A diffusion-based connectivity map of the GPi for optimised stereotactic targeting in DBS

Silva, Nádia Moreira da; Ahmadi, Seyed-Ahmad; Tafula, Sérgio Miguel Neves; Cunha, João Paulo Silva; Bötzel, Kai; Vollmar, Christian; Rozanski, Verena E.

doi:10.1016/j.neuroimage.2016.06.018

Cited by 36 publications

(41 citation statements)

References 48 publications

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“…Most electrodes were located in the postero-ventro-lateral GPi. This portion of the GPi is known to represent the sensorimotor territory, giving rise to projections to the basal ganglia recipient part of the motor thalamus [17]. In addition, the VTAs also covered parts of the GPe and typically extended largely into the subpallidal area.…”

Section: Discussionmentioning

confidence: 99%

Pallidal lead placement in dystonia: leads of non-responders are contained within an anatomical range defined by responders

et al. 2020

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Background Deep brain stimulation (DBS) within the pallidum represents an effective and well-established treatment for isolated dystonia. However, clinical outcome after surgery may be variable with limited response in 10-25% of patients. The effect of lead location on clinical improvement is still under debate. Objective To identify stimulated brain regions associated with the most beneficial clinical outcome in dystonia patients. Methods 18 patients with cervical and generalized dystonia with chronic DBS of the internal pallidum were investigated. Patients were grouped according to their clinical improvement into responders, intermediate responders and non-responders. Magnetic resonance and computed tomography images were co-registered, and the volume of tissue activated (VTA) with respect to the pallidum of individual patients was analysed. Results VTAs in responders (n = 11), intermediate responders (n = 3) and non-responders (n = 4) intersected with the posterior internal (GPi) and external (GPe) pallidum and the subpallidal area. VTA heat maps showed an almost complete overlap of VTAs of responders, intermediate and non-responders. VTA coverage of the GPi was not higher in responders. In contrast, VTAs of intermediate and non-responders covered the GPi to a significantly larger extent in the left hemisphere (p < 0.01).Conclusions DBS of ventral parts of the posterior GPi, GPe and the adjacent subpallidal area containing pallidothalamic output projections resulted in favourable clinical effects. Of note, non-responders were also stimulated within the same area. This suggests that factors other than mere lead location (e.g., clinical phenotype, genetic background) have determined clinical outcome in the present cohort.

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Section: Discussionmentioning

confidence: 99%

Pallidal lead placement in dystonia: leads of non-responders are contained within an anatomical range defined by responders

et al. 2020

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“…CBP was carried out for GPi and GPe separately, employing a winnertakes-all algorithm (Behrens et al, 2003;da Silva et al, 2017;Steele et al, 2016). We employed a two-stage hypothesis-driven parcellation:…”

Section: Connectivity-based Parcellationmentioning

confidence: 99%

Spatially coherent and topographically organized pathways of the human globus pallidus

Bertino

Basile

Bramanti

et al. 2020

Human Brain Mapping

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Internal and external segments of globus pallidus (GP) exert different functions in basal ganglia circuitry, despite their main connectional systems share the same topographical organization, delineating limbic, associative, and sensorimotor territories. The identification of internal GP sensorimotor territory has therapeutic implications in functional neurosurgery settings. This study is aimed at assessing the spatial coherence of striatopallidal, subthalamopallidal, and pallidothalamic pathways by using tractography-derived connectivity-based parcellation (CBP) on high quality diffusion MRI data of 100 unrelated healthy subjects from the Human Connectome Project. A two-stage hypothesis-driven CBP approach has been carried out on the internal and external GP. Dice coefficient between functionally homologous pairs of pallidal maps has been computed. In addition, reproducibility of parcellation according to different pathways of interest has been investigated, as well as spatial relations between connectivity maps and existing optimal stimulation points for dystonic patients. The spatial organization of connectivity clusters revealed anterior limbic, intermediate associative and posterior sensorimotor maps within both internal and external GP. Dice coefficients showed high degree of coherence between functionally similar maps derived from the different bundles of interest. Sensorimotor maps derived from the subthalamopallidal pathway resulted to be the nearest to known optimal pallidal stimulation sites for dystonic patients. Our findings suggest that functionally homologous afferent and efferent connections may share similar spatial territory within the GP and that subcortical pallidal connectional systems may have distinct implications in the treatment of movement disorders.

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“…A recent study using diffusion MRI-based tractography (both deterministic and probabilistic) showed that the connections from ipsilateral motor cortex primarily terminated in the dorsolateral STN, further highlighting a key role of hyperdirect pathways in mediating the effects of DBS (116). A diffusion tensor imaging (DTI) analysis investigating the connectivity map of GPi revealed the anterior part to be mainly connected to the prefrontal cortex, the middle section to the brainstem and GPe and the dorsal GPi mainly to the thalamus and GPe (117). In addition, the postero-ventro-lateral part of the GPi, shown to have the most effective clinical outcomes for PD (118), was found to be connected to the thalamus via the pallidothalamic tract.…”

Section: Network Effects Of Dbsmentioning

confidence: 99%

Deep Brain Stimulation and L-DOPA Therapy: Concepts of Action and Clinical Applications in Parkinson's Disease

et al. 2018

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L-DOPA is still the most effective pharmacological therapy for the treatment of motor symptoms in Parkinson's disease (PD) almost four decades after it was first used. Deep brain stimulation (DBS) is a safe and highly effective treatment option in patients with PD. Even though a clear understanding of the mechanisms of both treatment methods is yet to be obtained, the combination of both treatments is the most effective standard evidenced-based therapy to date. Recent studies have demonstrated that DBS is a therapy option even in the early course of the disease, when first complications arise despite a rigorous adjustment of the pharmacological treatment. The unique feature of this therapeutic approach is the ability to preferentially modulate specific brain networks through the choice of stimulation site. The clinical effects have been unequivocally confirmed in recent studies; however, the impact of DBS and the supplementary effect of L-DOPA on the neuronal network are not yet fully understood. In this review, we present emerging data on the presumable mechanisms of DBS in patients with PD and discuss the pathophysiological similarities and differences in the effects of DBS in comparison to dopaminergic medication. Targeted, selective modulation of brain networks by DBS and pharmacodynamic effects of L-DOPA therapy on the central nervous system are presented. Moreover, we outline the perioperative algorithms for PD patients before and directly after the implantation of DBS electrodes and strategies for the reduction of side effects and optimization of motor and non-motor symptoms.

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A diffusion-based connectivity map of the GPi for optimised stereotactic targeting in DBS

Cited by 36 publications

References 48 publications

Pallidal lead placement in dystonia: leads of non-responders are contained within an anatomical range defined by responders

Pallidal lead placement in dystonia: leads of non-responders are contained within an anatomical range defined by responders

Spatially coherent and topographically organized pathways of the human globus pallidus

Deep Brain Stimulation and L-DOPA Therapy: Concepts of Action and Clinical Applications in Parkinson's Disease

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