Increased structural connectivity of thalamic stimulation sites to motor cortex relates to tremor suppression | JoVE Visualize

Increased structural connectivity of thalamic stimulation sites to motor cortex relates to tremor suppression

Hannah H Riskin-Jones¹, Alon Kashanian¹, Hiro Sparks¹

¹Department of Neurosurgery, 300 UCLA Stein Plaza, Suite 562, David Geffen School of Medicine at UCLA (University of California, Los Angeles), Los Angeles, CA, United States.

Neuroimage. Clinical|March 27, 2021

View abstract on PubMed

Summary

Deep brain stimulation (DBS) for essential tremor (ET) is improved by targeting the thalamus based on brain connectivity. This approach enhances lead targeting and programming for better clinical outcomes in ET patients.

Area of Science:

Neurosurgery
Neurology
Medical Imaging

Background:

Deep brain stimulation (DBS) of the ventral intermediate nucleus (VIM-DBS) effectively treats medication-refractory essential tremor (ET).
Accurate targeting is crucial for optimal clinical outcomes in VIM-DBS therapy.
Current targeting methods may not fully leverage detailed brain connectivity information.

Purpose of the Study:

To develop and evaluate a framework for connectivity-guided DBS targeting in ET.
To assess the relationship between VIM-DBS VTA connectivity and clinical response.
To identify optimal targeting strategies for improved VIM-DBS efficacy.

Main Methods:

Utilized Lead-DBS and FSL for probabilistic tractography in 23 ET patients undergoing VIM-DBS.
Modeled Volume of Tissue Activated (VTA) and analyzed whole-brain connectivity.
Correlated VTA overlap with thalamic connectivity maps to motor cortices with clinical outcomes (CRST).

Main Results:

Clinically weighted VTA connectivity showed preferential links to the precentral gyrus and cerebellum/brainstem.
VTA intersection with the thalamic segment connected to the primary motor cortex predicted contact efficacy at initial programming.
This overlap also significantly predicted tremor reduction at clinical follow-up.

Conclusions:

Connectivity-based targeting, specifically focusing on thalamic regions linked to the primary motor cortex, is associated with superior VIM-DBS outcomes in ET.
This approach offers a valuable guide for both lead placement and therapeutic programming.
Probabilistic tractography provides a method to refine VIM-DBS targeting for essential tremor.

Keywords: