https://scholars.lib.ntu.edu.tw/handle/123456789/598877
標題: | Tractography patterns of pedunculopontine nucleus deep brain stimulation | 作者: | Raghu A.L.B Parker T Zand A.P.D STEPHEN JOHN PAYNE Andersson J Stein J Aziz T.Z Green, Alexander L. |
關鍵字: | Deep brain stimulation;Falls;Gait;Parkinson’s disease;Pedunculopontine nucleus;Pedunculotegmental nucleus;Tractography;abnormal posture;adult;aged;Article;brain depth stimulation;Brodmann area 9;cerebellum;clinical article;cohort analysis;controlled clinical trial;controlled study;cortical thickness (brain);diffusion tensor imaging;diffusion weighted imaging;follow up;freezing of gait questionnaire;functional connectivity;gait and falls questionnaire;gait disorder;human;image reconstruction;male;middle aged;motor dysfunction assessment;parietal lobe;Parkinson disease;pedunculopontine tegmental nucleus;premotor cortex;preoperative evaluation;primary motor cortex;priority journal;superior cerebellar peduncle;tractography;diagnostic imaging;gait;neurologic gait disorder;Deep Brain Stimulation;Gait Disorders, Neurologic;Humans;Parkinson Disease;Pedunculopontine Tegmental Nucleus | 公開日期: | 2021 | 卷: | 128 | 期: | 5 | 起(迄)頁: | 659-670 | 來源出版物: | Journal of Neural Transmission | 摘要: | Deep brain stimulation of the pedunculopontine nucleus is a promising surgical procedure for the treatment of Parkinsonian gait and balance dysfunction. It has, however, produced mixed clinical results that are poorly understood. We used tractography with the aim to rationalise this heterogeneity. A cohort of eight patients with postural instability and gait disturbance (Parkinson’s disease subtype) underwent pre-operative structural and diffusion MRI, then progressed to deep brain stimulation targeting the pedunculopontine nucleus. Pre-operative and follow-up assessments were carried out using the Gait and Falls Questionnaire, and Freezing of Gait Questionnaire. Probabilistic diffusion tensor tractography was carried out between the stimulating electrodes and both cortical and cerebellar regions of a priori interest. Cortical surface reconstructions were carried out to measure cortical thickness in relevant areas. Structural connectivity between stimulating electrode and precentral gyrus (r = 0.81, p = 0.01), Brodmann areas 1 (r = 0.78, p = 0.02) and 2 (r = 0.76, p = 0.03) were correlated with clinical improvement. A negative correlation was also observed for the superior cerebellar peduncle (r = ?0.76, p = 0.03). Lower cortical thickness of the left parietal lobe and bilateral premotor cortices were associated with greater pre-operative severity of symptoms. Both motor and sensory structural connectivity of the stimulated surgical target characterises the clinical benefit, or lack thereof, from surgery. In what is a challenging region of brainstem to effectively target, these results provide insights into how this can be better achieved. The mechanisms of action are likely to have both motor and sensory components, commensurate with the probable nature of the underlying dysfunction. ? 2021, The Author(s). |
URI: | https://www.scopus.com/inward/record.uri?eid=2-s2.0-85103379162&doi=10.1007%2fs00702-021-02327-x&partnerID=40&md5=b0fbce247686293cb112cabef7d43f7c https://scholars.lib.ntu.edu.tw/handle/123456789/598877 |
ISSN: | 03009564 | DOI: | 10.1007/s00702-021-02327-x |
顯示於: | 應用力學研究所 |
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