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Evaluating functional connectivity differences between DBS ON/OFF states in essential tremor.

Albert J Fenoy1, Zili D Chu2, Robert J Ritter3

  • 1Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA; Departments of Neurosurgery and Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.

Neurotherapeutics : the Journal of the American Society for Experimental Neurotherapeutics
|June 1, 2024
PubMed
Summary
This summary is machine-generated.

Deep brain stimulation (DBS) of the dentato-rubro-thalamic tract (DRTt) effectively treats essential tremor (ET). Functional MRI revealed significant connectivity changes in motor regions, correlating with tremor improvement and impacting gait ataxia.

Keywords:
Deep brain stimulationDentato-rubro-thalamic tractEssential tremorFunctional connectivityResting-state functional MRI

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Area of Science:

  • Neuroscience
  • Neurosurgery
  • Medical Imaging

Background:

  • Deep brain stimulation (DBS) targeting the ventral intermediate (Vim) nucleus is a primary treatment for essential tremor (ET).
  • The dentato-rubro-thalamic tract (DRTt), a key input/output pathway of the Vim, is a crucial target for DBS in ET.
  • Understanding the network-level effects of DRTT DBS is essential for optimizing tremor control and managing gait ataxia.

Purpose of the Study:

  • To investigate functional connectivity differences in essential tremor patients during DBS ON versus DBS OFF states.
  • To identify brain regions whose connectivity changes correlate with tremor improvement and/or gait ataxia severity.
  • To explore the potential of connectivity patterns as biomarkers for predicting DBS outcomes.

Main Methods:

  • Resting-state functional MRI (rsfMRI) was used to assess whole-brain and region-of-interest (ROI) functional connectivity in 15 ET patients.
  • Data were acquired with DBS ON (optimal parameters) and immediately after DBS OFF.
  • Dual regression analysis and randomized permutation testing were employed for statistical analysis, with tremor and ataxia severity scores recorded.

Main Results:

  • All patients demonstrated significant tremor improvement with DBS ON (p < 0.001).
  • Whole-brain analysis identified significant connectivity changes in the left pre-central gyrus and left supplemental motor area between DBS states.
  • Connectivity changes in multiple ROIs, including cortical and cerebellar regions, correlated significantly with tremor improvement and duration. Patients with greater ataxia showed decreased functional connectivity when DBS was ON.

Conclusions:

  • DBS of the DRTt induces widespread functional connectivity changes beyond the primary motor network, correlating with tremor control.
  • Connectivity alterations in specific cortical and cerebellar regions may serve as biomarkers for predicting DBS efficacy in essential tremor.
  • These findings highlight the network effects of DRTT DBS and offer insights for refining surgical targeting and predicting treatment outcomes.