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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] [What about the content of this article? (0)] [Affiliation(s)] [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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De la Garza-Ramos C, Jain A, Montazeri SA, Okromelidze L, McGeary R, Bhatt AA, Sandhu SJS, Grewal SS, Feyissa A, Sirven JI, Ritaccio AL, Tatum WO, Gupta V, Middlebrooks EH. Brain Abnormalities and Epilepsy in Patients with Parry-Romberg Syndrome. AJNR Am J Neuroradiol 2022; 43:850-856. [PMID: 35672084 DOI: 10.3174/ajnr.a7517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 03/21/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Parry-Romberg syndrome is a rare disorder characterized by progressive hemifacial atrophy. Concomitant brain abnormalities have been reported, frequently resulting in epilepsy, but the frequency and spectrum of brain involvement are not well-established. This study aimed to characterize brain abnormalities in Parry-Romberg syndrome and their association with epilepsy. MATERIALS AND METHODS This is a single-center, retrospective review of patients with a clinical diagnosis of Parry-Romberg syndrome and brain MR imaging. The degree of unilateral hemispheric atrophy, white matter disease, microhemorrhage, and leptomeningeal enhancement was graded as none, mild, moderate, or severe. Other abnormalities were qualitatively reported. Findings were considered potentially Parry-Romberg syndrome-related when occurring asymmetrically on the side affected by Parry-Romberg syndrome. RESULTS Of 80 patients, 48 (60%) had brain abnormalities identified on MR imaging, with 26 (32%) having abnormalities localized to the side of the hemifacial atrophy. Sixteen (20%) had epilepsy. MR imaging brain abnormalities were more common in the epilepsy group (100% versus 48%, P < .001) and were more frequently present ipsilateral to the hemifacial atrophy in patients with epilepsy (81% versus 20%, P < .001). Asymmetric white matter disease was the predominant finding in patients with (88%) and without (23%) epilepsy. White matter disease and hemispheric atrophy had a higher frequency and severity in patients with epilepsy (P < .001). Microhemorrhage was also more frequent in the epilepsy group (P = .015). CONCLUSIONS Ipsilateral MR imaging brain abnormalities are common in patients with Parry-Romberg syndrome, with a higher frequency and greater severity in those with epilepsy. The most common findings in both groups are white matter disease and hemispheric atrophy, both presenting with greater severity in patients with epilepsy.
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Affiliation(s)
- C De la Garza-Ramos
- From the Department of Neuroradiology (C.D.l.G.-R., A.J., S.A.M., L.O., R.M., A.A.B., S.J.S., V.G., E.H.M.), Mayo Clinic, Jacksonville, Florida
| | - A Jain
- From the Department of Neuroradiology (C.D.l.G.-R., A.J., S.A.M., L.O., R.M., A.A.B., S.J.S., V.G., E.H.M.), Mayo Clinic, Jacksonville, Florida
| | - S A Montazeri
- From the Department of Neuroradiology (C.D.l.G.-R., A.J., S.A.M., L.O., R.M., A.A.B., S.J.S., V.G., E.H.M.), Mayo Clinic, Jacksonville, Florida
| | - L Okromelidze
- From the Department of Neuroradiology (C.D.l.G.-R., A.J., S.A.M., L.O., R.M., A.A.B., S.J.S., V.G., E.H.M.), Mayo Clinic, Jacksonville, Florida
| | - R McGeary
- From the Department of Neuroradiology (C.D.l.G.-R., A.J., S.A.M., L.O., R.M., A.A.B., S.J.S., V.G., E.H.M.), Mayo Clinic, Jacksonville, Florida
| | - A A Bhatt
- From the Department of Neuroradiology (C.D.l.G.-R., A.J., S.A.M., L.O., R.M., A.A.B., S.J.S., V.G., E.H.M.), Mayo Clinic, Jacksonville, Florida
| | - S J S Sandhu
- From the Department of Neuroradiology (C.D.l.G.-R., A.J., S.A.M., L.O., R.M., A.A.B., S.J.S., V.G., E.H.M.), Mayo Clinic, Jacksonville, Florida
| | - S S Grewal
- Department of Neurologic Surgery (S.S.G.), Mayo Clinic, Jacksonville, Florida
| | - A Feyissa
- Department of Neurology (A.F., J.I.S., A.L.R., W.O.T.), Mayo Clinic, Jacksonville, Florida
| | - J I Sirven
- Department of Neurology (A.F., J.I.S., A.L.R., W.O.T.), Mayo Clinic, Jacksonville, Florida
| | - A L Ritaccio
- Department of Neurology (A.F., J.I.S., A.L.R., W.O.T.), Mayo Clinic, Jacksonville, Florida
| | - W O Tatum
- Department of Neurology (A.F., J.I.S., A.L.R., W.O.T.), Mayo Clinic, Jacksonville, Florida
| | - V Gupta
- From the Department of Neuroradiology (C.D.l.G.-R., A.J., S.A.M., L.O., R.M., A.A.B., S.J.S., V.G., E.H.M.), Mayo Clinic, Jacksonville, Florida
| | - E H Middlebrooks
- From the Department of Neuroradiology (C.D.l.G.-R., A.J., S.A.M., L.O., R.M., A.A.B., S.J.S., V.G., E.H.M.), Mayo Clinic, Jacksonville, Florida
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Jain A, Muneer MS, Okromelidze L, McGeary R, Valluri SK, Bhatt AA, Gupta V, Grewal SS, Cheshire WP, Middlebrooks EH, Sandhu SJS. Absence of Meckel Cave: A Rare Cause of Trigeminal Neuralgia. AJNR Am J Neuroradiol 2021; 42:1610-1614. [PMID: 34244131 DOI: 10.3174/ajnr.a7205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 04/20/2021] [Indexed: 11/07/2022]
Abstract
Trigeminal neuralgia is a debilitating condition with numerous etiologies. In this retrospective case series, we report a cohort of patients with a rarely described entity, absence of Meckel cave, and propose this as a rare cause of trigeminal neuralgia. A search of the electronic medical record was performed between 2000 and 2020 to identify MR imaging reports with terms including "Meckel's cave" and "hypoplasia," "atresia," "collapse," or "asymmetry." Images were reviewed by 2 blinded, board-certified neuroradiologists. Seven cases of the absence of Meckel cave were identified. Seven patients (100%) had ipsilateral trigeminal neuralgia and ipsilateral trigeminal nerve atrophy, suggesting an association between absence of Meckel cave and trigeminal neuralgia. Absence of Meckel cave is a rare entity of unknown etiology, with few existing reports that suggest the possibility of an association with trigeminal neuralgia. Its recognition may have important implications in patient management. Future studies and longitudinal data are needed to assess treatment outcomes and added risks from surgical intervention in these patients.
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Affiliation(s)
- A Jain
- From the Departments of Radiology (A.J., M.S.M., L.O., R.M., S.K.V., A.A.B., V.G., E.H.M., S.J.S.S.)
| | - M S Muneer
- From the Departments of Radiology (A.J., M.S.M., L.O., R.M., S.K.V., A.A.B., V.G., E.H.M., S.J.S.S.)
| | - L Okromelidze
- From the Departments of Radiology (A.J., M.S.M., L.O., R.M., S.K.V., A.A.B., V.G., E.H.M., S.J.S.S.)
| | - R McGeary
- From the Departments of Radiology (A.J., M.S.M., L.O., R.M., S.K.V., A.A.B., V.G., E.H.M., S.J.S.S.)
| | - S K Valluri
- From the Departments of Radiology (A.J., M.S.M., L.O., R.M., S.K.V., A.A.B., V.G., E.H.M., S.J.S.S.)
| | - A A Bhatt
- From the Departments of Radiology (A.J., M.S.M., L.O., R.M., S.K.V., A.A.B., V.G., E.H.M., S.J.S.S.)
| | - V Gupta
- From the Departments of Radiology (A.J., M.S.M., L.O., R.M., S.K.V., A.A.B., V.G., E.H.M., S.J.S.S.)
| | | | - W P Cheshire
- Neurology (W.P.C.), Mayo Clinic, Jacksonville, Florida
| | - E H Middlebrooks
- From the Departments of Radiology (A.J., M.S.M., L.O., R.M., S.K.V., A.A.B., V.G., E.H.M., S.J.S.S.) .,Neurosurgery (S.S.G., E.H.M.)
| | - S J S Sandhu
- From the Departments of Radiology (A.J., M.S.M., L.O., R.M., S.K.V., A.A.B., V.G., E.H.M., S.J.S.S.)
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Middlebrooks EH, Domingo RA, Vivas-Buitrago T, Okromelidze L, Tsuboi T, Wong JK, Eisinger RS, Almeida L, Burns MR, Horn A, Uitti RJ, Wharen RE, Holanda VM, Grewal SS. Neuroimaging Advances in Deep Brain Stimulation: Review of Indications, Anatomy, and Brain Connectomics. AJNR Am J Neuroradiol 2020; 41:1558-1568. [PMID: 32816768 DOI: 10.3174/ajnr.a6693] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 06/03/2020] [Indexed: 12/18/2022]
Abstract
Deep brain stimulation is an established therapy for multiple brain disorders, with rapidly expanding potential indications. Neuroimaging has advanced the field of deep brain stimulation through improvements in delineation of anatomy, and, more recently, application of brain connectomics. Older lesion-derived, localizationist theories of these conditions have evolved to newer, network-based "circuitopathies," aided by the ability to directly assess these brain circuits in vivo through the use of advanced neuroimaging techniques, such as diffusion tractography and fMRI. In this review, we use a combination of ultra-high-field MR imaging and diffusion tractography to highlight relevant anatomy for the currently approved indications for deep brain stimulation in the United States: essential tremor, Parkinson disease, drug-resistant epilepsy, dystonia, and obsessive-compulsive disorder. We also review the literature regarding the use of fMRI and diffusion tractography in understanding the role of deep brain stimulation in these disorders, as well as their potential use in both surgical targeting and device programming.
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Affiliation(s)
- E H Middlebrooks
- From the Departments of Radiology (E.H.M., L.O.) .,Neurosurgery (E.H.M., R.A.D., T.V.-B., R.E.W., S.S.G.)
| | - R A Domingo
- Neurosurgery (E.H.M., R.A.D., T.V.-B., R.E.W., S.S.G.)
| | | | | | - T Tsuboi
- and Neurology (R.J.U.), Mayo Clinic, Jacksonville, Florida.,Department of Neurology (T.T., J.K.W., R.S.E., L.A., M.R.B.), Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, Florida
| | - J K Wong
- and Neurology (R.J.U.), Mayo Clinic, Jacksonville, Florida
| | - R S Eisinger
- and Neurology (R.J.U.), Mayo Clinic, Jacksonville, Florida
| | - L Almeida
- and Neurology (R.J.U.), Mayo Clinic, Jacksonville, Florida
| | - M R Burns
- and Neurology (R.J.U.), Mayo Clinic, Jacksonville, Florida
| | - A Horn
- Department of Neurology (T.T.), Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - R J Uitti
- Department for Neurology (A.H.), Charité, University Medicine Berlin, Berlin, Germany
| | - R E Wharen
- Neurosurgery (E.H.M., R.A.D., T.V.-B., R.E.W., S.S.G.)
| | - V M Holanda
- Center of Neurology and Neurosurgery Associates (V.M.H.), BP-A Beneficência Portuguesa de São Paulo, São Paulo, Brazil
| | - S S Grewal
- Neurosurgery (E.H.M., R.A.D., T.V.-B., R.E.W., S.S.G.)
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Okromelidze L, Tsuboi T, Eisinger RS, Burns MR, Charbel M, Rana M, Grewal SS, Lu CQ, Almeida L, Foote KD, Okun MS, Middlebrooks EH. Functional and Structural Connectivity Patterns Associated with Clinical Outcomes in Deep Brain Stimulation of the Globus Pallidus Internus for Generalized Dystonia. AJNR Am J Neuroradiol 2020; 41:508-514. [PMID: 32054614 DOI: 10.3174/ajnr.a6429] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 01/07/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND PURPOSE Deep brain stimulation is a well-established treatment for generalized dystonia, but outcomes remain variable. Establishment of an imaging marker to guide device targeting and programming could possibly impact the efficacy of deep brain stimulation in dystonia, particularly in the absence of acute clinical markers to indicate benefit. We hypothesize that the stimulation-based functional and structural connectivity using resting-state fMRI and DTI can predict therapeutic outcomes in patients with generalized dystonia and deep brain stimulation. MATERIALS AND METHODS We performed a retrospective analysis of 39 patients with inherited or idiopathic-isolated generalized dystonia who underwent bilateral globus pallidus internus deep brain stimulation. After electrode localization, the volumes of tissue activated were modeled and used as seed regions for functional and structural connectivity measures using a normative data base. Resulting connectivity maps were correlated with postoperative improvement in the Unified Dystonia Rating Scale score. RESULTS Structural connectivity between the volumes of tissue activated and the primary sensorimotor cortex was correlated with Unified Dystonia Rating Scale improvement, while more anterior prefrontal connectivity was inversely correlated with Unified Dystonia Rating Scale improvement. Functional connectivity between the volumes of tissue activated and primary sensorimotor regions, motor thalamus, and cerebellum was most correlated with Unified Dystonia Rating Scale improvement; however, an inverse correlation with Unified Dystonia Rating Scale improvement was seen in the supplemental motor area and premotor cortex. CONCLUSIONS Functional and structural connectivity with multiple nodes of the motor network is associated with motor improvement in patients with generalized dystonia undergoing deep brain stimulation. Results from this study may serve as a basis for future development of clinical markers to guide deep brain stimulation targeting and programming in dystonia.
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Affiliation(s)
- L Okromelidze
- From the Departments of Radiology (L.O., C.-Q.L., E.H.M.) and Neurosurgery (S.S.G., E.H.M.), Mayo Clinic, Jacksonville, Florida
| | - T Tsuboi
- Department of Neurology (T.T., R.S.E., M.R.B., L.A., K.D.F., M.S.O.), Norman Fixel Institute for Neurological Diseases
| | - R S Eisinger
- Department of Neurology (T.T., R.S.E., M.R.B., L.A., K.D.F., M.S.O.), Norman Fixel Institute for Neurological Diseases
| | - M R Burns
- Department of Neurology (T.T., R.S.E., M.R.B., L.A., K.D.F., M.S.O.), Norman Fixel Institute for Neurological Diseases
| | - M Charbel
- Department of Neurosurgery (K.D.F.), and J. Crayton Pruitt Family Department of Biomedical Engineering (M.C.), University of Florida, Gainesville, Florida
| | - M Rana
- Institute of Medical Psychology and Behavioural Neurobiology (M.R.), University of Tübingen, Tübingen, Germany
| | - S S Grewal
- Department of Neurology (T.T., R.S.E., M.R.B., L.A., K.D.F., M.S.O.), Norman Fixel Institute for Neurological Diseases
| | - C-Q Lu
- From the Departments of Radiology (L.O., C.-Q.L., E.H.M.) and Neurosurgery (S.S.G., E.H.M.), Mayo Clinic, Jacksonville, Florida
| | - L Almeida
- Department of Neurosurgery (K.D.F.), and J. Crayton Pruitt Family Department of Biomedical Engineering (M.C.), University of Florida, Gainesville, Florida
| | - K D Foote
- Department of Neurosurgery (K.D.F.), and J. Crayton Pruitt Family Department of Biomedical Engineering (M.C.), University of Florida, Gainesville, Florida
| | - M S Okun
- Department of Neurology (T.T., R.S.E., M.R.B., L.A., K.D.F., M.S.O.), Norman Fixel Institute for Neurological Diseases
| | - E H Middlebrooks
- From the Departments of Radiology (L.O., C.-Q.L., E.H.M.) and Neurosurgery (S.S.G., E.H.M.), Mayo Clinic, Jacksonville, Florida .,Department of Neurology (T.T., R.S.E., M.R.B., L.A., K.D.F., M.S.O.), Norman Fixel Institute for Neurological Diseases
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