Evidence for the role of the dorsal ventral lateral posterior thalamic nucleus connectivity in deep brain stimulation for Gilles de la Tourette syndrome.
Evidence for the role of the dorsal ventral lateral posterior thalamic nucleus connectivity in deep brain stimulation for Gilles de la Tourette syndrome.
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DOI：
10.1016/j.jpsychires.2020.09.024
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发表时间：
2020-09
影响因子：
4.8
通讯作者：
B. Kakusa;S. Saluja;Daniel A. N. Barbosa;S. Cartmell;F. Espil;N. Williams;J. McNab;C. Halpern
中科院分区：
文献类型：
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作者：
B. Kakusa;S. Saluja;Daniel A. N. Barbosa;S. Cartmell;F. Espil;N. Williams;J. McNab;C. Halpern
图雷特Gilles de la Tourette综合征（GTS）可表现为使人衰弱，医学上难治性抽搐，深部脑刺激（DBS）中心体-束旁复合物（CM）可提供有效治疗。然而，患者报告了CM背侧接触激活的益处，可能在腹外侧丘脑（VL）。在我们的机构中，有一例GTS患者的强烈和持久的反应需要刺激CM和更多的背侧。我们利用弥散性MRI束状图探索与GTS相关的丘脑亚区结构连通性。我们分析了来自40名健康人类连接组计划（HCP）受试者和我们的GTS患者的扩散加权图像。以VL后核（VLp）和CM为种子进行全脑概率神经束造影。通过术前/术后图像的线性配准，并与DBS内在模板图谱交叉参考，定位导联。神经束造影显示中脑和中脑至额上回、额中回吻侧、脑干和腹侧间脑的流线概率高。鉴于已报道的丘脑对DBS的不同反应，我们根据其连接概况对VLp进行了分割。出现了腹侧和背侧的细分，在背侧VLp和CM之间具有不同的流线概率模式。CM是报道最多的GTS DBS靶点，与背侧VLp具有不同但看似互补的连接特征，正如我们的患者在术后1年获得显着治疗益处所证明的那样。刺激这两个区域可能更好地针对奖励和运动回路，从而增强GTS的症状控制。
Gilles de la Tourette syndrome (GTS) can manifest as debilitating, medically-refractory tics for which deep brain stimulation (DBS) of the centromedian-parafascicular complex (CM) can provide effective treatment. However, patients have reported benefit with activation of contacts dorsal to the CM and likely in the ventro-lateral thalamus (VL). At our institution, a case of a robust and durable response in a GTS patient required stimulation in the CM and more dorsally. We explore the structural connectivity of thalamic subregions associated with GTS using diffusion MRI tractography. Diffusion weighted images from 40 healthy Human Connectome Project (HCP) subjects and our GTS patient were analyzed. The VL posterior nucleus (VLp) and the CM were used as seeds for whole-brain probabilistic tractography. Leads were localized via linear registration of pre-/post-operative imaging and cross-referenced with the DBS Intrinsic Template Atlas. Tractography revealed high streamline probability from the CM and VLp to the superior frontal gyrus, rostral middle frontal gyrus, brainstem, and ventral diencephalon. Given reported variable responses to DBS along the thalamus, we segmented the VLp based on its connectivity profile. Ventral and dorsal subdivisions emerged, with streamline probability patterns differing between the dorsal VLp and CM. The CM, the most reported DBS target for GTS, and the dorsal VLp have different but seemingly complimentary connectivity profiles as evidenced by our patient who, at 1-year post-operatively, had significant therapeutic benefit. Stimulation of both regions may better target reward and motor circuits, resulting in enhanced symptom control for GTS.