open
Abstract
Ablation surgeries are utilized to treat certain brain disorders. Recently, these surgeries have become more prevalent using techniques such as magnetic resonance guided focused ultrasound (MRgFUS) ablation and Gamma knife thalamotomy (GKT). However, as the thalamus plays a critical role in cognitive functions, the potential impact of these surgeries on functional connectivity and cognition is a matter of concern. Various approaches have been developed to locate the target for ablation and also investigate changes in functional connectivity before and after surgery. Functional magnetic resonance imaging (fMRI) and electroencephalogram (EEG) are widely used methods for assessing changes in functional connectivity and activity in clinical research. In this Review, we summarize the use of fMRI and EEG in thalamotomy surgeries. Our analysis shows that thalamotomy surgery can result in changes in functional connectivity in motor-related, visuomotor, and default-mode networks, as detected by fMRI. EEG data also indicate a reduction in over-activities observed in the preoperative state.
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Affiliation(s)
- Mohammad-Hossein H. K. Nili
- School of Electrical and Computer Engineering, College of Engineering, University of Tehran, Tehran, Iran
- Department of Psychology, Faculty of Psychology and Education, University of Tehran, Tehran, Iran
- School of Cognitive Sciences, Institute for Research in Fundamental Sciences (IPM), Tehran, Iran
| | | | - Yamin Bagheri
- Department of Psychology, Faculty of Psychology and Education, University of Tehran, Tehran, Iran
- School of Cognitive Sciences, Institute for Research in Fundamental Sciences (IPM), Tehran, Iran
| | - Abdol-Hossein Vahabie
- School of Electrical and Computer Engineering, College of Engineering, University of Tehran, Tehran, Iran
- Department of Psychology, Faculty of Psychology and Education, University of Tehran, Tehran, Iran
| | - Mehdi Sanayei
- School of Cognitive Sciences, Institute for Research in Fundamental Sciences (IPM), Tehran, Iran
| | - Abolhassan Ertiaei
- Department of Neurosurgery, Sina Hospital, Tehran University of Medical Science, Tehran, Iran
| | - Mohammad Shirani
- Department of Neurosurgery, Sina Hospital, Tehran University of Medical Science, Tehran, Iran
| | - Mohammad-Reza A. Dehaqani
- School of Electrical and Computer Engineering, College of Engineering, University of Tehran, Tehran, Iran
- School of Cognitive Sciences, Institute for Research in Fundamental Sciences (IPM), Tehran, Iran
| | - Ehsan Rezayat
- Department of Psychology, Faculty of Psychology and Education, University of Tehran, Tehran, Iran
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11
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Lu H, Wang X, Lou X. Current applications for magnetic resonance-guided focused ultrasound in the treatment of Parkinson's disease. Chin Med J (Engl) 2023; 136:780-787. [PMID: 36914938 PMCID: PMC10150909 DOI: 10.1097/cm9.0000000000002319] [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: 12/22/2022] [Indexed: 03/16/2023] Open
Abstract
ABSTRACT Magnetic resonance-guided focused ultrasound (MRgFUS) is a novel and minimally invasive technology. Since the US Food and Drug Administration approved unilateral ventral intermediate nucleus-MRgFUS for medication-refractory essential tremor in 2016, studies on new indications, such as Parkinson's disease (PD), psychiatric diseases, and brain tumors, have been on the rise, and MRgFUS has become a promising method to treat such neurological diseases. Currently, as the second most common degenerative disease, PD is a research hotspot in the field of MRgFUS. The actions of MRgFUS on the brain range from thermoablation, blood-brain barrier (BBB) opening, to neuromodulation. Intensity is a key determinant of ultrasound actions. Generally, high intensity can be used to precisely thermoablate brain targets, whereas low intensity can be used as molecular therapies to modulate neuronal activity and open the BBB in conjunction with injected microbubbles. Here, we aimed to summarize advances in the application of MRgFUS for the treatment of PD, with a focus on thermal ablation, BBB opening, and neuromodulation, in the hope of informing clinicians of current applications.
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Affiliation(s)
- Haoxuan Lu
- Department of Radiology, Chinese PLA General Hospital/Chinese PLA Medical School, Beijing 100853, China
| | - Xiaoyu Wang
- Department of Radiology, Chinese PLA General Hospital/Chinese PLA Medical School, Beijing 100853, China
- School of Medicine, Nankai University, Tianjin 300071, China
| | - Xin Lou
- Department of Radiology, Chinese PLA General Hospital/Chinese PLA Medical School, Beijing 100853, China
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12
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Middlebrooks EH, Popple RA, Greco E, Okromelidze L, Walker HC, Lakhani DA, Anderson AR, Thomas EM, Deshpande HD, McCullough BA, Stover NP, Sung VW, Nicholas AP, Standaert DG, Yacoubian T, Dean MN, Roper JA, Grewal SS, Holland MT, Bentley JN, Guthrie BL, Bredel M. Connectomic Basis for Tremor Control in Stereotactic Radiosurgical Thalamotomy. AJNR Am J Neuroradiol 2023; 44:157-164. [PMID: 36702499 PMCID: PMC9891328 DOI: 10.3174/ajnr.a7778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 12/30/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND AND PURPOSE Given the increased use of stereotactic radiosurgical thalamotomy and other ablative therapies for tremor, new biomarkers are needed to improve outcomes. Using resting-state fMRI and MR tractography, we hypothesized that a "connectome fingerprint" can predict tremor outcomes and potentially serve as a targeting biomarker for stereotactic radiosurgical thalamotomy. MATERIALS AND METHODS We evaluated 27 patients who underwent unilateral stereotactic radiosurgical thalamotomy for essential tremor or tremor-predominant Parkinson disease. Percentage postoperative improvement in the contralateral limb Fahn-Tolosa-Marin Clinical Tremor Rating Scale (TRS) was the primary end point. Connectome-style resting-state fMRI and MR tractography were performed before stereotactic radiosurgery. Using the final lesion volume as a seed, "connectivity fingerprints" representing ideal connectivity maps were generated as whole-brain R-maps using a voxelwise nonparametric Spearman correlation. A leave-one-out cross-validation was performed using the generated R-maps. RESULTS The mean improvement in the contralateral tremor score was 55.1% (SD, 38.9%) at a mean follow-up of 10.0 (SD, 5.0) months. Structural connectivity correlated with contralateral TRS improvement (r = 0.52; P = .006) and explained 27.0% of the variance in outcome. Functional connectivity correlated with contralateral TRS improvement (r = 0.50; P = .008) and explained 25.0% of the variance in outcome. Nodes most correlated with tremor improvement corresponded to areas of known network dysfunction in tremor, including the cerebello-thalamo-cortical pathway and the primary and extrastriate visual cortices. CONCLUSIONS Stereotactic radiosurgical targets with a distinct connectivity profile predict improvement in tremor after treatment. Such connectomic fingerprints show promise for developing patient-specific biomarkers to guide therapy with stereotactic radiosurgical thalamotomy.
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Affiliation(s)
- E H Middlebrooks
- From the Departments of Radiology (E.H.M., E.G., L.O., D.A.L.)
- Neurosurgery (E.H.M., S.S.G.), Mayo Clinic, Jacksonville, Florida
| | - R A Popple
- Departments of Radiation Oncology (R.A.P., A.R.A., E.M.T., M.B.)
| | - E Greco
- From the Departments of Radiology (E.H.M., E.G., L.O., D.A.L.)
| | - L Okromelidze
- From the Departments of Radiology (E.H.M., E.G., L.O., D.A.L.)
| | - H C Walker
- Neurology (H.C.W., B.A.M., N.P.S., V.W.S., A.P.N., D.G.S., T.Y., M.N.D.)
| | - D A Lakhani
- From the Departments of Radiology (E.H.M., E.G., L.O., D.A.L.)
- Department of Radiology (D.A.L.), West Virginia University, Morgantown, West Virginia
| | - A R Anderson
- Departments of Radiation Oncology (R.A.P., A.R.A., E.M.T., M.B.)
| | - E M Thomas
- Departments of Radiation Oncology (R.A.P., A.R.A., E.M.T., M.B.)
- Department of Radiation Oncology (E.M.T.), Ohio State University, Columbus, Ohio
| | | | - B A McCullough
- Neurology (H.C.W., B.A.M., N.P.S., V.W.S., A.P.N., D.G.S., T.Y., M.N.D.)
| | - N P Stover
- Neurology (H.C.W., B.A.M., N.P.S., V.W.S., A.P.N., D.G.S., T.Y., M.N.D.)
| | - V W Sung
- Neurology (H.C.W., B.A.M., N.P.S., V.W.S., A.P.N., D.G.S., T.Y., M.N.D.)
| | - A P Nicholas
- Neurology (H.C.W., B.A.M., N.P.S., V.W.S., A.P.N., D.G.S., T.Y., M.N.D.)
| | - D G Standaert
- Neurology (H.C.W., B.A.M., N.P.S., V.W.S., A.P.N., D.G.S., T.Y., M.N.D.)
| | - T Yacoubian
- Neurology (H.C.W., B.A.M., N.P.S., V.W.S., A.P.N., D.G.S., T.Y., M.N.D.)
| | - M N Dean
- Neurology (H.C.W., B.A.M., N.P.S., V.W.S., A.P.N., D.G.S., T.Y., M.N.D.)
| | - J A Roper
- School of Kinesiology (J.A.R.), Auburn University, Auburn, Alabama
| | - S S Grewal
- Neurosurgery (E.H.M., S.S.G.), Mayo Clinic, Jacksonville, Florida
| | - M T Holland
- Neurosurgery (M.T.H., J.N.B., B.L.G.), University of Alabama at Birmingham, Birmingham, Alabama
| | - J N Bentley
- Neurosurgery (M.T.H., J.N.B., B.L.G.), University of Alabama at Birmingham, Birmingham, Alabama
| | - B L Guthrie
- Neurosurgery (M.T.H., J.N.B., B.L.G.), University of Alabama at Birmingham, Birmingham, Alabama
| | - M Bredel
- Departments of Radiation Oncology (R.A.P., A.R.A., E.M.T., M.B.)
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13
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Lu H, Lin J, Xiong Y, Deng L, Wang X, Zhang D, Bian X, Zhou J, Pan L, Lou X. Assessing the impact of MR-guided focused ultrasound thalamotomy on brain activity and connectivity in patients with essential tremor. Neurosurg Focus 2022; 53:E5. [PMID: 36455269 DOI: 10.3171/2022.9.focus22228] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 09/20/2022] [Indexed: 12/04/2022]
Abstract
OBJECTIVE Although magnetic resonance-guided focused ultrasound (MRgFUS) at the ventral intermediate (VIM) thalamic nucleus is a novel and effective treatment for medication-refractory essential tremor (ET), it is unclear how the ablation lesion affects functional activity. The current study sought to evaluate the functional impact of MRgFUS thalamotomy in patients with ET, as well as to investigate the relationship between neuronal activity changes and tremor control. METHODS This study included 30 patients with ET who underwent MRgFUS thalamotomy with a 6-month follow-up involving MRI and clinical tremor rating. Additional sex- and age-matched healthy people were recruited for the healthy control group. The fractional amplitude of low-frequency fluctuation (fALFF) and regional homogeneity were used to identify functional alteration regions of interest (ROIs). To investigate changes after treatment, ROI- and seed-based functional connectivity (FC) analyses were performed. RESULTS Patients with ET had significantly increased fALFF in the right postcentral gyrus (PoCG; ROI 1), regional homogeneity in the left PoCG (ROI 2), and regional homogeneity in the right PoCG (ROI 3, cluster-level p value family-wise error [pFWE] < 0.05), which were recovered and normalized at 6 months after MRgFUS thalamotomy. FCs between ROI 2 and the right supramarginal gyrus, ROI 2 and the right superior parietal gyrus, and ROI 3 and the left precentral gyrus were also found to be increased after treatment (cluster-level pFWE < 0.05). Furthermore, changes in fALFF, regional homogeneity, and FC values were significantly correlated with tremor relief (p < 0.05). Preoperative FC strengths were found to be inversely related to the postoperative tremor control ratio (p < 0.05). CONCLUSIONS In patients with ET, the VIM lesion of MRgFUS thalamotomy resulted in symptom-related regional functional recovery associated with sensorimotor and attention networks. Preoperative FC strengths may reflect the postoperative tremor control ratio, implying that this metric could be a useful neuroimaging biomarker for predicting symptom relief in patients with ET following thalamotomy.
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Affiliation(s)
| | | | | | | | | | | | | | - Jiayou Zhou
- 2Neurosurgery, Chinese PLA General Hospital/Chinese PLA Medical School, Beijing, China
| | - Longsheng Pan
- 2Neurosurgery, Chinese PLA General Hospital/Chinese PLA Medical School, Beijing, China
| | - Xin Lou
- Departments of1Radiology and
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14
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Veréb D, Kovács MA, Antal S, Kocsis K, Szabó N, Kincses B, Bozsik B, Faragó P, Tóth E, Király A, Klivényi P, Zádori D, Kincses ZT. Modulation of cortical resting state functional connectivity during a visuospatial attention task in Parkinson's disease. Front Neurol 2022; 13:927481. [PMID: 36016543 PMCID: PMC9396258 DOI: 10.3389/fneur.2022.927481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 07/18/2022] [Indexed: 11/13/2022] Open
Abstract
Visual dysfunction is a recognized early symptom of Parkinson's disease (PD) that partly scales motor symptoms, yet its background is heterogeneous. With additional deficits in visuospatial attention, the two systems are hard to disentangle and it is not known whether impaired functional connectivity in the visual cortex is translative in nature or disrupted attentional modulation also contributes. In this study, we investigate functional connectivity modulation during a visuospatial attention task in patients with PD. In total, 15 PD and 16 age-matched healthy controls performed a visuospatial attention task while undergoing fMRI, in addition to a resting-state fMRI scan. Tensorial independent component analysis was used to investigate task-related network activity patterns. Independently, an atlas-based connectivity modulation analysis was performed using the task potency method. Spearman's rank correlation was calculated between task-related network expression, connectivity modulation, and clinical characteristics. Task-related networks including mostly visual, parietal, and prefrontal cortices were expressed to a significantly lesser degree in patients with PD (p < 0.027). Resting-state functional connectivity did not differ between the healthy and diseased cohorts. Connectivity between the precuneus and ventromedial prefrontal cortex was modulated to a higher degree in patients with PD (p < 0.004), while connections between the posterior parietal cortex and primary visual cortex, and also the superior frontal gyrus and opercular cortex were modulated to a lesser degree (p < 0.001 and p < 0.011). Task-related network expression and superior frontal gyrus–opercular cortex connectivity modulation were significantly associated with UPDRSIII motor scores and the Hoehn–Yahr stages (R = −0.72, p < 0.006 and R = −0.90, p < 0.001; R = −0.68, p < 0.01 and R = −0.71, p < 0.007). Task-related networks function differently in patients with PD in association with motor symptoms, whereas impaired modulation of visual and default-mode network connectivity was not correlated with motor function.
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Affiliation(s)
- Dániel Veréb
- Department of Radiology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Márton Attila Kovács
- Department of Radiology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Szabolcs Antal
- Department of Radiology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Krisztián Kocsis
- Department of Radiology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Nikoletta Szabó
- Department of Neurology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Bálint Kincses
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Bence Bozsik
- Department of Radiology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Péter Faragó
- Department of Neurology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Eszter Tóth
- Department of Radiology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - András Király
- Department of Radiology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Péter Klivényi
- Department of Neurology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Dénes Zádori
- Department of Neurology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Zsigmond Tamás Kincses
- Department of Radiology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
- *Correspondence: Zsigmond Tamás Kincses
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15
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Bolton TAW, Van De Ville D, Régis J, Witjas T, Girard N, Levivier M, Tuleasca C. Morphometric features of drug-resistant essential tremor and recovery after stereotactic radiosurgical thalamotomy. Netw Neurosci 2022; 6:850-869. [PMID: 36605417 PMCID: PMC9810368 DOI: 10.1162/netn_a_00253] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 05/02/2022] [Indexed: 01/09/2023] Open
Abstract
Essential tremor (ET) is the most common movement disorder. Its neural underpinnings remain unclear. Here, we quantified structural covariance between cortical thickness (CT), surface area (SA), and mean curvature (MC) estimates in patients with ET before and 1 year after ventro-intermediate nucleus stereotactic radiosurgical thalamotomy, and contrasted the observed patterns with those from matched healthy controls. For SA, complex rearrangements within a network of motion-related brain areas characterized patients with ET. This was complemented by MC alterations revolving around the left middle temporal cortex and the disappearance of positive-valued covariance across both modalities in the right fusiform gyrus. Recovery following thalamotomy involved MC readjustments in frontal brain centers, the amygdala, and the insula, capturing nonmotor characteristics of the disease. The appearance of negative-valued CT covariance between the left parahippocampal gyrus and hippocampus was another recovery mechanism involving high-level visual areas. This was complemented by the appearance of negative-valued CT/MC covariance, and positive-valued SA/MC covariance, in the right inferior temporal cortex and bilateral fusiform gyrus. Our results demonstrate that different morphometric properties provide complementary information to understand ET, and that their statistical cross-dependences are also valuable. They pinpoint several anatomical features of the disease and highlight routes of recovery following thalamotomy.
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Affiliation(s)
- Thomas A. W. Bolton
- Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland,Connectomics Laboratory, Department of Radiology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland,* Corresponding Author:
| | - Dimitri Van De Ville
- Institute of Bioengineering, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland,Department of Radiology and Medical Informatics, University of Geneva (UNIGE), Geneva, Switzerland
| | - Jean Régis
- Stereotactic and Functional Neurosurgery Service and Gamma Knife Unit, Assistance Publique-Hôpitaux de Marseille, Centre Hospitalier Universitaire de la Timone, Marseille, France
| | - Tatiana Witjas
- Neurology Department, Assistance Publique-Hôpitaux de Marseille, Centre Hospitalier Universitaire de la Timone, Marseille, France
| | - Nadine Girard
- Department of Diagnostic and Interventional Neuroradiology, Centre de Résonance Magnétique Biologique et Médicale, Assistance Publique-Hôpitaux de Marseille, Centre Hospitalier Universitaire de la Timone, Marseille, France
| | - Marc Levivier
- Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland,Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland
| | - Constantin Tuleasca
- Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland,Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland,Signal Processing Laboratory (LTS 5), Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
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16
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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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