Resting-state functional magnetic resonance imaging of the subthalamic microlesion and stimulation effects in Parkinson's disease: Indications of a principal role of the brainstem.
Resting-state functional magnetic resonance imaging of the subthalamic microlesion and stimulation effects in Parkinson's disease: Indications of a principal role of the brainstem.
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DOI：
10.1016/j.nicl.2015.08.008
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发表时间：
2015
期刊：
影响因子：
--
通讯作者：
Jech R
中科院分区：
文献类型：
--
作者：
Holiga Š;Mueller K;Möller HE;Urgošík D;Růžička E;Schroeter ML;Jech R
在目标结构中植入深部脑刺激（DBS）电极时，神经外科医生和神经科医生通常会观察到“微损伤效应”（MLE），这种效应发生在启动丘脑底深部脑刺激之前。这种现象通常会导致帕金森病（PD）患者运动症状的短暂改善。MLE背后的机制仍然知之甚少。在这项工作中，我们利用排序的概念来评估PD患者的自发性大脑活动，通过静息状态功能磁共振成像检查丘脑下核DBS电极的穿透反应。特别是，我们采用了一种无假设的方法，特征向量中心性（EC），以揭示最高等级的运动通信中心及其在手术后的重组；提供了一个独特的机会来评估破坏体内PD电机电路的直接影响，而无需事先假设。电极的穿透与脑干功能连接的EC增加有关。连通性的改变在数量上与运动改善有关，这进一步强调了脑干功能完整性的临床重要性。令人惊讶的是，尽管MLE和DBS在运动功能方面的临床益处相似，但它们与解剖学上不同的EC图相关。DBS仅引起左侧运动前区连通性的增加，这表明两种干预措施有不同的病理生理机制。DBS在皮质水平上起作用，表明受影响较小的运动区域的代偿激活，而MLE影响的是更基本的电路，因为在PD开始时，功能失调的脑干占主导地位。这些发现激发了对PD的理解中被忽视的脑干观点，并支持了目前对其早期诊断的趋势。帕金森患者的DBS手术通常与“微病变效应”（MLE）有关。MLE背后的机制仍然知之甚少。通过静息状态功能磁共振成像，我们确定脑干是对MLE做出反应的主要中枢。这激发了对帕金森氏病的理解中被忽视的脑干观点。
During implantation of deep-brain stimulation (DBS) electrodes in the target structure, neurosurgeons and neurologists commonly observe a “microlesion effect” (MLE), which occurs well before initiating subthalamic DBS. This phenomenon typically leads to a transitory improvement of motor symptoms of patients suffering from Parkinson's disease (PD). Mechanisms behind MLE remain poorly understood. In this work, we exploited the notion of ranking to assess spontaneous brain activity in PD patients examined by resting-state functional magnetic resonance imaging in response to penetration of DBS electrodes in the subthalamic nucleus. In particular, we employed a hypothesis-free method, eigenvector centrality (EC), to reveal motor-communication-hubs of the highest rank and their reorganization following the surgery; providing a unique opportunity to evaluate the direct impact of disrupting the PD motor circuitry in vivo without prior assumptions. Penetration of electrodes was associated with increased EC of functional connectivity in the brainstem. Changes in connectivity were quantitatively related to motor improvement, which further emphasizes the clinical importance of the functional integrity of the brainstem. Surprisingly, MLE and DBS were associated with anatomically different EC maps despite their similar clinical benefit on motor functions. The DBS solely caused an increase in connectivity of the left premotor region suggesting separate pathophysiological mechanisms of both interventions. While the DBS acts at the cortical level suggesting compensatory activation of less affected motor regions, the MLE affects more fundamental circuitry as the dysfunctional brainstem predominates in the beginning of PD. These findings invigorate the overlooked brainstem perspective in the understanding of PD and support the current trend towards its early diagnosis. DBS surgery in Parkinson's patients is often associated with a “microlesion effect” (MLE). Mechanisms behind MLE remain poorly understood. Using resting-state fMRI, we identified the brainstem as the principal hub responding to MLE. This invigorates the overlooked brainstem perspective in the understanding of Parkinson's disease.