Pretherapeutic functional neuroimaging predicts tremor arrest after thalamotomy

Abstract

Our findings have clinical implications for predicting clinical response after SRS-T. Here, using pretherapeutic magnetic resonance imaging and data processing without prior hypothesis, we show that pretherapeutic network(s) interconnectivity strength predicts tremor arrest in drug-naïve ET, following stereotactic radiosurgical thalamotomy.

Connectivity profile of thalamic deep brain stimulation to effectively treat essential tremor

“…This is in line with the results of most studies that showed tremor related alterations of the sensorimotor and cerebellar areas (Colebatch, 1990;Jenkins et al, 1993;Wills et al, 1995;Czarnecki et al, 2011;Fang et al, 2013;Mueller et al, 2017). Additionally, target connectivity to the aforementioned areas was associated with tremor improvement in VIM-DBS and ablative (thalamotomy) surgeries (Klein et al, 2012;Gibson et al, 2016;Akram et al, 2018;Middlebrooks et al, 2018;Tuleasca et al, 2018a).…”

Pretherapeutic resting-state fMRI profiles are associated with MR signature volumes after stereotactic radiosurgical thalamotomy for essential tremor

“…Furthermore, we observed parts of the anterior DMN. In a recent report, we suggested that pretherapeutic IC between the anterior DMN and Brodmann's area 10 would be predictive of tremor arrest after SRS-T. 33 Moreover, in the same report, IC within another network, containing the bilateral thalamus and motor cerebellum lobule V, also found in the present analysis, was predictive of a decrease in tremor amplitude on the treated hand. 33 Lobule V is mainly associated with motor control.…”

“…In a recent report, we suggested that pretherapeutic IC between the anterior DMN and Brodmann's area 10 would be predictive of tremor arrest after SRS-T. 33 Moreover, in the same report, IC within another network, containing the bilateral thalamus and motor cerebellum lobule V, also found in the present analysis, was predictive of a decrease in tremor amplitude on the treated hand. 33 Lobule V is mainly associated with motor control. Furthermore, motor and somatosensory representations show largely overlapping activation patterns, with a major cluster focused in lobule V. 32 With regard to the SMA, it is interconnected with numerous structures by both efferent (including multiple basal ganglia structures such as the putamen, caudate, and ventrolateral and ventral anterior thalamus [targeted in our patients]) and afferent (basal ganglia [ventrolateral and anterior thalamus], insula, midbrain, etc.)…”

“…An overview of these components can be found in our previously published papers. 33,36 In the present report, we show only the statistically significant networks and their respective interconnected clusters. Using spatial regression, healthy control rs-fMRI data, as well as the 1-year after SRS-T time points, were projected on the respective networks, and the values from the reference cluster extracted.…”

Proceedings of the 2018 next-generation Gamma Knife research meeting

“…5,13,15 Vim radiosurgery (VimRS), as an alternative to standard stereotactic procedures, has 3 major limitations: indirect targeting, no intraoperative confirmation of the Vim target by electrophysiology, and a delayed clinical effect of up to 1 year after the procedure. 7,18,33,37 Tuleasca et al have proposed using resting-state functional MRI (fMRI), [30][31][32]34 a noninvasive neuroimaging technique that can be used to study spontaneous brain activity with minimal patient compliance, to study tremor pathophysiology and improve tremor arrest after VimRS, by using advanced computational techniques. 6 Resting fMRI measures functional connectivity, which has been classically defined as the temporal correlations between spatially remote, statistically independent neurophysiological events distributed across varying neuronal groups and areas.…”