Tuleasca Constantin, Régis Jean, Najdenovska Elena, Witjas Tatiana, Girard Nadine, Champoudry Jérôme, Faouzi Mohamed, Thiran Jean-Philippe, Cuadra Meritxell Bach, Levivier Marc, Van De Ville Dimitri
Centre Hospitalier Universitaire Vaudois, Neurosurgery Service and Gamma Knife Center, Lausanne, Switzerland; Signal Processing Laboratory (LTS5), Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland; Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland.
Stereotactic and Functional Neurosurgery Service and Gamma Knife Unit, CHU Timone, Marseille, France.
World Neurosurg. 2018 Apr;112:e479-e488. doi: 10.1016/j.wneu.2018.01.063. Epub 2018 Feb 2.
To correlate pretherapeutic resting-state functional magnetic resonance imaging (rs-fMRI) measures with pretherapeutic head tremor presence and/or further improvement 1 year after stereotactic radiosurgical thalamotomy (SRS-T) for essential tremor (ET).
We prospectively collected head tremor scores (range, 0-3) and rs-fMRI data for a cohort of 17 consecutive ET patients in pretherapeutic and 1 year after SRS-T states. We additionally acquired rs-fMRI data for a healthy control (HC) group (n = 12). Group-level independent component analysis (n = 17 for pretherapeutic rs-fMRI) was applied to decompose neuroimaging data into 20 large-scale brain networks using a standard approach. Through spatial regression, we projected 1 year after SRS-T and HC rs-fMRI time points, on the same 20 brain networks.
Pretherapeutic interconnectivity (IC) strength between the network including bilateral thalamus and limbic system with left supplementary motor area predicted head tremor improvement at 1 year after SRS-T (family-wise corrected P < 0.001, cluster size K = 146). For the statistically significant cluster, IC strength was strongest in HCs (mean, 4.6; median, 3.8) compared with pre- (mean, 0.1; median, 0.2) or posttherapeutic (mean, -0.2; median, 0.09) states.
Baseline measures of IC between bilateral thalamus and limbic system with left supplementary motor area may predict head tremor arrest after thalamotomy. However, procedures such as SRS-T, for this particular clinical feature, do not align patients to HCs in terms of functional brain connectivity. We postulate that supplementary motor area is modulating head tremor appearance, by abnormal connectivity with the thalamolimbic system.
将立体定向放射外科丘脑切开术（SRS-T）治疗特发性震颤（ET）前的静息态功能磁共振成像（rs-fMRI）测量结果与治疗前头部震颤的存在情况和/或1年后的进一步改善情况相关联。
我们前瞻性地收集了17例连续ET患者在治疗前和SRS-T术后1年的头部震颤评分（范围0-3）和rs-fMRI数据。我们还获取了健康对照组（HC，n = 12）的rs-fMRI数据。采用标准方法进行组水平独立成分分析（治疗前rs-fMRI分析n = 17），将神经影像数据分解为20个大规模脑网络。通过空间回归分析，我们将SRS-T术后1年和HC组rs-fMRI时间点的数据投影到相同的20个脑网络上。
包括双侧丘脑和边缘系统与左侧辅助运动区的网络之间的治疗前互联性（IC）强度可预测SRS-T术后1年头部震颤的改善情况（家族性校正P < 0.001，聚类大小K = 146）。对于具有统计学意义的聚类，与治疗前（平均，0.1；中位数，0.2）或治疗后（平均，-0.2；中位数，0.09）状态相比，HC组的IC强度最强（平均，4.6；中位数，3.8）。
双侧丘脑和边缘系统与左侧辅助运动区之间的IC基线测量可能预测丘脑切开术后头部震颤的停止。然而，就这一特定临床特征而言，SRS-T等手术在功能性脑连接方面并未使患者与HC组一致。我们推测，辅助运动区通过与丘脑边缘系统的异常连接来调节头部震颤的表现。
