Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA.
Department of Neurological Surgery, University of California, San Francisco, California, USA.
Hum Brain Mapp. 2022 Feb 1;43(2):633-646. doi: 10.1002/hbm.25676. Epub 2021 Oct 5.
Neuromodulation treatment effect size for bothersome tinnitus may be larger and more predictable by adopting a target selection approach guided by personalized striatal networks or functional connectivity maps. Several corticostriatal mechanisms are likely to play a role in tinnitus, including the dorsal/ventral striatum and the putamen. We examined whether significant tinnitus treatment response by deep brain stimulation (DBS) of the caudate nucleus may be related to striatal network increased functional connectivity with tinnitus networks that involve the auditory cortex or ventral cerebellum. The first study was a cross-sectional 2-by-2 factorial design (tinnitus, no tinnitus; hearing loss, normal hearing, n = 68) to define cohort level abnormal functional connectivity maps using high-field 7.0 T resting-state fMRI. The second study was a pilot case-control series (n = 2) to examine whether tinnitus modulation response to caudate tail subdivision stimulation would be contingent on individual level striatal connectivity map relationships with tinnitus networks. Resting-state fMRI identified five caudate subdivisions with abnormal cohort level functional connectivity maps. Of those, two connectivity maps exhibited increased connectivity with tinnitus networks-dorsal caudate head with Heschl's gyrus and caudate tail with the ventral cerebellum. DBS of the caudate tail in the case-series responder resulted in dramatic reductions in tinnitus severity and loudness, in contrast to the nonresponder who showed no tinnitus modulation. The individual level connectivity map of the responder was in alignment with the cohort expectation connectivity map, where the caudate tail exhibited increased connectivity with tinnitus networks, whereas the nonresponder individual level connectivity map did not.
采用基于个性化纹状体网络或功能连接图谱的靶向选择方法，神经调节治疗烦人的耳鸣的效果大小可能更大且更可预测。几个皮质纹状体机制可能在耳鸣中起作用，包括背/腹纹状体和壳核。我们研究了深部脑刺激（DBS）对尾状核的显著耳鸣治疗反应是否可能与纹状体网络与涉及听觉皮层或腹侧小脑的耳鸣网络的功能连接增加有关。第一项研究是一个 2×2 析因设计（耳鸣，无耳鸣；听力损失，正常听力，n=68），使用高场 7.0 T 静息态 fMRI 定义队列水平异常功能连接图谱。第二项研究是一项试点病例对照系列研究（n=2），以检验尾状核尾部亚区刺激对耳鸣调制反应是否取决于个体水平纹状体与耳鸣网络的连接图谱关系。静息态 fMRI 确定了五个尾状核亚区具有异常的队列水平功能连接图谱。其中，两个连接图谱与耳鸣网络的连接增加——尾状核头部与 Heschl 回，以及尾状核尾部与腹侧小脑。病例系列中反应者的尾状核尾部 DBS 导致耳鸣严重程度和响度显著降低，而无反应者则无耳鸣调节。反应者的个体水平连接图谱与队列预期连接图谱一致，其中尾状核尾部与耳鸣网络的连接增加，而无反应者的个体水平连接图谱则没有。
