Functional correlates of the therapeutic and adverse effects evoked by thalamic stimulation for essential tremor.
Functional correlates of the therapeutic and adverse effects evoked by thalamic stimulation for essential tremor.
复制标题
丘脑刺激引起的基本震颤引起的治疗和不良反应的功能相关性。
DOI：
10.1093/brain/aww145
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发表时间：
2016-08
期刊：
影响因子：
--
通讯作者：
Lee KH
中科院分区：
文献类型：
--
作者：
Gibson WS;Jo HJ;Testini P;Cho S;Felmlee JP;Welker KM;Klassen BT;Min HK;Lee KH
丘脑深部脑刺激(DBS)是治疗特发性震颤的有效方法。Gibson等人。使用功能磁共振成像来揭示与刺激诱导的治疗和不良反应相关的激活模式。他们的结果表明，丘脑DBS通过对震颤相关网络节点的远端调制来控制震颤，并诱导感觉异常。丘脑深部脑刺激(DBS)是治疗特发性震颤的有效方法。Gibson等人。使用功能磁共振成像来揭示与刺激诱导的治疗和不良反应相关的激活模式。他们的结果表明，丘脑DBS通过对震颤相关网络节点的远端调制来控制震颤，并诱导感觉异常。脑深部刺激是一种公认的治疗运动障碍的神经外科疗法，包括特发性震颤和帕金森氏病。虽然脑深部刺激通常非常有效，但有时会产生不太理想的治疗效果，并可能导致不良反应。在这项研究中，我们验证了术中功能磁共振成像可以用来检测脑深部刺激的假设--刺激引起的功能和有效连接的变化将与刺激的治疗和不良反应相关。10例因特发性震颤接受丘脑腹侧中间核深部脑刺激的患者，在一系列刺激定位时进行功能磁共振成像，然后评估脑深部刺激诱发的治疗和不良反应。分别使用基于兴趣区的相关分析和动态因果模型来评估脑深部刺激的疗效(术后3个月)与脑深部刺激诱发的功能和有效连接改变之间的相关性。此外，我们还调查了是否存在深部脑刺激引起的激活可能与感觉异常相关的脑区，这是最常见的深部脑刺激诱发的不良反应。丘脑深部刺激导致震颤回路已建立的节点内的激活：感觉运动皮质、丘脑、对侧小脑皮层和小脑深核(FDR Q<；0.05)。所有这些感兴趣区域的刺激诱发激活，以及辅助运动区、脑干和额叶下回的激活，与脑深部刺激的长期疗效显著相关(P<；0.001)，其中以对侧小脑的相关性最强(P<；0.05)。动态因果模型揭示了治疗效果与小脑区域内抑制性连接减弱之间的相关性。最后，确定了感觉运动皮质的特定亚区，其中大脑深部刺激诱发的激活与不想要的感觉异常的存在相关。这些结果表明，震颤时的丘脑深部刺激可能通过调制橄榄小脑和丘脑皮质回路来发挥作用。此外，我们的研究结果表明，术中获得的脑深部刺激诱发的功能激活图可能包含与脑深部刺激引起的治疗和不良反应有关的预测性信息。
Thalamic deep brain stimulation (DBS) is an effective therapy for essential tremor. Gibson et al. use functional MRI to reveal patterns of activation that correlate with stimulation-induced therapeutic and adverse effects. Their results suggest that thalamic DBS controls tremor, and induces paraesthesias, through distal modulation of tremor-related network nodes. Thalamic deep brain stimulation (DBS) is an effective therapy for essential tremor. Gibson et al. use functional MRI to reveal patterns of activation that correlate with stimulation-induced therapeutic and adverse effects. Their results suggest that thalamic DBS controls tremor, and induces paraesthesias, through distal modulation of tremor-related network nodes. Deep brain stimulation is an established neurosurgical therapy for movement disorders including essential tremor and Parkinson’s disease. While typically highly effective, deep brain stimulation can sometimes yield suboptimal therapeutic benefit and can cause adverse effects. In this study, we tested the hypothesis that intraoperative functional magnetic resonance imaging could be used to detect deep brain stimulation-evoked changes in functional and effective connectivity that would correlate with the therapeutic and adverse effects of stimulation. Ten patients receiving deep brain stimulation of the ventralis intermedius thalamic nucleus for essential tremor underwent functional magnetic resonance imaging during stimulation applied at a series of stimulation localizations, followed by evaluation of deep brain stimulation-evoked therapeutic and adverse effects. Correlations between the therapeutic effectiveness of deep brain stimulation (3 months postoperatively) and deep brain stimulation-evoked changes in functional and effective connectivity were assessed using region of interest-based correlation analysis and dynamic causal modelling, respectively. Further, we investigated whether brain regions might exist in which activation resulting from deep brain stimulation might correlate with the presence of paraesthesias, the most common deep brain stimulation-evoked adverse effect. Thalamic deep brain stimulation resulted in activation within established nodes of the tremor circuit: sensorimotor cortex, thalamus, contralateral cerebellar cortex and deep cerebellar nuclei (FDR q < 0.05). Stimulation-evoked activation in all these regions of interest, as well as activation within the supplementary motor area, brainstem, and inferior frontal gyrus, exhibited significant correlations with the long-term therapeutic effectiveness of deep brain stimulation (P < 0.05), with the strongest correlation (P < 0.001) observed within the contralateral cerebellum. Dynamic causal modelling revealed a correlation between therapeutic effectiveness and attenuated within-region inhibitory connectivity in cerebellum. Finally, specific subregions of sensorimotor cortex were identified in which deep brain stimulation-evoked activation correlated with the presence of unwanted paraesthesias. These results suggest that thalamic deep brain stimulation in tremor likely exerts its effects through modulation of both olivocerebellar and thalamocortical circuits. In addition, our findings indicate that deep brain stimulation-evoked functional activation maps obtained intraoperatively may contain predictive information pertaining to the therapeutic and adverse effects induced by deep brain stimulation.