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Akram H, Dayal V, Mahlknecht P, Georgiev D, Hyam J, Foltynie T, Limousin P, De Vita E, Jahanshahi M, Ashburner J, Behrens T, Hariz M, Zrinzo L. Connectivity derived thalamic segmentation in deep brain stimulation for tremor. Neuroimage Clin 2018; 18:130-142. [PMID: 29387530 PMCID: PMC5790021 DOI: 10.1016/j.nicl.2018.01.008] [Citation(s) in RCA: 113] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Revised: 12/23/2017] [Accepted: 01/13/2018] [Indexed: 02/02/2023]
Abstract
The ventral intermediate nucleus (VIM) of the thalamus is an established surgical target for stereotactic ablation and deep brain stimulation (DBS) in the treatment of tremor in Parkinson's disease (PD) and essential tremor (ET). It is centrally placed on a cerebello-thalamo-cortical network connecting the primary motor cortex, to the dentate nucleus of the contralateral cerebellum through the dentato-rubro-thalamic tract (DRT). The VIM is not readily visible on conventional MR imaging, so identifying the surgical target traditionally involved indirect targeting that relies on atlas-defined coordinates. Unfortunately, this approach does not fully account for individual variability and requires surgery to be performed with the patient awake to allow for intraoperative targeting confirmation. The aim of this study is to identify the VIM and the DRT using probabilistic tractography in patients that will undergo thalamic DBS for tremor. Four male patients with tremor dominant PD and five patients (three female) with ET underwent high angular resolution diffusion imaging (HARDI) (128 diffusion directions, 1.5 mm isotropic voxels and b value = 1500) preoperatively. Patients received VIM-DBS using an MR image guided and MR image verified approach with indirect targeting. Postoperatively, using parallel Graphical Processing Unit (GPU) processing, thalamic areas with the highest diffusion connectivity to the primary motor area (M1), supplementary motor area (SMA), primary sensory area (S1) and contralateral dentate nucleus were identified. Additionally, volume of tissue activation (VTA) corresponding to active DBS contacts were modelled. Response to treatment was defined as 40% reduction in the total Fahn-Tolosa-Martin Tremor Rating Score (FTMTRS) with DBS-ON, one year from surgery. Three out of nine patients had a suboptimal, long-term response to treatment. The segmented thalamic areas corresponded well to anatomically known counterparts in the ventrolateral (VL) and ventroposterior (VP) thalamus. The dentate-thalamic area, lay within the M1-thalamic area in a ventral and lateral location. Streamlines corresponding to the DRT connected M1 to the contralateral dentate nucleus via the dentate-thalamic area, clearly crossing the midline in the mesencephalon. Good response was seen when the active contact VTA was in the thalamic area with highest connectivity to the contralateral dentate nucleus. Non-responders had active contact VTAs outside the dentate-thalamic area. We conclude that probabilistic tractography techniques can be used to segment the VL and VP thalamus based on cortical and cerebellar connectivity. The thalamic area, best representing the VIM, is connected to the contralateral dentate cerebellar nucleus. Connectivity based segmentation of the VIM can be achieved in individual patients in a clinically feasible timescale, using HARDI and high performance computing with parallel GPU processing. This same technique can map out the DRT tract with clear mesencephalic crossing.
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Key Words
- AC, anterior commissure
- BEDPOSTX, Bayesian estimation of diffusion parameters obtained using sampling techniques X
- BET, brain extraction tool
- CI, confidence interval
- CON, connectivity
- Connectivity
- DBS
- DBS, deep brain stimulation
- DF, degrees of freedom
- DICOM, digital imaging and communications in medicine
- DRT
- DWI
- DWI, diffusion weighted imaging
- Deep brain stimulation
- Dentate nucleus
- Dentato-rubro-thalamic tract
- Diffusion weighted imaging
- EV, explanatory variable
- FLIRT, FMRIB's linear image registration tool
- FMRIB, Oxford centre for functional MRI of the brain
- FNIRT, FMRIB's non-linear image registration tool
- FSL, FMRIB's software library
- FoV, field of view
- GLM, general linear model
- HARDI, high angular resolution diffusion imaging
- HFS, high frequency stimulation
- IPG, implantable pulse generator
- LC, Levodopa challenge
- LEDD, l-DOPA equivalent daily dose
- M1, primary motor cortex
- MMS, mini-mental score
- MNI, Montreal neurological institute
- MPRAGE, magnetization-prepared rapid gradient-echo
- MPTP, 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine
- NHNN, National Hospital for Neurology and Neurosurgery
- NIfTI, neuroimaging informatics technology initiative
- PC, posterior commissure
- PD
- PFC, prefrontal cortex
- PMC, premotor cortex
- Parkinson's disease
- S1, primary sensory cortex
- SAR, specific absorption rate
- SD, standard deviation
- SE, standard error
- SMA, supplementary motor area
- SNR, signal-to-noise ratio
- SSEPI, single-shot echo planar imaging
- STN, subthalamic nucleus
- TFCE, threshold-free cluster enhancement
- TMS, transcranial magnetic stimulation
- Tremor
- UPDRS, unified Parkinson's disease rating scale
- VBM, voxel based morphometry
- VIM
- VL
- VL, ventral lateral
- VP, ventral posterior
- VTA, volume of tissue activated
- Ventrointermedialis
- Ventrolateral nucleus
- cZI, caudal zona incerta
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Affiliation(s)
- Harith Akram
- Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK; Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK.
| | - Viswas Dayal
- Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK
| | - Philipp Mahlknecht
- Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK; Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Dejan Georgiev
- Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK
| | - Jonathan Hyam
- Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK; Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK
| | - Thomas Foltynie
- Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK
| | - Patricia Limousin
- Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK
| | - Enrico De Vita
- Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK; Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, University College London NHS Foundation Trust, London, UK
| | - Marjan Jahanshahi
- Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK
| | - John Ashburner
- Wellcome Trust Centre for Neuroimaging, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK
| | - Tim Behrens
- Wellcome Trust Centre for Neuroimaging, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK; Centre for Functional MRI of the Brain (FMRIB), John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - Marwan Hariz
- Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK; Department of Clinical Neuroscience, Umeå University, Umeå, Sweden
| | - Ludvic Zrinzo
- Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK; Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK
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Desbordes G, Li A, Loggia ML, Kim J, Schalock PC, Lerner E, Tran TN, Ring J, Rosen BR, Kaptchuk TJ, Pfab F, Napadow V. Evoked itch perception is associated with changes in functional brain connectivity. Neuroimage Clin 2014; 7:213-21. [PMID: 25610783 PMCID: PMC4300003 DOI: 10.1016/j.nicl.2014.12.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 10/28/2014] [Accepted: 12/01/2014] [Indexed: 02/07/2023]
Abstract
Chronic itch, a highly debilitating condition, has received relatively little attention in the neuroimaging literature. Recent studies suggest that brain regions supporting itch in chronic itch patients encompass sensorimotor and salience networks, and corticostriatal circuits involved in motor preparation for scratching. However, how these different brain areas interact with one another in the context of itch is still unknown. We acquired BOLD fMRI scans in 14 atopic dermatitis patients to investigate resting-state functional connectivity before and after allergen-induced itch exacerbated the clinical itch perception in these patients. A seed-based analysis revealed decreased functional connectivity from baseline resting state to the evoked-itch state between several itch-related brain regions, particularly the insular and cingulate cortices and basal ganglia, where decreased connectivity was significantly correlated with increased levels of perceived itch. In contrast, evoked itch increased connectivity between key nodes of the frontoparietal control network (superior parietal lobule and dorsolateral prefrontal cortex), where higher increase in connectivity was correlated with a lesser increase in perceived itch, suggesting that greater interaction between nodes of this executive attention network serves to limit itch sensation via enhanced top-down regulation. Overall, our results provide the first evidence of itch-dependent changes in functional connectivity across multiple brain regions. Atopic dermatitis patients were subjected to allergen-induced itch. Evoked itch reduced functional connectivity between itch-related brain regions. Evoked itch increased functional connectivity within frontoparietal control network. The above changes in functional connectivity correlated with perceived itch level. Itch sensation may be top-down regulated by frontoparietal control network.
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Key Words
- AD, atopic dermatitis
- ASL, arterial spin labeling
- Atopic dermatitis
- BA, Brodmann area
- BOLD, blood-oxygen-level dependent
- DMN, default mode network
- ECG, electrocardiography
- Eczema
- GLM, general linear model
- ITCH, evoked itch resting-state scan
- Insula
- L, left
- MNI, Montreal Neurological Institute
- MR, magnetic resonance
- PCC, posterior cingulate cortex
- PET, positron emission tomography
- PMC, premotor cortex
- Pruritus
- Putamen
- R, right
- REST, baseline resting-state scan
- S1/M1, primary sensorimotor cortex
- SCORAD, SCORing atopic dermatitis scale
- SPL, Superior parietal lobule
- VAS, visual analog scale
- aMCC, anterior mid-cingulate cortex
- dlPFC, dorsolateral prefrontal cortex
- fMRI, functional magnetic resonance imaging
- fcMRI, functional connectivity magnetic resonance imaging
- pMCC, posterior mid-cingulate cortex
- vlPFC, ventrolateral prefrontal cortex.
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Affiliation(s)
- Gaëlle Desbordes
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ang Li
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Marco L Loggia
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jieun Kim
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Peter C Schalock
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ethan Lerner
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Thanh N Tran
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Johannes Ring
- Department of Dermatology and Allergy, Technische Universität München, Munich, Germany
| | - Bruce R Rosen
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ted J Kaptchuk
- Department of Internal Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Florian Pfab
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA ; Department of Dermatology and Allergy, Technische Universität München, Munich, Germany ; Department of Prevention and Sports Medicine, Technische Universität München, Munich, Germany
| | - Vitaly Napadow
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA ; Department of Radiology, Logan College of Chiropractic, Chesterfield, MO, USA ; Department of Biomedical Engineering, Kyunghee University, Yongin, Korea
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Ceko M, Bushnell MC, Fitzcharles MA, Schweinhardt P. Fibromyalgia interacts with age to change the brain. Neuroimage Clin 2013; 3:249-60. [PMID: 24273710 DOI: 10.1016/j.nicl.2013.08.015] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2013] [Revised: 08/28/2013] [Accepted: 08/29/2013] [Indexed: 12/12/2022]
Abstract
Although brain plasticity in the form of gray matter increases and decreases has been observed in chronic pain, factors determining the patterns of directionality are largely unknown. Here we tested the hypothesis that fibromyalgia interacts with age to produce distinct patterns of gray matter differences, specifically increases in younger and decreases in older patients, when compared to age-matched healthy controls. The relative contribution of pain duration was also investigated. Regional gray matter was measured in younger (n = 14, mean age 43, range 29–49) and older (n = 14; mean age 55, range 51–60) female fibromyalgia patients and matched controls using voxel-based morphometry and cortical thickness analysis of T1-weighted magnetic resonance images. To examine their functional significance, gray matter differences were compared with experimental pain sensitivity. Diffusion-tensor imaging was used to assess whether white matter changed in parallel with gray matter, and resting-state fMRI was acquired to examine whether pain-related gray matter changes are associated with altered functional connectivity. Older patients showed exclusively decreased gray matter, accompanied by compromised white matter integrity. In contrast, younger patients showed exclusively gray matter increases, namely in the basal ganglia and insula, which were independent of pain duration. Associated white matter changes in younger patients were compatible with gray matter hypertrophy. In both age groups, structural brain alterations were associated with experimental pain sensitivity, which was increased in older patients but normal in younger patients. Whereas more pronounced gray matter decreases in the posterior cingulate cortex were related to increased experimental pain sensitivity in older patients, insular gray matter increases in younger patients correlated with lower pain sensitivity, possibly indicating the recruitment of endogenous pain modulatory mechanisms. This is supported by the finding that the insula in younger patients showed functional decoupling from an important pain-processing region, the dorsal anterior cingulate cortex. These results suggest that brain structure and function shift from being adaptive in younger to being maladaptive in older patients, which might have important treatment implications.
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Key Words
- ACC, anterior cingulate cortex
- Age
- CTA, cortical thickness analysis
- Chronic pain
- Cingulate
- DLPFC, dorsolateral prefrontal cortex
- FA, fractional anisotropy
- Insula
- MPFC, medial prefrontal cortex
- MRI
- NAc, nucleus accumbens
- PCC, posterior cingulate cortex
- PMC, premotor cortex
- VBM
- VBM, voxel-based morphometry
- aINS, anterior insula
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