Thalamo-cortical network underlying deep brain stimulation of centromedian thalamic nuclei in intractable epilepsy: a multimodal imaging analysis
Thalamo-cortical network underlying deep brain stimulation of centromedian thalamic nuclei in intractable epilepsy: a multimodal imaging analysis
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DOI：
10.2147/ndt.s148617
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发表时间：
2017-01-01
影响因子：
3.2
通讯作者：
Shon, Young-Min
中科院分区：
文献类型：
--
作者：
Kim, Seong Hoon;Lim, Sung Chul;Shon, Young-Min
目的：丘脑中央核（CM）的深部脑刺激（DBS）可以成为难治性癫痫患者的替代治疗选择。由于 CM 可能涉及广泛的皮质-皮质下网络，因此识别特定于目标刺激的皮质子网络可能有助于进一步了解 CM DBS 的潜在机制。一些大脑结构具有明显的大脑连接，可能与 DBS 的关键传播和随后的临床效果有关。方法：为了探索与 CM DBS 相关的核心结构及其连接，我们对 10 名医学上难以治愈的患者应用脑电图（EEG）和弥散张量成像（DTI），其中 3 名全身性癫痫（GE）和 7 名不适合切除手术的多灶性癫痫（MFE）患者。通过提供低频刺激（5 Hz）从头皮脑电图绘制时空激活模式。使用 DTI 评估 CM 和皮质激活点之间的结构连接。结果：我们证实 CM DBS 后癫痫发作平均减少 72%，并且其临床效率在观察期间（平均 21 个月）保持一致。脑电图数据显示顺序源传播从前扣带回，然后是双侧额颞区。此外，在右侧和左侧 CM 刺激期间，左侧扣带回和右侧内侧额叶皮层分别出现最大激活。从 DTI 数据中，我们确认了 CM 与 EEG 数据中识别的最大激活点之间的具体结构联系。结论：这些结果表明前扣带皮层可以是 CM 刺激双边传播的核心皮质结构。我们的 DTI 研究结果还表明，CM 刺激的传播可能依赖于 CM 和这些关键皮质区域之间结构连接的完整性。本研究中发现的结构及其联系可能与解释 CM DBS 的临床结果相关。
Objective: Deep brain stimulation (DBS) of the centromedian thalamic nucleus (CM) can be an alternative treatment option for intractable epilepsy patients. Since CM may be involved in widespread cortico-subcortical networks, identification of the cortical sub-networks specific to the target stimuli may provide further understanding on the underlying mechanisms of CM DBS. Several brain structures have distinguishing brain connections that may be related to the pivotal propagation and subsequent clinical effect of DBS.Methods: To explore core structures and their connections relevant to CM DBS, we applied electroencephalogram (EEG) and diffusion tensor imaging (DTI) to 10 medically intractable patients - three generalized epilepsy (GE) and seven multifocal epilepsy (MFE) patients unsuitable for resective surgery. Spatiotemporal activation pattern was mapped from scalp EEG by delivering low-frequency stimuli (5 Hz). Structural connections between the CM and the cortical activation spots were assessed using DTI.Results: We confirmed an average 72% seizure reduction after CM DBS and its clinical efficiency remained consistent during the observation period (mean 21 months). EEG data revealed sequential source propagation from the anterior cingulate, followed by the frontotemporal regions bilaterally. In addition, maximal activation was found in the left cingulate gyrus and the right medial frontal cortex during the right and left CM stimulation, respectively. From DTI data, we confirmed concrete structural connections between CM and those maximal activation spots identified from EEG data.Conclusion: These results suggest that the anterior cingulate can be a core cortical structure for the bilateral propagation of CM stimulation. Our DTI findings also indicate that the propagation of CM stimulation may rely upon integrity of structural connections between CM and these key cortical regions. Structures and their connections found in this study may be relevant in the interpretation of the clinical outcomes of CM DBS.