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深部脑刺激治疗运动障碍临床运动结果的结构磁共振成像综述

A structural magnetic resonance imaging review of clinical motor outcomes from deep brain stimulation in movement disorders.

作者信息

Andrews Luke, Keller Simon S, Osman-Farah Jibril, Macerollo Antonella

机构信息

The Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool L3 9TA, UK.

Department of Neurology and Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool L97LJ, UK.

出版信息

Brain Commun. 2023 May 31;5(3):fcad171. doi: 10.1093/braincomms/fcad171. eCollection 2023.

Abstract

Patients with movement disorders treated by deep brain stimulation do not always achieve successful therapeutic alleviation of motor symptoms, even in cases where surgery is without complications. Magnetic resonance imaging (MRI) offers methods to investigate structural brain-related factors that may be predictive of clinical motor outcomes. This review aimed to identify features which have been associated with variability in clinical post-operative motor outcomes in patients with Parkinson's disease, dystonia, and essential tremor from structural MRI modalities. We performed a literature search for articles published between 1 January 2000 and 1 April 2022 and identified 5197 articles. Following screening through our inclusion criteria, we identified 60 total studies (39 = Parkinson's disease, 11 = dystonia syndromes and 10 = essential tremor). The review captured a range of structural MRI methods and analysis techniques used to identify factors related to clinical post-operative motor outcomes from deep brain stimulation. Morphometric markers, including volume and cortical thickness were commonly identified in studies focused on patients with Parkinson's disease and dystonia syndromes. Reduced metrics in basal ganglia, sensorimotor and frontal regions showed frequent associations with reduced motor outcomes. Increased structural connectivity to subcortical nuclei, sensorimotor and frontal regions was also associated with greater motor outcomes. In patients with tremor, increased structural connectivity to the cerebellum and cortical motor regions showed high prevalence across studies for greater clinical motor outcomes. In addition, we highlight conceptual issues for studies assessing clinical response with structural MRI and discuss future approaches towards optimizing individualized therapeutic benefits. Although quantitative MRI markers are in their infancy for clinical purposes in movement disorder treatments, structural features obtained from MRI offer the powerful potential to identify candidates who are more likely to benefit from deep brain stimulation and provide insight into the complexity of disorder pathophysiology.

摘要

即使在手术无并发症的情况下,接受深部脑刺激治疗的运动障碍患者也并非总能成功缓解运动症状。磁共振成像(MRI)提供了一些方法来研究可能预测临床运动结果的与大脑结构相关的因素。本综述旨在从结构MRI模态中识别与帕金森病、肌张力障碍和特发性震颤患者术后临床运动结果变异性相关的特征。我们对2000年1月1日至2022年4月1日发表的文章进行了文献检索,共识别出5197篇文章。根据纳入标准进行筛选后,我们确定了60项研究(39项关于帕金森病,11项关于肌张力障碍综合征,10项关于特发性震颤)。该综述涵盖了一系列用于识别与深部脑刺激术后临床运动结果相关因素的结构MRI方法和分析技术。在针对帕金森病和肌张力障碍综合征患者的研究中,通常会识别出形态学标志物,包括体积和皮质厚度。基底神经节、感觉运动和额叶区域的指标降低与运动结果降低频繁相关。与皮质下核、感觉运动和额叶区域的结构连接增加也与更好的运动结果相关。在震颤患者中,与小脑和皮质运动区域的结构连接增加在各项研究中普遍存在,与更好的临床运动结果相关。此外,我们强调了用结构MRI评估临床反应的研究中的概念性问题,并讨论了优化个体化治疗益处的未来方法。尽管定量MRI标志物在运动障碍治疗的临床应用中尚处于起步阶段,但从MRI获得的结构特征具有强大的潜力,可识别更可能从深部脑刺激中受益的患者,并深入了解疾病病理生理学的复杂性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a1c7/10257440/c60fb4de5bdb/fcad171_ga1.jpg

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