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Targeting the centromedian thalamic nucleus for deep brain stimulation.

Aaron E L Warren1,2,3, Linda J Dalic4,2,5, Wesley Thevathasan5,6,7,8

  • 1Department of Medicine (Austin Health), The University of Melbourne, Melbourne, Victoria, Australia aaron.warren@unimelb.edu.au.

Journal of Neurology, Neurosurgery, and Psychiatry
|January 26, 2020
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Summary

Accurate deep brain stimulation (DBS) targeting for Lennox-Gastaut syndrome (LGS) epilepsy is achievable using advanced MRI. Microelectrode recordings offer supplementary localization, but functional MRI reveals key brain network connections for therapeutic effects.

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Area of Science:

  • Neurosurgery
  • Neurology
  • Medical Imaging

Background:

  • Deep brain stimulation (DBS) is an emerging treatment for neurological disorders.
  • Lennox-Gastaut syndrome (LGS) is a severe form of drug-resistant epilepsy.
  • Accurate targeting of the centromedian thalamic nucleus (CM) is crucial for effective DBS.

Purpose of the Study:

  • To enhance neurosurgical targeting of the CM for DBS in LGS patients.
  • To develop a structural MRI approach for CM visualization.
  • To identify CM neurophysiological characteristics using microelectrode recordings (MERs).
  • To map functional connectivity from CM-DBS sites using functional MRI (fMRI).

Main Methods:

  • 19 LGS patients underwent 3T MP2RAGE MRI and fMRI.
  • 16 patients received bilateral CM-DBS and intraoperative thalamic MERs.
  • CM visualization utilized MP2RAGE with Sobel edge detection.
  • MER features and fMRI connectivity were analyzed.

Main Results:

  • CM visualization was successful, appearing as a hyperintense region.
  • Reduced spike firing and background noise distinguished CM from other nuclei in group analysis.
  • fMRI connectivity mapped to basal ganglia, brainstem, cerebellum, and cortical areas.

Conclusions:

  • Accurate CM targeting for LGS DBS is feasible with 3T MP2RAGE MRI.
  • Intraoperative MERs provide limited additional localization due to variability.
  • Therapeutic effects of CM-DBS are likely mediated by connections with arousal, cognitive, and sensorimotor networks.