scholarly journals Clinically Weighted Probabilistic Tractography Mapping of Therapeutic Thalamic Deep Brain Stimulation for Essential Tremor

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Evangelia Tsolaki ◽  
Alon Kashanian ◽  
Nader Pouratian
Keyword(s):  
Deep Brain Stimulation ◽  
Clinical Outcome ◽  
Essential Tremor ◽  
Clinical Improvement ◽  
Brain Stimulation ◽  
Structural Connectivity ◽  
Precentral Gyrus ◽  
Probabilistic Tractography ◽  
Whole Brain ◽  
Deep Brain

Abstract INTRODUCTION Traditional targeting methods rely on indirect targeting with atlas-defined coordinates that induce interpatient anatomical and functional variability. Precise targeting is crucial for successful surgical intervention associated with improved surgical outcomes. Here, we use clinically weighted probabilistic tractography to investigate the connectivity from volume of tissue activated (VTA) to whole brain in order to evaluate the relationship between structural connectivity and clinical outcome of patients that underwent thalamic deep brain stimulation (DBS). METHODS Magnetic resonance imaging and clinical outcomes from 10 essential tremor (ET) patients who were treated by VIM-DBS at the University of California Los Angeles were evaluated. LeadBDS was used for the VTA calculation and FSL was used to evaluate the whole brain probabilistic tractography of VTA. Tractography maps were binarized and weighted based on the percent of clinical improvement using the Fahn-Tolosa-Martin Tremor Rating Score. The resulting clinically weighted maps were non-linearly fused to MNI space and averaged. These population maps provide a voxel-by-voxel map of the average clinical improvement observed when the VTA demonstrates structural connectivity to the whole brain. RESULTS The VTA connectivity to the whole brain was delineated. Superior clinical improvement was associated with connectivity to voxels connecting the thalamus to the precentral gyrus and to the brainstem/cerebellum. Also, the clinical efficacy map showed that patients with higher clinical improvement (>70%) presented stronger structural connectivity to the precentral gyrus and to the caudal projection to the cerebellum. CONCLUSION Stronger connectivity to the precentral gyrus and to brainstem/cerebellum is associated with superior clinical outcome in thalamic DBS for ET. In the future, rather than focusing on connectivity to predetermined targets, these clinically weighted tractography maps can be used with a reverse algorithm to identify the optimal region of the thalamus to provide clinically superior results.

Mapping efficacious deep brain stimulation for pediatric dystonia

2021 ◽  
pp. 1-11
Author(s):  
Ailish Coblentz ◽  
Gavin J. B. Elias ◽  
Alexandre Boutet ◽  
Jurgen Germann ◽  
Musleh Algarni ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Clinical Outcome ◽  
Brain Stimulation ◽  
Pediatric Patients ◽  
Rating Scale ◽  
Structural Connectivity ◽  
Response To Treatment ◽  
Internal Globus Pallidus ◽  
Probabilistic Map ◽  
Deep Brain

OBJECTIVEThe objective of this study was to report the authors’ experience with deep brain stimulation (DBS) of the internal globus pallidus (GPi) as a treatment for pediatric dystonia, and to elucidate substrates underlying clinical outcome using state-of-the-art neuroimaging techniques.METHODSA retrospective analysis was conducted in 11 pediatric patients (6 girls and 5 boys, mean age 12 ± 4 years) with medically refractory dystonia who underwent GPi-DBS implantation between June 2009 and September 2017. Using pre- and postoperative MRI, volumes of tissue activated were modeled and weighted by clinical outcome to identify brain regions associated with clinical outcome. Functional and structural networks associated with clinical benefits were also determined using large-scale normative data sets.RESULTSA total of 21 implanted leads were analyzed in 11 patients. The average follow-up duration was 19 ± 20 months (median 5 months). Using a 7-point clinical rating scale, 10 patients showed response to treatment, as defined by scores < 3. The mean improvement in the Burke-Fahn-Marsden Dystonia Rating Scale motor score was 40% ± 23%. The probabilistic map of efficacy showed that the voxel cluster most associated with clinical improvement was located at the posterior aspect of the GPi, comparatively posterior and superior to the coordinates of the classic GPi target. Strong functional and structural connectivity was evident between the probabilistic map and areas such as the precentral and postcentral gyri, parietooccipital cortex, and brainstem.CONCLUSIONSThis study reported on a series of pediatric patients with dystonia in whom GPi-DBS resulted in variable clinical benefit and described a clinically favorable stimulation site for this cohort, as well as its structural and functional connectivity. This information could be valuable for improving surgical planning, simplifying programming, and further informing disease pathophysiology.

scholarly journals Long-term Thalamic Deep Brain Stimulation for Essential Tremor: Clinical Outcome and Stimulation Parameters

2016 ◽  
Vol 3 (6) ◽  
pp. 567-572 ◽  
Author(s):  
Pedro M. Rodríguez Cruz ◽  
Antonio Vargas ◽  
Carlos Fernández-Carballal ◽  
Jose Garbizu ◽  
Beatriz De La Casa-Fages ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Clinical Outcome ◽  
Essential Tremor ◽  
Brain Stimulation ◽  
Stimulation Parameters ◽  
Deep Brain

Comparative connectivity correlates of dystonic and essential tremor deep brain stimulation

Brain ◽  
2021 ◽  
Author(s):  
Takashi Tsuboi ◽  
Joshua K Wong ◽  
Robert S Eisinger ◽  
Lela Okromelidze ◽  
Mathew R Burns ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Essential Tremor ◽  
Brain Stimulation ◽  
Rating Scale ◽  
Structural Connectivity ◽  
Cortical Network ◽  
Dystonic Tremor ◽  
Intermediate Nucleus ◽  
Ventral Intermediate Nucleus ◽  
Deep Brain

Abstract The pathophysiology of dystonic tremor and essential tremor remains partially understood. In patients with medication-refractory dystonic tremor or essential tremor, deep brain stimulation (DBS) targeting the thalamus or posterior subthalamic area has evolved into a promising treatment option. However, the optimal DBS targets for these disorders remains unknown. This retrospective study explored the optimal targets for DBS in essential tremor and dystonic tremor using a combination of volumes of tissue activated estimation and functional and structural connectivity analyses. We included 20 patients with dystonic tremor who underwent unilateral thalamic DBS, along with a matched cohort of 20 patients with essential tremor DBS. Tremor severity was assessed preoperatively and approximately 6 months after DBS implantation using the Fahn-Tolosa-Marin Tremor Rating Scale. The tremor-suppressing effects of DBS were estimated using the percentage improvement in the unilateral tremor-rating scale score contralateral to the side of implantation. The optimal stimulation region, based on the cluster centre of gravity for peak contralateral motor score improvement, for essential tremor was located in the ventral intermediate nucleus region and for dystonic tremor in the ventralis oralis posterior nucleus region along the ventral intermediate nucleus/ventralis oralis posterior nucleus border (4 mm anterior and 3 mm superior to that for essential tremor). Both disorders showed similar functional connectivity patterns: a positive correlation between tremor improvement and involvement of the primary sensorimotor, secondary motor and associative prefrontal regions. Tremor improvement, however, was tightly correlated with the primary sensorimotor regions in essential tremor, whereas in dystonic tremor, the correlation was tighter with the premotor and prefrontal regions. The dentato-rubro-thalamic tract, comprising the decussating and non-decussating fibres, significantly correlated with tremor improvement in both dystonic and essential tremor. In contrast, the pallidothalamic tracts, which primarily project to the ventralis oralis posterior nucleus region, significantly correlated with tremor improvement only in dystonic tremor. Our findings support the hypothesis that the pathophysiology underpinning dystonic tremor involves both the cerebello-thalamo-cortical network and the basal ganglia-thalamo-cortical network. Further our data suggest that the pathophysiology of essential tremor is primarily attributable to the abnormalities within the cerebello-thalamo-cortical network. We conclude that the ventral intermediate nucleus/ventralis oralis posterior nucleus border and ventral intermediate nucleus region may be a reasonable DBS target for patients with medication-refractory dystonic tremor and essential tremor, respectively. Uncovering the pathophysiology of these disorders may in the future aid in further improving DBS outcomes.

A method for pre-operative single-subject thalamic segmentation based on probabilistic tractography for essential tremor deep brain stimulation

2018 ◽  
Vol 60 (3) ◽  
pp. 303-309 ◽  
Author(s):  
Erik H. Middlebrooks ◽  
Vanessa M. Holanda ◽  
Ibrahim S. Tuna ◽  
Hrishikesh D. Deshpande ◽  
Markus Bredel ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Essential Tremor ◽  
Brain Stimulation ◽  
Single Subject ◽  
Probabilistic Tractography ◽  
Deep Brain

scholarly journals Tractography patterns of pedunculopontine nucleus deep brain stimulation

2021 ◽  
Author(s):  
Ashley L. B. Raghu ◽  
Tariq Parker ◽  
Amir P. Divanbeighi Zand ◽  
Stephen Payne ◽  
Jesper Andersson ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Cortical Thickness ◽  
Brain Stimulation ◽  
Diffusion Tensor ◽  
Freezing Of Gait ◽  
Structural Connectivity ◽  
Pedunculopontine Nucleus ◽  
Precentral Gyrus ◽  
Superior Cerebellar Peduncle ◽  
Deep Brain

AbstractDeep brain stimulation of the pedunculopontine nucleus is a promising surgical procedure for the treatment of Parkinsonian gait and balance dysfunction. It has, however, produced mixed clinical results that are poorly understood. We used tractography with the aim to rationalise this heterogeneity. A cohort of eight patients with postural instability and gait disturbance (Parkinson’s disease subtype) underwent pre-operative structural and diffusion MRI, then progressed to deep brain stimulation targeting the pedunculopontine nucleus. Pre-operative and follow-up assessments were carried out using the Gait and Falls Questionnaire, and Freezing of Gait Questionnaire. Probabilistic diffusion tensor tractography was carried out between the stimulating electrodes and both cortical and cerebellar regions of a priori interest. Cortical surface reconstructions were carried out to measure cortical thickness in relevant areas. Structural connectivity between stimulating electrode and precentral gyrus (r = 0.81, p = 0.01), Brodmann areas 1 (r = 0.78, p = 0.02) and 2 (r = 0.76, p = 0.03) were correlated with clinical improvement. A negative correlation was also observed for the superior cerebellar peduncle (r = −0.76, p = 0.03). Lower cortical thickness of the left parietal lobe and bilateral premotor cortices were associated with greater pre-operative severity of symptoms. Both motor and sensory structural connectivity of the stimulated surgical target characterises the clinical benefit, or lack thereof, from surgery. In what is a challenging region of brainstem to effectively target, these results provide insights into how this can be better achieved. The mechanisms of action are likely to have both motor and sensory components, commensurate with the probable nature of the underlying dysfunction.

scholarly journals Impact of an Interdisciplinary Deep Brain Stimulation Screening Model on Post-Surgical Complications in Essential Tremor Patients

PLoS ONE ◽  
2015 ◽  
Vol 10 (12) ◽  
pp. e0145623 ◽  
Author(s):  
Masa-aki Higuchi ◽  
Dan D. Topiol ◽  
Bilal Ahmed ◽  
Hokuto Morita ◽  
Samuel Carbunaru ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Essential Tremor ◽  
Brain Stimulation ◽  
Surgical Complications ◽  
Screening Model ◽  
Deep Brain

Pallidal Deep Brain Stimulation for Primary Dystonia in Children

Neurosurgery ◽  
2011 ◽  
Vol 68 (3) ◽  
pp. 738-743 ◽  
Author(s):  
Abilash Haridas ◽  
Michele Tagliati ◽  
Irene Osborn ◽  
Ioannis Isaias ◽  
Yakov Gologorsky ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Clinical Improvement ◽  
Brain Stimulation ◽  
Functional Disability ◽  
Rating Scale ◽  
Retrospective Chart Review ◽  
Consecutive Series ◽  
Internal Globus Pallidus ◽  
Deep Brain

Abstract BACKGROUND: Deep brain stimulation (DBS) at the internal globus pallidus (GPi) has replaced ablative procedures for the treatment of primary generalized dystonia (PGD) because it is adjustable, reversible, and yields robust clinical improvement that appears to be long lasting. OBJECTIVE: To describe the long-term responses to pallidal DBS of a consecutive series of 22 pediatric patients with PGD. METHODS: Retrospective chart review of 22 consecutive PGD patients, ≤21 years of age treated by one DBS team over an 8-year period. The Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) was used to evaluate symptom severity and functional disability, pre- and post-operatively. Adverse events and medication changes were also noted. RESULTS: The median follow-up was 2 years (range, 1-8 years). All 22 patients reached 1-year follow-up; 14 reached 2 years, and 11 reached 3 years. The BFMDRS motor subscores were improved 84%, 93%, and 94% (median) at these time points. These motor responses were matched by equivalent improvements in function, and the response to DBS resulted in significant reductions in oral and intrathecal medication requirements after 12 and 24 months of stimulation. There were no hemorrhages or neurological complications related to surgery and no adverse effects from stimulation. Significant hardware-related complications were noted, in particular, infection (14%), which delayed clinical improvement. CONCLUSION: Pallidal DBS is a safe and effective treatment for PGD in patients &lt;21 years of age. The improvement appears durable. Improvement in device design should reduce hardware-related complications over time.

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