Subthalamic deep brain stimulation sweet spots and hyperdirect cortical connectivity in Parkinson's disease.
Subthalamic deep brain stimulation sweet spots and hyperdirect cortical connectivity in Parkinson's disease.
复制标题
DOI：
10.1016/j.neuroimage.2017.07.012
复制
发表时间：
2017-09
期刊：
影响因子：
5.7
通讯作者：
Zrinzo L
中科院分区：
文献类型：
--
作者：
Akram H;Sotiropoulos SN;Jbabdi S;Georgiev D;Mahlknecht P;Hyam J;Foltynie T;Limousin P;De Vita E;Jahanshahi M;Hariz M;Ashburner J;Behrens T;Zrinzo L
首先，确定能最大程度改善强直、运动迟缓和震颤或出现副作用的丘脑底区刺激簇；其次，绘制皮质指纹图谱，由超直接通路介导，预测最大功效。对20例晚期帕金森病患者进行双侧丘脑下核深部脑刺激前的高角分辨率弥散成像。手术后一年对所有接触者进行不同程度的疗效和副作用筛查。使用基于体素的组织激活模型体积统计分析来识别显著的治疗簇。采用概率神经束造影确定与治疗效果相关的皮质连接模式。所有患者对治疗反应良好（46%的患者在UPDRS-III药物治疗后改善[p<0.0001]），无明显不良事件。震颤的最大改善对应于核的后、上、外侧部分。与运动迟缓和僵硬改善相对应的群位于靠近上边界的更远的内侧和后部位置。刚性簇扩展到上部边界以外的区域，延伸到中间带和Forel-H2油田。当集群平均时，在MNI（AC-PC）空间中，具有最大总体功效的区域坐标为X=-10(-9.5)， Y=-13（-1）和Z=-7（-3）。与初级运动区的皮质连通性预示着震颤的更高改善；辅助运动区域的变化预示着运动迟缓和强直的改善；与前额皮质的连接预示着刚性的改善。这些发现支持在丘脑底核及其上边界存在重叠的刺激位点，具有不同的皮质连接模式，与震颤、强直和运动迟缓的最大改善有关。
Firstly, to identify subthalamic region stimulation clusters that predict maximum improvement in rigidity, bradykinesia and tremor, or emergence of side-effects; and secondly, to map-out the cortical fingerprint, mediated by the hyperdirect pathways which predict maximum efficacy. High angular resolution diffusion imaging in twenty patients with advanced Parkinson’s disease was acquired prior to bilateral subthalamic nucleus deep brain stimulation. All contacts were screened one-year from surgery for efficacy and side-effects at different amplitudes. Voxel-based statistical analysis of volumes of tissue activated models was used to identify significant treatment clusters. Probabilistic tractography was employed to identify cortical connectivity patterns associated with treatment efficacy. All patients responded well to treatment (46% mean improvement off medication UPDRS-III [p<0.0001]) without significant adverse events. Cluster corresponding to maximum improvement in tremor was in the posterior, superior and lateral portion of the nucleus. Clusters corresponding to improvement in bradykinesia and rigidity were nearer the superior border in a further medial and posterior location. The rigidity cluster extended beyond the superior border to the area of the zona incerta and Forel-H2 field. When the clusters where averaged, the coordinates of the area with maximum overall efficacy was X=-10(-9.5), Y=-13(-1) and Z=-7(-3) in MNI(AC-PC) space. Cortical connectivity to primary motor area was predictive of higher improvement in tremor; whilst that to supplementary motor area was predictive of improvement in bradykinesia and rigidity; and connectivity to prefrontal cortex was predictive of improvement in rigidity. These findings support the presence of overlapping stimulation sites within the subthalamic nucleus and its superior border, with different cortical connectivity patterns, associated with maximum improvement in tremor, rigidity and bradykinesia.
登录
查看更多内容
使用 7 特斯拉磁共振成像直接可视化帕金森病的深部脑刺激目标。
影响因子：
4.1
作者：
Cho ZH;Min HK;Oh SH;Han JY;Park CW;Chi JG;Kim YB;Paek SH;Lozano AM;Lee KH
通讯作者：
Lee KH
影响因子：
5.7
作者：
Baudrexel, Simon;Witte, Torsten;Hilker, Ruediger
通讯作者：
Hilker, Ruediger
影响因子：
5.3
作者：
Brown, P;Oliviero, A;Di Lazzaro, V
通讯作者：
Di Lazzaro, V
影响因子：
3
作者：
Eitan R;Shamir RR;Linetsky E;Rosenbluh O;Moshel S;Ben-Hur T;Bergman H;Israel Z
通讯作者：
Israel Z
影响因子：
15.9
作者：
Eidelberg, David
通讯作者：
Eidelberg, David