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帕金森病中丘脑底核深部脑刺激所涉及的白质束:一项基于术前弥散张量成像纤维束示踪的连通性研究

White matter tracts involved by deep brain stimulation of the subthalamic nucleus in Parkinson's disease: a connectivity study based on preoperative diffusion tensor imaging tractography.

作者信息

Vassal François, Dilly Domitille, Boutet Claire, Bertholon Frédérique, Charier David, Pommier Benjamin

机构信息

Department of Neurosurgery, University Hospital of Saint-Etienne, Saint-Etienne, France.

Department of Neurology, University Hospital of Saint-Etienne, Saint-Etienne, France.

出版信息

Br J Neurosurg. 2020 Apr;34(2):187-195. doi: 10.1080/02688697.2019.1701630. Epub 2019 Dec 13.

Abstract

To depict the specific brain networks that are modulated by deep brain stimulation (DBS) of the subthalamic nucleus (STN) in Parkinson's disease (PD), using diffusion tensor imaging-based fibre tractography (DTI-FT). Nine patients who received bilateral STN-DBS for PD were included. Electrodes were localized by co-registering preoperative magnetic resonance imaging and postoperative computed tomography. The volume of tissue activated (VTA) was estimated as an isotropic, spherical electric field distribution centred at each effective electrode contact's centroid coordinates, taking into account individual stimulation parameters (i.e. voltage, impedance). Brain connectivity analysis was undertaken using a deterministic DTI-FT method, seeded from a single region of interest corresponding to the VTA. The labelling of the reconstructed white matter fibre tracts relied on their path and (sub)cortical termination territories. Six months after surgery, we observed a statistically significant reduction in both the Unified Parkinson Disease Rating Scale part III and L-dopa equivalent daily dose. Areas consistently connected to the VTA included the brainstem (100%), cerebellum (94%), dorsal (i.e. supplementary motor area) and lateral premotor cortex (94%), and primary motor cortex (72%). An involvement of the hyperdirect pathway (HDP) connecting the STN and the (pre)motor cortex was demonstrated. The connectivity patterns observed in this study suggest that the therapeutic effects of STN-DBS are mediated through the modulation of distributed, large-scale motor networks. Specifically, the depiction of projection neurons connecting the stimulated area/STN to the (pre)motor cortex, reinforce the growing evidence that the HDP might be a potential therapeutic target in PD. If further replicated, these findings could raise the possibility that DTI-FT reconstruction of the HDP may critically improve DBS targeting and stimulation parameters selection, through the development of programming tools that incorporate VTA modelling and patient-specific DTI-FT data.

摘要

为描绘帕金森病(PD)患者中丘脑底核(STN)深部脑刺激(DBS)所调节的特定脑网络,采用基于扩散张量成像的纤维束示踪法(DTI-FT)。纳入9例接受双侧STN-DBS治疗的PD患者。通过术前磁共振成像与术后计算机断层扫描的配准来定位电极。考虑个体刺激参数(即电压、阻抗),将组织激活体积(VTA)估计为以每个有效电极触点的质心坐标为中心的各向同性球形电场分布。使用确定性DTI-FT方法进行脑连接性分析,从与VTA对应的单个感兴趣区域作为种子点。重建的白质纤维束的标记依赖于其路径和(亚)皮质终末区域。术后6个月,我们观察到统一帕金森病评定量表第三部分评分和左旋多巴等效日剂量均有统计学意义的降低。与VTA持续相连的区域包括脑干(100%)、小脑(94%)、背侧(即辅助运动区)和外侧运动前皮质(94%)以及初级运动皮质(72%)。证实了连接STN与(前)运动皮质的超直接通路(HDP)的参与。本研究中观察到的连接模式表明,STN-DBS的治疗效果是通过调节分布式大规模运动网络介导的。具体而言,描绘连接受刺激区域/STN与(前)运动皮质的投射神经元,进一步证明了HDP可能是PD的潜在治疗靶点。如果进一步得到验证,这些发现可能会增加一种可能性,即通过开发结合VTA建模和患者特异性DTI-FT数据的编程工具,HDP的DTI-FT重建可能会显著改善DBS靶点定位和刺激参数选择。

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