Disbalanced recruitment of crossed and uncrossed cerebello-thalamic pathways during deep brain stimulation is predictive of delayed therapy escape in essential tremor

IF 3.4 2区医学 Q2 NEUROIMAGING

Neuroimage-Clinical Pub Date : 2024-01-01 DOI:10.1016/j.nicl.2024.103576

Bastian E.A. Sajonz , Marvin L. Frommer , Marco Reisert , Ganna Blazhenets , Nils Schröter , Alexander Rau , Thomas Prokop , Peter C. Reinacher , Michel Rijntjes , Horst Urbach , Philipp T. Meyer , Volker A. Coenen

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引用次数: 0

Abstract

Background

Thalamic deep brain stimulation (DBS) is an efficacious treatment for drug-resistant essential tremor (ET) and the dentato-rubro-thalamic tract (DRT) constitutes an important target structure. However, up to 40% of patients habituate and lose treatment efficacy over time, frequently accompanied by a stimulation-induced cerebellar syndrome. The phenomenon termed delayed therapy escape (DTE) is insufficiently understood. Our previous work showed that DTE clinically is pronounced on the non-dominant side and suggested that differential involvement of crossed versus uncrossed DRT (DRTx/DRTu) might play a role in DTE development.

Methods

We retrospectively enrolled right-handed patients under bilateral thalamic DBS >12 months for ET from a cross-sectional study. They were characterized with the Fahn-Tolosa-Marin Tremor Rating Scale (FTMTRS) and Scale for the Assessment and Rating of Ataxia (SARA) scores at different timepoints. Normative fiber tractographic evaluations of crossed and uncrossed cerebellothalamic pathways and volume of activated tissue (VAT) studies together with [¹⁸F]Fluorodeoxyglucose positron emission tomography were applied.

Results

A total of 29 patients met the inclusion criteria. Favoring DRTu over DRTx in the non-dominant VAT was associated with DTE (R² = 0.4463, p < 0.01) and ataxia (R² = 0.2319, p < 0.01). Moreover, increasing VAT size on the right (non-dominant) side was associated at trend level with more asymmetric glucose metabolism shifting towards the right (dominant) dentate nucleus.

Conclusion

Our results suggest that a disbalanced recruitment of DRTu in the non-dominant VAT induces detrimental stimulation effects on the dominant cerebellar outflow (together with contralateral stimulation) leading to DTE and thus hampering the overall treatment efficacy.

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在深部脑刺激过程中，交叉和非交叉大脑小脑通路的不均衡招募可预测本质性震颤的延迟治疗效果

背景丘脑深部脑刺激（DBS）是治疗耐药性本质性震颤（ET）的有效方法，而齿状突触丘脑束（DRT）是重要的靶结构。然而，多达 40% 的患者会随着时间的推移而习惯性丧失疗效，并经常伴有刺激诱发的小脑综合征。人们对这种被称为 "延迟治疗逃避"（DTE）的现象认识不足。我们之前的研究表明，DTE 在临床上以非优势侧明显，并提示交叉与非交叉 DRT（DRTx/DRTu）的不同参与可能在 DTE 的发展中起作用。在不同的时间点，我们使用法恩-托洛萨-马林震颤评分量表（Fahn-Tolosa-Marin Tremor Rating Scale，FTMTRS）和共济失调评估与评分量表（Scale for the Assessment and Rating of Ataxia，SARA）对这些患者进行了特征描述。对交叉和未交叉的小脑通路进行了标准纤维束学评估，并结合[18F]氟脱氧葡萄糖正电子发射断层扫描对激活组织体积（VAT）进行了研究。非优势 VAT 中的 DRTu 优于 DRTx 与 DTE（R2 = 0.4463，p < 0.01）和共济失调（R2 = 0.2319，p < 0.01）相关。此外，右侧（非优势侧）VAT 的增大与葡萄糖代谢向右侧（优势侧）齿状核转移的不对称趋势相关。结论我们的研究结果表明，非优势侧 VAT 中 DRTu 的不平衡招募会对优势侧小脑外流产生有害的刺激作用（与对侧刺激一起），导致 DTE，从而阻碍整体治疗效果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Neuroimage-Clinical NEUROIMAGING-

CiteScore

7.50

自引率

4.80%

发文量

368

审稿时长

52 days

期刊介绍： NeuroImage: Clinical, a journal of diseases, disorders and syndromes involving the Nervous System, provides a vehicle for communicating important advances in the study of abnormal structure-function relationships of the human nervous system based on imaging. The focus of NeuroImage: Clinical is on defining changes to the brain associated with primary neurologic and psychiatric diseases and disorders of the nervous system as well as behavioral syndromes and developmental conditions. The main criterion for judging papers is the extent of scientific advancement in the understanding of the pathophysiologic mechanisms of diseases and disorders, in identification of functional models that link clinical signs and symptoms with brain function and in the creation of image based tools applicable to a broad range of clinical needs including diagnosis, monitoring and tracking of illness, predicting therapeutic response and development of new treatments. Papers dealing with structure and function in animal models will also be considered if they reveal mechanisms that can be readily translated to human conditions.

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