Probabilistic Refinement of Focused Ultrasound Thalamotomy Targeting for Parkinson's Disease Tremor

IF 7.4 1区医学 Q1 CLINICAL NEUROLOGY Movement Disorders Pub Date : 2024-08-09 DOI:10.1002/mds.29965

Cletus Cheyuo MD, PhD, Jürgen Germann PhD, Kazuaki Yamamoto MD, Zion Zibly MD, Vibhor Krishna MD, PhD, Can Sarica MD, Yuri Ferreira Felloni Borges MD, Artur Vetkas MD, PhD, Suneil K. Kalia MD, PhD, Mojgan Hodaie MD, Alfonso Fasano MD, PhD, Michael L. Schwartz MD, MSc, W. Jeffrey Elias MD, Andres M. Lozano MD, PhD

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Abstract

Background

There remains high variability in clinical outcomes when the same magnetic resonance image-guided focused ultrasound (MRgFUS) thalamotomy target is used for both essential tremor (ET) and tremor-dominant Parkinson's disease (TDPD).

Objective

Our goal is to refine the MRgFUS thalamotomy target for TDPD versus ET.

Methods

We retrospectively performed voxel-wise efficacy and structural connectivity mapping using 3-12-month post-procedure hand tremor scores for a multicenter cohort of 32 TDPD patients and a previously published cohort of 79 ET patients, and 24-hour T1-weighted post-MRgFUS brain images. We validated our findings using Unified Parkinson's Disease Rating Scale part III scores for an independent cohort of nine TDPD patients.

Results

The post-MRgFUS clinical improvements were 45.9% ± 35.9%, 55.5% ± 36%, and 46.1% ± 18.6% for ET, multicenter TDPD and validation TDPD cohorts, respectively. The TDPD and ET efficacy maps differed significantly (p_permute < 0.05), with peak TDPD improvement (87%) at x = −13.5; y = −15.0; z = 1.5, ~3.5 mm anterior and 3 mm dorsal to the ET target. Discriminative connectivity projections were to the motor and premotor regions in TDPD, and to the motor and somatosensory regions in ET. The disorder-specific voxel-wise efficacy map could be used to estimate outcome in TDPD patients with high accuracy (R = 0.8; R² = 0.64; P < 0.0001). The model was validated using the independent cohort of nine TDPD patients (R = 0.73; R² = 0.53; P = 0.025—voxel analysis).

Conclusion

We demonstrated that the most effective MRgFUS thalamotomy target in TDPD is in the ventral intermediate nucleus/ventralis oralis posterior border region. This finding offers new insights into the thalamic regions instrumental in tremor control, with pivotal implications for improving treatment outcomes. © 2024 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

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聚焦超声丘脑切开术靶向治疗帕金森病震颤的概率论改进

背景：当同一磁共振图像引导下聚焦超声（MRgFUS）丘脑切开术靶点同时用于治疗本质性震颤（ET）和震颤为主的帕金森病（TDPD）时，临床结果仍存在很大差异：我们的目标是改进用于 TDPD 和 ET 的 MRgFUS 丘脑切开术目标：我们回顾性地对多中心队列中的 32 名 TDPD 患者和之前发表的队列中的 79 名 ET 患者进行了体素疗效和结构连接图绘制，并使用了术后 3-12 个月的手震颤评分和 24 小时 T1 加权 MRgFUS 术后脑图像。我们使用统一帕金森病评定量表第三部分的评分对9名TDPD患者的独立队列进行了验证：结果：ET、多中心 TDPD 和验证 TDPD 队列的 MRgFUS 术后临床改善率分别为 45.9% ± 35.9%、55.5% ± 36% 和 46.1% ± 18.6%。TDPD和ET疗效图差异显著（Ppermute 2 = 0.64；P 2 = 0.53；P = 0.025-体素分析）：我们证明，MRgFUS丘脑切开术在TDPD中最有效的目标是腹侧中间核/口腔嵴后缘区域。这一发现为我们了解丘脑在震颤控制中的作用区域提供了新的视角，对改善治疗效果具有重要意义。© 2024 作者简介运动障碍》由 Wiley Periodicals LLC 代表国际帕金森和运动障碍协会出版。

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来源期刊

Movement Disorders 医学-临床神经学

CiteScore

13.30

自引率

8.10%

发文量

371

审稿时长

12 months

期刊介绍： Movement Disorders publishes a variety of content types including Reviews, Viewpoints, Full Length Articles, Historical Reports, Brief Reports, and Letters. The journal considers original manuscripts on topics related to the diagnosis, therapeutics, pharmacology, biochemistry, physiology, etiology, genetics, and epidemiology of movement disorders. Appropriate topics include Parkinsonism, Chorea, Tremors, Dystonia, Myoclonus, Tics, Tardive Dyskinesia, Spasticity, and Ataxia.