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Restoration of mammillothalamic functional connectivity through thiamine replacement therapy in Wernicke's
Eosu Kim1, Jeonghun Ku, Young-Chul Jung
1Department of Psychiatry, Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, 134 Shinchon-dong, 250 Seongsanno, Seodaemeun-gu, Seoul 120-752, Republic of Korea.
Abstract:
Resting-state functional MRI (fMRI) is now providing further understanding of neuropsychiatric illnesses. However, its practical applicability in the clinical realms is still questionable. Here we report three consecutive followed-up resting-state fMRI data in a single case with Wernicke encephalopathy before and after high-dose thiamine replacement therapy ranging over 20 months. We measured the mammillothalamic functional connectivity strength between the first ROI (mammillary body) and a voxel which showed the highest co-activation among voxels within the anterior thalamus (the second ROI) to enhance the specificity of the functional connectivity data. We found that the time-series changes in the mammillothalamic functional connectivity generally paralleled to the changes in delayed verbal and nonverbal recall memory scores in the left and right hemisphere, respectively. Among these, the left-side connectivity and delayed verbal recall score seemed to be related to the overall clinical status change. Modified directed transfer function (dDTF) analysis also identified significant information flows with mammillary-to-thalamic direction except at the acute illness state. Our findings, though preliminary in nature, suggest the practical applicability of resting-state fMRI to trace an effect of thiamine replacement therapy on the memory tract function in Wernicke encephalopathy at single-patient level.
Insights
Resting-state fMRI shows promise in tracking memory recovery in Wernicke encephalopathy patients undergoing thiamine therapy. Connectivity changes in the mammillothalamic tract correlated with memory improvements, suggesting clinical utility.
Area of Science:
- Neuroscience
- Radiology
- Clinical Neurology
Background:
- Neuropsychiatric illnesses are increasingly studied using resting-state functional MRI (fMRI).
- The clinical utility of fMRI in these conditions remains under investigation.
- Wernicke encephalopathy (WE) is a neurological condition often associated with thiamine deficiency.
Observation:
- This study presents longitudinal resting-state fMRI data from a single WE patient over 20 months.
- Mammillothalamic functional connectivity was measured between the mammillary body and anterior thalamus.
- Delayed verbal and nonverbal recall memory scores were assessed alongside fMRI data.
Findings:
- Mammillothalamic functional connectivity changes mirrored memory score fluctuations in both hemispheres.
- Left-hemisphere connectivity and verbal recall showed a strong correlation with overall clinical status.
- Modified directed transfer function (dDTF) analysis revealed directional information flow from mammillary bodies to the thalamus, except during acute illness.
Implications:
- Resting-state fMRI may be a valuable tool for monitoring thiamine replacement therapy effectiveness in WE patients.
- The findings suggest fMRI can track functional recovery in memory-related neural pathways at an individual level.
- This preliminary study highlights the potential of fMRI in personalized medicine for WE and similar conditions.
