1
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Suresh H, Morgan BR, Mithani K, Warsi NM, Yan H, Germann J, Boutet A, Loh A, Gouveia FV, Young J, Quon J, Morgado F, Lerch J, Lozano AM, Al-Fatly B, Kühn AA, Laughlin S, Dewan MC, Mabbott D, Gorodetsky C, Bartels U, Huang A, Tabori U, Rutka JT, Drake JM, Kulkarni AV, Dirks P, Taylor MD, Ramaswamy V, Ibrahim GM. Postoperative cerebellar mutism syndrome is an acquired autism-like network disturbance. Neuro Oncol 2024; 26:950-964. [PMID: 38079480 PMCID: PMC11066932 DOI: 10.1093/neuonc/noad230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2024] Open
Abstract
BACKGROUND Cerebellar mutism syndrome (CMS) is a common and debilitating complication of posterior fossa tumor surgery in children. Affected children exhibit communication and social impairments that overlap phenomenologically with subsets of deficits exhibited by children with Autism spectrum disorder (ASD). Although both CMS and ASD are thought to involve disrupted cerebro-cerebellar circuitry, they are considered independent conditions due to an incomplete understanding of their shared neural substrates. METHODS In this study, we analyzed postoperative cerebellar lesions from 90 children undergoing posterior fossa resection of medulloblastoma, 30 of whom developed CMS. Lesion locations were mapped to a standard atlas, and the networks functionally connected to each lesion were computed in normative adult and pediatric datasets. Generalizability to ASD was assessed using an independent cohort of children with ASD and matched controls (n = 427). RESULTS Lesions in children who developed CMS involved the vermis and inferomedial cerebellar lobules. They engaged large-scale cerebellothalamocortical circuits with a preponderance for the prefrontal and parietal cortices in the pediatric and adult connectomes, respectively. Moreover, with increasing connectomic age, CMS-associated lesions demonstrated stronger connectivity to the midbrain/red nuclei, thalami and inferior parietal lobules and weaker connectivity to the prefrontal cortex. Importantly, the CMS-associated lesion network was independently reproduced in ASD and correlated with communication and social deficits, but not repetitive behaviors. CONCLUSIONS Our findings indicate that CMS-associated lesions may result in an ASD-like network disturbance that occurs during sensitive windows of brain development. A common network disturbance between CMS and ASD may inform improved treatment strategies for affected children.
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Affiliation(s)
- Hrishikesh Suresh
- Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
- Program in Neuroscience and Mental Health, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
- Division of Neurosurgery, The Hospital for Sick Children, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Benjamin R Morgan
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Karim Mithani
- Division of Neurosurgery, The Hospital for Sick Children, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Nebras M Warsi
- Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
- Program in Neuroscience and Mental Health, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
- Division of Neurosurgery, The Hospital for Sick Children, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Han Yan
- Program in Neuroscience and Mental Health, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
- Division of Neurosurgery, The Hospital for Sick Children, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Jürgen Germann
- Division of Neurosurgery, University Health Network, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Krembil Brain Institute, University Health Network, Toronto, Ontario, Canada
| | - Alexandre Boutet
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
- Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Aaron Loh
- Division of Neurosurgery, The Hospital for Sick Children, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Flavia Venetucci Gouveia
- Program in Neuroscience and Mental Health, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Julia Young
- Department of Psychology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jennifer Quon
- Division of Neurosurgery, The Hospital for Sick Children, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Felipe Morgado
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jason Lerch
- Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, UK
| | - Andres M Lozano
- Division of Neurosurgery, University Health Network, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Krembil Brain Institute, University Health Network, Toronto, Ontario, Canada
| | - Bassam Al-Fatly
- Department of Neurology and Experimental Neurology, Movement Disorders and Neuromodulation Unit, Charité, Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Andrea A Kühn
- Department of Neurology and Experimental Neurology, Movement Disorders and Neuromodulation Unit, Charité, Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
- Exzellenzcluster NeuroCure, Charité, Universitätsmedizin, Berlin, Germany
| | - Suzanne Laughlin
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Michael C Dewan
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Donald Mabbott
- Department of Psychology, University of Toronto, Toronto, Ontario, Canada
| | - Carolina Gorodetsky
- Division of Neurology, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Ute Bartels
- Division of Neuro-Oncology, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Annie Huang
- Division of Neuro-Oncology, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Uri Tabori
- Division of Neuro-Oncology, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - James T Rutka
- Division of Neurosurgery, The Hospital for Sick Children, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - James M Drake
- Division of Neurosurgery, The Hospital for Sick Children, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Abhaya V Kulkarni
- Division of Neurosurgery, The Hospital for Sick Children, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Peter Dirks
- Division of Neurosurgery, The Hospital for Sick Children, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Michael D Taylor
- Division of Neurosurgery, The Hospital for Sick Children, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Vijay Ramaswamy
- Division of Neuro-Oncology, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - George M Ibrahim
- Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
- Division of Neurosurgery, The Hospital for Sick Children, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
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2
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Steiner LA, Crompton D, Sumarac S, Vetkas A, Germann J, Scherer M, Justich M, Boutet A, Popovic MR, Hodaie M, Kalia SK, Fasano A, Hutchison Wd WD, Lozano AM, Lankarany M, Kühn AA, Milosevic L. Neural signatures of indirect pathway activity during subthalamic stimulation in Parkinson's disease. Nat Commun 2024; 15:3130. [PMID: 38605039 PMCID: PMC11009243 DOI: 10.1038/s41467-024-47552-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 04/02/2024] [Indexed: 04/13/2024] Open
Abstract
Deep brain stimulation (DBS) of the subthalamic nucleus (STN) produces an electrophysiological signature called evoked resonant neural activity (ERNA); a high-frequency oscillation that has been linked to treatment efficacy. However, the single-neuron and synaptic bases of ERNA are unsubstantiated. This study proposes that ERNA is a subcortical neuronal circuit signature of DBS-mediated engagement of the basal ganglia indirect pathway network. In people with Parkinson's disease, we: (i) showed that each peak of the ERNA waveform is associated with temporally-locked neuronal inhibition in the STN; (ii) characterized the temporal dynamics of ERNA; (iii) identified a putative mesocircuit architecture, embedded with empirically-derived synaptic dynamics, that is necessary for the emergence of ERNA in silico; (iv) localized ERNA to the dorsal STN in electrophysiological and normative anatomical space; (v) used patient-wise hotspot locations to assess spatial relevance of ERNA with respect to DBS outcome; and (vi) characterized the local fiber activation profile associated with the derived group-level ERNA hotspot.
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Affiliation(s)
- Leon A Steiner
- Krembil Brain Institute, University Health Network, Toronto, ON, M5T 1M8, Canada
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, 10117, Germany
- Berlin Institute of Health (BIH), Berlin, 10178, Germany
| | - David Crompton
- Krembil Brain Institute, University Health Network, Toronto, ON, M5T 1M8, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, M5S 3G9, Canada
| | - Srdjan Sumarac
- Krembil Brain Institute, University Health Network, Toronto, ON, M5T 1M8, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, M5S 3G9, Canada
| | - Artur Vetkas
- Krembil Brain Institute, University Health Network, Toronto, ON, M5T 1M8, Canada
- Division of Neurosurgery, Toronto Western Hospital, Toronto, ON, M5T 2S8, Canada
| | - Jürgen Germann
- Krembil Brain Institute, University Health Network, Toronto, ON, M5T 1M8, Canada
- Division of Neurosurgery, Toronto Western Hospital, Toronto, ON, M5T 2S8, Canada
- Department of Surgery, University of Toronto, Toronto, ON, M5G 2C4, Canada
| | - Maximilian Scherer
- Krembil Brain Institute, University Health Network, Toronto, ON, M5T 1M8, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, M5S 3G9, Canada
| | - Maria Justich
- Krembil Brain Institute, University Health Network, Toronto, ON, M5T 1M8, Canada
- Department of Neurology, University of Toronto, Toronto, ON, M5S 3H2, Canada
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Toronto, ON, M5T 2S8, Canada
| | - Alexandre Boutet
- Joint Department of Medical Imaging, University of Toronto, Toronto, ON, M5G 1×6, Canada
| | - Milos R Popovic
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, M5S 3G9, Canada
- KITE Research Institute, University Health Network, Toronto, ON, M5G 2A2, Canada
- Center for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, ON, M5T 2S8, Canada
| | - Mojgan Hodaie
- Krembil Brain Institute, University Health Network, Toronto, ON, M5T 1M8, Canada
- Division of Neurosurgery, Toronto Western Hospital, Toronto, ON, M5T 2S8, Canada
- Department of Surgery, University of Toronto, Toronto, ON, M5G 2C4, Canada
- Center for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, ON, M5T 2S8, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, ON, M5S 1A8, Canada
| | - Suneil K Kalia
- Krembil Brain Institute, University Health Network, Toronto, ON, M5T 1M8, Canada
- Division of Neurosurgery, Toronto Western Hospital, Toronto, ON, M5T 2S8, Canada
- Department of Surgery, University of Toronto, Toronto, ON, M5G 2C4, Canada
- KITE Research Institute, University Health Network, Toronto, ON, M5G 2A2, Canada
- Center for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, ON, M5T 2S8, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, ON, M5S 1A8, Canada
| | - Alfonso Fasano
- Krembil Brain Institute, University Health Network, Toronto, ON, M5T 1M8, Canada
- Department of Neurology, University of Toronto, Toronto, ON, M5S 3H2, Canada
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Toronto, ON, M5T 2S8, Canada
- Center for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, ON, M5T 2S8, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, ON, M5S 1A8, Canada
| | - William D Hutchison Wd
- Krembil Brain Institute, University Health Network, Toronto, ON, M5T 1M8, Canada
- Department of Surgery, University of Toronto, Toronto, ON, M5G 2C4, Canada
- Center for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, ON, M5T 2S8, Canada
- Department of Physiology, University of Toronto, Toronto, ON, M5S 1A8, Canada
| | - Andres M Lozano
- Krembil Brain Institute, University Health Network, Toronto, ON, M5T 1M8, Canada
- Division of Neurosurgery, Toronto Western Hospital, Toronto, ON, M5T 2S8, Canada
- Department of Surgery, University of Toronto, Toronto, ON, M5G 2C4, Canada
- Center for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, ON, M5T 2S8, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, ON, M5S 1A8, Canada
| | - Milad Lankarany
- Krembil Brain Institute, University Health Network, Toronto, ON, M5T 1M8, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, M5S 3G9, Canada
- Center for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, ON, M5T 2S8, Canada
| | - Andrea A Kühn
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, 10117, Germany
| | - Luka Milosevic
- Krembil Brain Institute, University Health Network, Toronto, ON, M5T 1M8, Canada.
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, M5S 3G9, Canada.
- KITE Research Institute, University Health Network, Toronto, ON, M5G 2A2, Canada.
- Center for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, ON, M5T 2S8, Canada.
- Institute of Medical Sciences, University of Toronto, Toronto, ON, M5S 1A8, Canada.
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Cho NS, Ozkara BB, Boutet A, Halm K, Wilhelm L, Shah L, Wintermark M. Introducing Our New AJNR Early Career, Women in Neuroradiology, and Global Neuroradiology Awards. AJNR Am J Neuroradiol 2024; 45:362. [PMID: 38514092 DOI: 10.3174/ajnr.a8231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
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4
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Elias GJB, Germann J, Joel SE, Li N, Horn A, Boutet A, Lozano AM. A large normative connectome for exploring the tractographic correlates of focal brain interventions. Sci Data 2024; 11:353. [PMID: 38589407 PMCID: PMC11002007 DOI: 10.1038/s41597-024-03197-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 03/28/2024] [Indexed: 04/10/2024] Open
Abstract
Diffusion-weighted MRI (dMRI) is a widely used neuroimaging modality that permits the in vivo exploration of white matter connections in the human brain. Normative structural connectomics - the application of large-scale, group-derived dMRI datasets to out-of-sample cohorts - have increasingly been leveraged to study the network correlates of focal brain interventions, insults, and other regions-of-interest (ROIs). Here, we provide a normative, whole-brain connectome in MNI space that enables researchers to interrogate fiber streamlines that are likely perturbed by given ROIs, even in the absence of subject-specific dMRI data. Assembled from multi-shell dMRI data of 985 healthy Human Connectome Project subjects using generalized Q-sampling imaging and multispectral normalization techniques, this connectome comprises ~12 million unique streamlines, the largest to date. It has already been utilized in at least 18 peer-reviewed publications, most frequently in the context of neuromodulatory interventions like deep brain stimulation and focused ultrasound. Now publicly available, this connectome will constitute a useful tool for understanding the wider impact of focal brain perturbations on white matter architecture going forward.
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Affiliation(s)
- Gavin J B Elias
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Canada
- Krembil Research Institute, University of Toronto, Toronto, Canada
| | - Jürgen Germann
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Canada
- Krembil Research Institute, University of Toronto, Toronto, Canada
- Center for Advancing Neurotechnological Innovation to Application (CRANIA), University Health Network, Toronto, Canada
| | | | - Ningfei Li
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Andreas Horn
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Einstein Center for Neurosciences Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Center for Brain Circuit Therapeutics, Department of Neurology, Brigham & Women's Hospital, Harvard Medical School, Boston, USA
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Alexandre Boutet
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Canada
- Krembil Research Institute, University of Toronto, Toronto, Canada
- Joint Department of Medical Imaging, University of Toronto, Toronto, Canada
| | - Andres M Lozano
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Canada.
- Krembil Research Institute, University of Toronto, Toronto, Canada.
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5
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Boutet A, Son HJ, Malik M, Haile S, Yang AZ, Pai V, Germann J, Mandell DM. Enlarging and shrinking focal perivascular spaces. Neuroradiol J 2024:19714009241242642. [PMID: 38565221 DOI: 10.1177/19714009241242642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND AND PURPOSE Perivascular spaces (PVS) are interstitial fluid-filled spaces surrounding blood vessels traversing the deep gray nuclei and white matter of the brain. These are commonly encountered on CT and MR imaging and are generally asymptomatic and of no clinical significance. However, occasional changes in the size of focal PVS, for example, when enlarging, may mimic pathologies including neoplasms and infections, hence potentially confounding radiological interpretation. Given these potential diagnostic issues, we sought to better characterize common clinical and imaging features of focal PVS demonstrating size fluctuations. MATERIALS AND METHODS Upon institutional approval, we retrospectively identified 4 cases demonstrating PVS with size changes at our institution. To supplement our cases, we also performed a literature review, which identified an additional 14 cases. Their clinical and imaging data were analyzed to identify characteristic features. RESULTS Of the 18 total cases (including the 4 institutional cases), 10 cases increased and 8 decreased in size. These focal PVS ranged from 0.4-4.5 cm in size. Whereas a decrease in size did not represent a diagnostic issue, focal increase in size of PVS led to concerning differential diagnoses in at least 30% of the radiology reports. These enlarging PVS were most found in the basal ganglia and temporal lobe, and in patients with previous brain radiation treatment. CONCLUSION Focal size change of PVS can occur, especially years after brain radiation treatment. Being cognizant of this benign finding is important to consider in the differential diagnosis to avoid undue patient anxiety or unnecessary medical intervention.
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Affiliation(s)
- Alexandre Boutet
- Joint Department of Medical Imaging, University of Toronto, Canada
| | - Hyo Jin Son
- Temerty Faculty of Medicine, University of Toronto, Canada
| | - Mikail Malik
- Temerty Faculty of Medicine, University of Toronto, Canada
| | - Samuel Haile
- Temerty Faculty of Medicine, University of Toronto, Canada
| | - Andrew Z Yang
- Division of Neurosurgery, University of Toronto, Canada
| | - Vivek Pai
- Joint Department of Medical Imaging, University of Toronto, Canada
- Division of Neuroradiology, Department of Diagnostic Imaging, The Hospital for Sick Children, Canada
| | | | - Daniel M Mandell
- Joint Department of Medical Imaging, University of Toronto, Canada
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6
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Boutet A, Haile SS, Yang AZ, Son HJ, Malik M, Pai V, Nasralla M, Germann J, Vetkas A, Khalvati F, Ertl-Wagner BB. Assessing the Emergence and Evolution of Artificial Intelligence and Machine Learning Research in Neuroradiology. AJNR Am J Neuroradiol 2024:ajnr.A8252. [PMID: 38521092 DOI: 10.3174/ajnr.a8252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 03/19/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND AND PURPOSE Interest in artificial intelligence (AI) and machine learning (ML) has been growing in neuroradiology, but there is limited knowledge on how this interest has manifested into research and specifically, its qualities and characteristics. This study aims to characterize the emergence and evolution of AI/ML articles within neuroradiology and provide a comprehensive overview of the trends, challenges, and future directions of the field. MATERIALS AND METHODS We performed a bibliometric analysis of the American Journal of Neuroradiology (AJNR): the journal was queried for original research articles published since inception (Jan. 1, 1980) to Dec. 3, 2022 that contained any of the following key terms: "machine learning", "artificial intelligence", "radiomics", "deep learning", "neural network", "generative adversarial network", "object detection", or "natural language processing". Articles were screened by two independent reviewers, and categorized into Statistical Modelling (Type 1), AI/ML Development (Type 2), both representing developmental research work but without a direct clinical integration, or End-user Application (Type 3) which is the closest surrogate of potential AI/ML integration into day-to-day practice. To better understand the limiting factors to Type 3 articles being published, we analyzed Type 2 articles as they should represent the precursor work leading to Type 3. RESULTS A total of 182 articles were identified with 79% being non-integration focused (Type 1 n = 53, Type 2 n = 90) and 21% (n = 39) being Type 3. The total number of articles published grew roughly five-fold in the last five years, with the non-integration focused articles mainly driving this growth. Additionally, a minority of Type 2 articles addressed bias (22%) and explainability (16%). These articles were primarily led by radiologists (63%), with most of them (60%) having additional postgraduate degrees. CONCLUSIONS AI/ML publications have been rapidly increasing in neuroradiology with only a minority of this growth being attributable to end-user application. Areas identified for improvement include enhancing the quality of Type 2 articles, namely external validation, and addressing both bias and explainability. These results ultimately provide authors, editors, clinicians, and policymakers important insights to promote a shift towards integrating practical AI/ML solutions in neuroradiology. ABBREVIATIONS AI = artificial intelligence; ML = machine learning.
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Affiliation(s)
- Alexandre Boutet
- From the Joint Department of Medical Imaging (A.B., M.N.), University Health Network, Toronto, ON, Canada; Temerty Faculty of Medicine (S.S.H., H.S., M.M.), Division of Neurosurgery, Department of Surgery, Toronto Western Hospital (A.Z.W., J.G., A.V.), Department of Medical Imaging (V.P., F.K., B.B.E.-W.), Department of Computer Science (F.K.), Department of Mechanical and Industrial Engineering (F.K.), University of Toronto, Toronto, ON, Canada; Division of Neuroradiology, Department of Diagnostic Imaging (V.P., B.B.E.-W.) The Hospital for Sick Children, Toronto, ON, Canada; Neurosciences and Mental Health Program, (F.K., B.B.E.-W.) SickKids Research Institute, Toronto, ON, Canada
| | - Samuel S Haile
- From the Joint Department of Medical Imaging (A.B., M.N.), University Health Network, Toronto, ON, Canada; Temerty Faculty of Medicine (S.S.H., H.S., M.M.), Division of Neurosurgery, Department of Surgery, Toronto Western Hospital (A.Z.W., J.G., A.V.), Department of Medical Imaging (V.P., F.K., B.B.E.-W.), Department of Computer Science (F.K.), Department of Mechanical and Industrial Engineering (F.K.), University of Toronto, Toronto, ON, Canada; Division of Neuroradiology, Department of Diagnostic Imaging (V.P., B.B.E.-W.) The Hospital for Sick Children, Toronto, ON, Canada; Neurosciences and Mental Health Program, (F.K., B.B.E.-W.) SickKids Research Institute, Toronto, ON, Canada
| | - Andrew Z Yang
- From the Joint Department of Medical Imaging (A.B., M.N.), University Health Network, Toronto, ON, Canada; Temerty Faculty of Medicine (S.S.H., H.S., M.M.), Division of Neurosurgery, Department of Surgery, Toronto Western Hospital (A.Z.W., J.G., A.V.), Department of Medical Imaging (V.P., F.K., B.B.E.-W.), Department of Computer Science (F.K.), Department of Mechanical and Industrial Engineering (F.K.), University of Toronto, Toronto, ON, Canada; Division of Neuroradiology, Department of Diagnostic Imaging (V.P., B.B.E.-W.) The Hospital for Sick Children, Toronto, ON, Canada; Neurosciences and Mental Health Program, (F.K., B.B.E.-W.) SickKids Research Institute, Toronto, ON, Canada
| | - Hyo Jin Son
- From the Joint Department of Medical Imaging (A.B., M.N.), University Health Network, Toronto, ON, Canada; Temerty Faculty of Medicine (S.S.H., H.S., M.M.), Division of Neurosurgery, Department of Surgery, Toronto Western Hospital (A.Z.W., J.G., A.V.), Department of Medical Imaging (V.P., F.K., B.B.E.-W.), Department of Computer Science (F.K.), Department of Mechanical and Industrial Engineering (F.K.), University of Toronto, Toronto, ON, Canada; Division of Neuroradiology, Department of Diagnostic Imaging (V.P., B.B.E.-W.) The Hospital for Sick Children, Toronto, ON, Canada; Neurosciences and Mental Health Program, (F.K., B.B.E.-W.) SickKids Research Institute, Toronto, ON, Canada
| | - Mikail Malik
- From the Joint Department of Medical Imaging (A.B., M.N.), University Health Network, Toronto, ON, Canada; Temerty Faculty of Medicine (S.S.H., H.S., M.M.), Division of Neurosurgery, Department of Surgery, Toronto Western Hospital (A.Z.W., J.G., A.V.), Department of Medical Imaging (V.P., F.K., B.B.E.-W.), Department of Computer Science (F.K.), Department of Mechanical and Industrial Engineering (F.K.), University of Toronto, Toronto, ON, Canada; Division of Neuroradiology, Department of Diagnostic Imaging (V.P., B.B.E.-W.) The Hospital for Sick Children, Toronto, ON, Canada; Neurosciences and Mental Health Program, (F.K., B.B.E.-W.) SickKids Research Institute, Toronto, ON, Canada
| | - Vivek Pai
- From the Joint Department of Medical Imaging (A.B., M.N.), University Health Network, Toronto, ON, Canada; Temerty Faculty of Medicine (S.S.H., H.S., M.M.), Division of Neurosurgery, Department of Surgery, Toronto Western Hospital (A.Z.W., J.G., A.V.), Department of Medical Imaging (V.P., F.K., B.B.E.-W.), Department of Computer Science (F.K.), Department of Mechanical and Industrial Engineering (F.K.), University of Toronto, Toronto, ON, Canada; Division of Neuroradiology, Department of Diagnostic Imaging (V.P., B.B.E.-W.) The Hospital for Sick Children, Toronto, ON, Canada; Neurosciences and Mental Health Program, (F.K., B.B.E.-W.) SickKids Research Institute, Toronto, ON, Canada
| | - Mehran Nasralla
- From the Joint Department of Medical Imaging (A.B., M.N.), University Health Network, Toronto, ON, Canada; Temerty Faculty of Medicine (S.S.H., H.S., M.M.), Division of Neurosurgery, Department of Surgery, Toronto Western Hospital (A.Z.W., J.G., A.V.), Department of Medical Imaging (V.P., F.K., B.B.E.-W.), Department of Computer Science (F.K.), Department of Mechanical and Industrial Engineering (F.K.), University of Toronto, Toronto, ON, Canada; Division of Neuroradiology, Department of Diagnostic Imaging (V.P., B.B.E.-W.) The Hospital for Sick Children, Toronto, ON, Canada; Neurosciences and Mental Health Program, (F.K., B.B.E.-W.) SickKids Research Institute, Toronto, ON, Canada
| | - Jurgen Germann
- From the Joint Department of Medical Imaging (A.B., M.N.), University Health Network, Toronto, ON, Canada; Temerty Faculty of Medicine (S.S.H., H.S., M.M.), Division of Neurosurgery, Department of Surgery, Toronto Western Hospital (A.Z.W., J.G., A.V.), Department of Medical Imaging (V.P., F.K., B.B.E.-W.), Department of Computer Science (F.K.), Department of Mechanical and Industrial Engineering (F.K.), University of Toronto, Toronto, ON, Canada; Division of Neuroradiology, Department of Diagnostic Imaging (V.P., B.B.E.-W.) The Hospital for Sick Children, Toronto, ON, Canada; Neurosciences and Mental Health Program, (F.K., B.B.E.-W.) SickKids Research Institute, Toronto, ON, Canada
| | - Artur Vetkas
- From the Joint Department of Medical Imaging (A.B., M.N.), University Health Network, Toronto, ON, Canada; Temerty Faculty of Medicine (S.S.H., H.S., M.M.), Division of Neurosurgery, Department of Surgery, Toronto Western Hospital (A.Z.W., J.G., A.V.), Department of Medical Imaging (V.P., F.K., B.B.E.-W.), Department of Computer Science (F.K.), Department of Mechanical and Industrial Engineering (F.K.), University of Toronto, Toronto, ON, Canada; Division of Neuroradiology, Department of Diagnostic Imaging (V.P., B.B.E.-W.) The Hospital for Sick Children, Toronto, ON, Canada; Neurosciences and Mental Health Program, (F.K., B.B.E.-W.) SickKids Research Institute, Toronto, ON, Canada
| | - Farzad Khalvati
- From the Joint Department of Medical Imaging (A.B., M.N.), University Health Network, Toronto, ON, Canada; Temerty Faculty of Medicine (S.S.H., H.S., M.M.), Division of Neurosurgery, Department of Surgery, Toronto Western Hospital (A.Z.W., J.G., A.V.), Department of Medical Imaging (V.P., F.K., B.B.E.-W.), Department of Computer Science (F.K.), Department of Mechanical and Industrial Engineering (F.K.), University of Toronto, Toronto, ON, Canada; Division of Neuroradiology, Department of Diagnostic Imaging (V.P., B.B.E.-W.) The Hospital for Sick Children, Toronto, ON, Canada; Neurosciences and Mental Health Program, (F.K., B.B.E.-W.) SickKids Research Institute, Toronto, ON, Canada
| | - Birgit B Ertl-Wagner
- From the Joint Department of Medical Imaging (A.B., M.N.), University Health Network, Toronto, ON, Canada; Temerty Faculty of Medicine (S.S.H., H.S., M.M.), Division of Neurosurgery, Department of Surgery, Toronto Western Hospital (A.Z.W., J.G., A.V.), Department of Medical Imaging (V.P., F.K., B.B.E.-W.), Department of Computer Science (F.K.), Department of Mechanical and Industrial Engineering (F.K.), University of Toronto, Toronto, ON, Canada; Division of Neuroradiology, Department of Diagnostic Imaging (V.P., B.B.E.-W.) The Hospital for Sick Children, Toronto, ON, Canada; Neurosciences and Mental Health Program, (F.K., B.B.E.-W.) SickKids Research Institute, Toronto, ON, Canada
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7
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Vetkas A, Boutet A, Sarica C, Germann J, Gwun D, Yamamoto K, Jung HH, Alkhotani A, Samuel N, Lang S, Conner CR, Elias GJB, Cheyuo C, Chow C, Santyr B, Iorio-Morin C, Yang AZ, Candeias da Silva C, Fasano A, Kalia SK, Lozano AM. Successful magnetic resonance-guided focused ultrasound treatment of tremor in patients with a skull density ratio of 0.4 or less. J Neurosurg 2024; 140:639-647. [PMID: 37657095 DOI: 10.3171/2023.6.jns23171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 06/28/2023] [Indexed: 09/03/2023]
Abstract
OBJECTIVE The use of magnetic resonance-guided focused ultrasound (MRgFUS) for the treatment of tremor-related disorders and other novel indications has been limited by guidelines advocating treatment of patients with a skull density ratio (SDR) above 0.45 ± 0.05 despite reports of successful outcomes in patients with a low SDR (LSDR). The authors' goal was to retrospectively analyze the sonication strategies, adverse effects, and clinical and imaging outcomes in patients with SDR ≤ 0.4 treated for tremor using MRgFUS. METHODS Clinical outcomes and adverse effects were assessed at 3 and 12 months after MRgFUS. Outcomes and lesion location, volume, and shape characteristics (elongation and eccentricity) were compared between the SDR groups. RESULTS A total of 102 consecutive patients were included in the analysis, of whom 39 had SDRs ≤ 0.4. No patient was excluded from treatment because of an LSDR, with the lowest being 0.22. Lesioning temperatures (> 52°C) and therapeutic ablations were achieved in all patients. There were no significant differences in clinical outcome, adverse effects, lesion location, and volume between the high SDR group and the LSDR group. SDR was significantly associated with total energy (rho = -0.459, p < 0.001), heating efficiency (rho = 0.605, p < 0.001), and peak temperature (rho = 0.222, p = 0.025). CONCLUSIONS The authors' results show that treatment of tremor in patients with an LSDR using MRgFUS is technically possible, leading to a safe and lasting therapeutic effect. Limiting the number of sonications and adjusting the energy and duration to achieve the required temperature early during the treatment are suitable strategies in LSDR patients.
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Affiliation(s)
- Artur Vetkas
- 1Department of Surgery, Division of Neurosurgery, University Health Network and University of Toronto
| | - Alexandre Boutet
- 1Department of Surgery, Division of Neurosurgery, University Health Network and University of Toronto
- 2Joint Department of Medical Imaging, University of Toronto, Ontario, Canada
| | - Can Sarica
- 1Department of Surgery, Division of Neurosurgery, University Health Network and University of Toronto
| | - Jurgen Germann
- 1Department of Surgery, Division of Neurosurgery, University Health Network and University of Toronto
| | - Dave Gwun
- 1Department of Surgery, Division of Neurosurgery, University Health Network and University of Toronto
| | - Kazuaki Yamamoto
- 1Department of Surgery, Division of Neurosurgery, University Health Network and University of Toronto
| | - Hyun Ho Jung
- 3Center for Innovative Functional Neurosurgery, Brain Research Institute, Seoul
- 4Graduate School of Medical Science, Brain Korea 21 Project, Yonsei University College of Medicine, Seoul, South Korea
| | - Afnan Alkhotani
- 1Department of Surgery, Division of Neurosurgery, University Health Network and University of Toronto
| | - Nardin Samuel
- 1Department of Surgery, Division of Neurosurgery, University Health Network and University of Toronto
| | - Stefan Lang
- 1Department of Surgery, Division of Neurosurgery, University Health Network and University of Toronto
| | - Christopher R Conner
- 1Department of Surgery, Division of Neurosurgery, University Health Network and University of Toronto
| | - Gavin J B Elias
- 1Department of Surgery, Division of Neurosurgery, University Health Network and University of Toronto
| | - Cletus Cheyuo
- 1Department of Surgery, Division of Neurosurgery, University Health Network and University of Toronto
| | - Clement Chow
- 1Department of Surgery, Division of Neurosurgery, University Health Network and University of Toronto
| | - Brendan Santyr
- 1Department of Surgery, Division of Neurosurgery, University Health Network and University of Toronto
- 5Schulich School of Medicine and Dentistry, Western University, London, Ontario
| | | | - Andrew Z Yang
- 1Department of Surgery, Division of Neurosurgery, University Health Network and University of Toronto
| | | | - Alfonso Fasano
- 7Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, Toronto
- 8Department of Medicine, Division of Neurology, University of Toronto
- 9Krembil Research Institute, Toronto
- 10CRANIA, University Health Network and University of Toronto; and
- 11The KITE Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Suneil K Kalia
- 1Department of Surgery, Division of Neurosurgery, University Health Network and University of Toronto
- 9Krembil Research Institute, Toronto
- 10CRANIA, University Health Network and University of Toronto; and
- 11The KITE Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Andres M Lozano
- 1Department of Surgery, Division of Neurosurgery, University Health Network and University of Toronto
- 9Krembil Research Institute, Toronto
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8
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Santyr B, Loh A, Vetkas A, Gwun D, Fung WK, Qazi S, Germann J, Boutet A, Sarica C, Yang A, Elias G, Kalia SK, Fasano A, Lozano AM. Uncovering neuroanatomical correlates of impaired coordinated movement after pallidal deep brain stimulation. J Neurol Neurosurg Psychiatry 2024; 95:167-170. [PMID: 37438098 DOI: 10.1136/jnnp-2022-330734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 05/30/2023] [Indexed: 07/14/2023]
Abstract
BACKGROUND The loss of the ability to swim following deep brain stimulation (DBS), although rare, poses a worrisome risk of drowning. It is unclear what anatomic substrate and neural circuitry underlie this phenomenon. We report a case of cervical dystonia with lost ability to swim and dance during active stimulation of globus pallidus internus. We investigated the anatomical underpinning of this phenomenon using unique functional and structural imaging analysis. METHODS Tesla (3T) functional MRI (fMRI) of the patient was used during active DBS and compared with a cohort of four matched patients without this side effect. Structural connectivity mapping was used to identify brain network engagement by stimulation. RESULTS fMRI during stimulation revealed significant (Pbonferroni<0.0001) stimulation-evoked responses (DBS ON CONCLUSIONS These stimulation-induced impairments are likely a manifestation of a broader deficit in interlimb coordination mediated by stimulation effects on the SMA. This neuroanatomical underpinning can help inform future patient-specific stimulation and targeting.
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Affiliation(s)
- Brendan Santyr
- Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
| | - Aaron Loh
- Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
| | - Artur Vetkas
- Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
| | - Dave Gwun
- Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
| | - Wilson Kw Fung
- Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Centre, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Shakeel Qazi
- Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
| | - Jurgen Germann
- Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
| | - Alexandre Boutet
- Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
- Joint Department of Medical Imaging, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Can Sarica
- Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
| | - Andrew Yang
- Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
| | - Gavin Elias
- Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
| | - Suneil K Kalia
- Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
- Krembil Brain Institute, University Health Network, Toronto, Ontario, Canada
- Center for Advancing Neurotechnological Innovation to Application (CRANIA), University Health Network, Toronto, Ontario, Canada
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Centre, Toronto Western Hospital, Toronto, Ontario, Canada
- Krembil Brain Institute, University Health Network, Toronto, Ontario, Canada
- Center for Advancing Neurotechnological Innovation to Application (CRANIA), University Health Network, Toronto, Ontario, Canada
- Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Andres M Lozano
- Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
- Krembil Brain Institute, University Health Network, Toronto, Ontario, Canada
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9
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Germann J, Santyr B, Boutet A, Sarica C, Chow CT, Elias GJB, Vetkas A, Yang A, Hodaie M, Fasano A, Kalia SK, Schwartz ML, Lozano AM. Comparative neural correlates of DBS and MRgFUS lesioning for tremor control in essential tremor. J Neurol Neurosurg Psychiatry 2024; 95:180-183. [PMID: 37722831 PMCID: PMC10866130 DOI: 10.1136/jnnp-2022-330795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 08/23/2023] [Indexed: 09/20/2023]
Abstract
BACKGROUND Given high rates of early complications and non-reversibility, refined targeting is necessitated for magnetic resonance-guided focused ultrasound (MRgFUS) thalamotomy for essential tremor (ET). Selection of lesion location can be informed by considering optimal stimulation area from deep brain stimulation (DBS). METHODS 118 patients with ET who received DBS (39) or MRgFUS (79) of the ventral intermediate nucleus (VIM) underwent stimulation/lesion mapping, probabilistic mapping of clinical efficacy and normative structural connectivity analysis. The efficacy maps were compared, which depict the relationship between stimulation/lesion location and clinical outcome. RESULTS Efficacy maps overlap around the VIM ventral border and encompass the dentato-rubro-thalamic tract. While the MRgFUS map extends inferiorly into the posterior subthalamic area, the DBS map spreads inside the VIM antero-superiorly. CONCLUSION Comparing the efficacy maps of DBS and MRgFUS suggests a potential alternative location for lesioning, more antero-superiorly. This may reduce complications, without sacrificing efficacy, and individualise targeting. TRIAL REGISTRATION NUMBER NCT02252380.
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Affiliation(s)
- Jurgen Germann
- Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
- Krembil Brain Institute, Toronto, Ontario, Canada
- Center for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, Ontario, Canada
| | - Brendan Santyr
- Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
| | - Alexandre Boutet
- Joint Department of Medical Imaging, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Can Sarica
- Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
| | - Clement T Chow
- Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
| | - Gavin J B Elias
- Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
| | - Artur Vetkas
- Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
| | - Andrew Yang
- Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
| | - Mojgan Hodaie
- Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
- Krembil Brain Institute, Toronto, Ontario, Canada
| | - Alfonso Fasano
- Krembil Brain Institute, Toronto, Ontario, Canada
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto WesternHospital, Toronto, Ontario, Canada
- Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Suneil K Kalia
- Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
- Krembil Brain Institute, Toronto, Ontario, Canada
| | - Michael L Schwartz
- Division of Neurosurgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Andres M Lozano
- Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
- Krembil Brain Institute, Toronto, Ontario, Canada
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10
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Oxenford S, Ríos AS, Hollunder B, Neudorfer C, Boutet A, Elias GJB, Germann J, Loh A, Deeb W, Salvato B, Almeida L, Foote KD, Amaral R, Rosenberg PB, Tang-Wai DF, Wolk DA, Burke AD, Sabbagh MN, Salloway S, Chakravarty MM, Smith GS, Lyketsos CG, Okun MS, Anderson WS, Mari Z, Ponce FA, Lozano A, Neumann WJ, Al-Fatly B, Horn A. WarpDrive: Improving spatial normalization using manual refinements. Med Image Anal 2024; 91:103041. [PMID: 38007978 PMCID: PMC10842752 DOI: 10.1016/j.media.2023.103041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 11/08/2023] [Accepted: 11/17/2023] [Indexed: 11/28/2023]
Abstract
Spatial normalization-the process of mapping subject brain images to an average template brain-has evolved over the last 20+ years into a reliable method that facilitates the comparison of brain imaging results across patients, centers & modalities. While overall successful, sometimes, this automatic process yields suboptimal results, especially when dealing with brains with extensive neurodegeneration and atrophy patterns, or when high accuracy in specific regions is needed. Here we introduce WarpDrive, a novel tool for manual refinements of image alignment after automated registration. We show that the tool applied in a cohort of patients with Alzheimer's disease who underwent deep brain stimulation surgery helps create more accurate representations of the data as well as meaningful models to explain patient outcomes. The tool is built to handle any type of 3D imaging data, also allowing refinements in high-resolution imaging, including histology and multiple modalities to precisely aggregate multiple data sources together.
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Affiliation(s)
- Simón Oxenford
- Movement Disorders and Neuromodulation Unit, Department of Neurology, Charité -Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
| | - Ana Sofía Ríos
- Movement Disorders and Neuromodulation Unit, Department of Neurology, Charité -Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Barbara Hollunder
- Movement Disorders and Neuromodulation Unit, Department of Neurology, Charité -Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Einstein Center for Neurosciences Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany; Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Clemens Neudorfer
- Movement Disorders and Neuromodulation Unit, Department of Neurology, Charité -Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Brain Modulation Lab, Department of Neurosurgery, Massachusetts General Hospital, Boston, MA 02114, United States; Center for Brain Circuit Therapeutics Department of Neurology Brigham & Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Alexandre Boutet
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, ON M5T2S8, Canada; Krembil Research Institute, University of Toronto, Toronto, ON M5T2S8, Canada; Joint Department of Medical Imaging, University of Toronto, Toronto, ON M5T1W7, Canada
| | - Gavin J B Elias
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, ON M5T2S8, Canada; Krembil Research Institute, University of Toronto, Toronto, ON M5T2S8, Canada
| | - Jurgen Germann
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, ON M5T2S8, Canada; Krembil Research Institute, University of Toronto, Toronto, ON M5T2S8, Canada
| | - Aaron Loh
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, ON M5T2S8, Canada; Krembil Research Institute, University of Toronto, Toronto, ON M5T2S8, Canada
| | - Wissam Deeb
- UMass Chan Medical School, Department of Neurology, Worcester, MA 01655, United States; UMass Memorial Health, Department of Neurology, Worcester, MA 01655, United States
| | - Bryan Salvato
- University of Florida Health Jacksonville, Jacksonville, FL, United States
| | - Leonardo Almeida
- Department of Neurology, University of Minnesota, Twin Cities Campus, Minneapolis, MN, United States
| | - Kelly D Foote
- Norman Fixel Institute for Neurological Diseases, Departments of Neurology and Neurosurgery, University of Florida, Gainesville, FL, United States
| | - Robert Amaral
- Cerebral Imaging Centre, Douglas Research Centre, Montreal, QC, Canada
| | - Paul B Rosenberg
- Department of Psychiatry and Behavioral Sciences and Richman Family Precision Medicine Center of Excellence, School of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - David F Tang-Wai
- Krembil Research Institute, University of Toronto, Toronto, ON M5T2S8, Canada; Department of Medicine, Division of Neurology, University Health Network and University of Toronto, Toronto, ON M5T2S8, Canada
| | - David A Wolk
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, United States
| | - Anna D Burke
- Barrow Neurological Institute, Phoenix, AZ, United States
| | | | - Stephen Salloway
- Department of Psychiatry and Human Behavior and Neurology, Alpert Medical School of Brown University, Providence, RI, United States; Memory & Aging Program, Butler Hospital, Providence, United States
| | - M Mallar Chakravarty
- Cerebral Imaging Centre, Douglas Research Centre, Montreal, QC, Canada; Department of Psychiatry, McGill University, Montreal, QC, Canada; Biological and Biomedical Engineering, McGill University, Montreal, QC, Canada
| | - Gwenn S Smith
- Cerebral Imaging Centre, Douglas Research Centre, Montreal, QC, Canada
| | | | - Michael S Okun
- Norman Fixel Institute for Neurological Diseases, Departments of Neurology and Neurosurgery, University of Florida, Gainesville, FL, United States
| | | | - Zoltan Mari
- Johns Hopkins School of Medicine, Baltimore, MD, United States; Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, United States
| | | | - Andres Lozano
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, ON M5T2S8, Canada; Krembil Research Institute, University of Toronto, Toronto, ON M5T2S8, Canada
| | - Wolf-Julian Neumann
- Movement Disorders and Neuromodulation Unit, Department of Neurology, Charité -Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Bassam Al-Fatly
- Movement Disorders and Neuromodulation Unit, Department of Neurology, Charité -Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Andreas Horn
- Movement Disorders and Neuromodulation Unit, Department of Neurology, Charité -Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Brain Modulation Lab, Department of Neurosurgery, Massachusetts General Hospital, Boston, MA 02114, United States; Center for Brain Circuit Therapeutics Department of Neurology Brigham & Women's Hospital, Harvard Medical School, Boston, MA, United States
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11
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Di Luca DG, Ramirez-Gomez C, Germann J, Santyr B, Boutet A, Milosevic L, Lang AE, Kalia SK, Lozano AM, Fasano A. Deep Brain Stimulation of the Globus Pallidus Internus and Externus in Multiple System Atrophy. Mov Disord 2023; 38:2121-2125. [PMID: 37544011 DOI: 10.1002/mds.29573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 06/17/2023] [Accepted: 07/20/2023] [Indexed: 08/08/2023] Open
Abstract
BACKGROUND Multiple system atrophy with parkinsonism (MSA-P) is a progressive condition with no effective treatment. OBJECTIVE The aim of this study was to describe the safety and efficacy of deep brain stimulation (DBS) of globus pallidus pars interna and externa in a cohort of patients with MSA-P. METHODS Six patients were included. Changes in Movement Disorders Society Unified Parkinson's Disease Rating Scale Part III (MDS-UPDRS III), Parkinson's Disease Questionnaire (PDQ-39) scores, and levodopa equivalent daily dose were compared before and after DBS. Electrode localization and volume tissue activation were calculated. RESULTS DBS surgery did not result in any major adverse events or intraoperative complications. Overall, no differences in MDS-UPDRS III scores were demonstrated (55.2 ± 17.6 preoperatively compared with 67.3 ± 19.2 at 1 year after surgery), although transient improvement in mobility and dyskinesia was reported in some subjects. CONCLUSIONS Globus pallidus pars interna and externa DBS for patients with MSA-P did not result in major complications, although it did not provide significant clinical benefit as measured by MDS-UPDRS III. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Daniel G Di Luca
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, Ontario, Canada
- Division of Neurology, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Neurology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Carolina Ramirez-Gomez
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, Ontario, Canada
- Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Jurgen Germann
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Brendan Santyr
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Alexandre Boutet
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Luka Milosevic
- Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada
- Krembil Brain Institute, Toronto, Ontario, Canada
- Center for Advancing Neurotechnological Innovation to Application, Toronto, Ontario, Canada
| | - Anthony E Lang
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, Ontario, Canada
- Krembil Brain Institute, Toronto, Ontario, Canada
| | - Suneil K Kalia
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Krembil Brain Institute, Toronto, Ontario, Canada
- Center for Advancing Neurotechnological Innovation to Application, Toronto, Ontario, Canada
| | - Andres M Lozano
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Krembil Brain Institute, Toronto, Ontario, Canada
- Center for Advancing Neurotechnological Innovation to Application, Toronto, Ontario, Canada
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, Ontario, Canada
- Division of Neurology, University of Toronto, Toronto, Ontario, Canada
- Krembil Brain Institute, Toronto, Ontario, Canada
- Center for Advancing Neurotechnological Innovation to Application, Toronto, Ontario, Canada
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12
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Scherer M, Harmsen IE, Samuel N, Elias GJB, Germann J, Boutet A, MacLeod CE, Giacobbe P, Rowland NC, Lozano AM, Milosevic L. Oscillatory network markers of subcallosal cingulate deep brain stimulation for depression. Brain Stimul 2023; 16:1764-1775. [PMID: 38061548 PMCID: PMC10947774 DOI: 10.1016/j.brs.2023.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 11/12/2023] [Accepted: 11/27/2023] [Indexed: 12/24/2023] Open
Abstract
Identifying functional biomarkers related to treatment success can aid in expediting therapy optimization, as well as contribute to a better understanding of the neural mechanisms of the treatment-resistant depression (TRD) and subcallosal cingulate deep brain stimulation (SCC-DBS). Magnetoencephalography data were obtained from 16 individuals with SCC-DBS for TRD and 25 healthy subjects. The first objective of the study was to identify region-specific oscillatory modulations that both (i) discriminate individuals with TRD (with SCC-DBS OFF) from healthy controls, and (ii) discriminate TRD treatment responders from non-responders (with SCC-DBS ON). The second objective of this work was to further explore the effects of stimulation intensity and frequency on oscillatory activity in the identified brain regions of interest. Oscillatory power analyses led to the identification of brain regions that differentiated responders from non-responders based on modulations of increased alpha (8-12 Hz) and decreased gamma (32-116 Hz) power within nodes of the default mode, central executive, and somatomotor networks, Broca's area, and lingual gyrus. Within these nodes, it was also found that low stimulation frequency had stronger effects on oscillatory modulation than increased stimulation intensity. The identified functional network biomarkers implicate modulation of TRD-related activity in brain regions involved in emotional control/processing, motor control, and the interaction between speech, vision, and memory, which have all been implicated in depression. These electrophysiological biomarkers have the potential to be used as functional proxies for therapy optimization. Additional stimulation parameter analyses revealed that oscillatory modulations can be strengthened by increasing stimulation intensity or reducing frequency, which may represent potential avenues of direction in non-responders.
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Affiliation(s)
- M Scherer
- Krembil Brain Institute, University Health Network, Toronto, Canada; Institute of Biomedical Engineering, University of Toronto, Canada
| | - I E Harmsen
- Krembil Brain Institute, University Health Network, Toronto, Canada; Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada; Mitchell Goldhar MEG Unit, University Health Network, Toronto, Canada
| | - N Samuel
- Krembil Brain Institute, University Health Network, Toronto, Canada; Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - G J B Elias
- Krembil Brain Institute, University Health Network, Toronto, Canada; Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - J Germann
- Krembil Brain Institute, University Health Network, Toronto, Canada; Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - A Boutet
- Krembil Brain Institute, University Health Network, Toronto, Canada; Joint Department of Medical Imaging, University of Toronto, Canada
| | - C E MacLeod
- Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, Ontario, Canada
| | - P Giacobbe
- Department of Psychiatry, Sunnybrook Health Sciences, University of Toronto, Toronto, Ontario, Canada
| | - N C Rowland
- Department of Neurosurgery, Medical University of South Carolina, Charleston, SC, USA; Murray Center for Research on Parkinson's Disease and Related Disorders, Medical University of South Carolina, Charleston, SC, USA
| | - A M Lozano
- Krembil Brain Institute, University Health Network, Toronto, Canada; Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada; Center for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, Canada
| | - L Milosevic
- Krembil Brain Institute, University Health Network, Toronto, Canada; Institute of Biomedical Engineering, University of Toronto, Canada; Center for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, Canada; KITE Research Institute, University Health Network, Toronto, Canada.
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13
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Warsi NM, Wong SM, Germann J, Boutet A, Arski ON, Anderson R, Erdman L, Yan H, Suresh H, Gouveia FV, Loh A, Elias GJB, Kerr E, Smith ML, Ochi A, Otsubo H, Sharma R, Jain P, Donner E, Lozano AM, Snead OC, Ibrahim GM. Dissociable default-mode subnetworks subserve childhood attention and cognitive flexibility: Evidence from deep learning and stereotactic electroencephalography. Neural Netw 2023; 167:827-837. [PMID: 37741065 DOI: 10.1016/j.neunet.2023.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 05/13/2023] [Accepted: 07/12/2023] [Indexed: 09/25/2023]
Abstract
Cognitive flexibility encompasses the ability to efficiently shift focus and forms a critical component of goal-directed attention. The neural substrates of this process are incompletely understood in part due to difficulties in sampling the involved circuitry. We leverage stereotactic intracranial recordings to directly resolve local-field potentials from otherwise inaccessible structures to study moment-to-moment attentional activity in children with epilepsy performing a flexible attentional task. On an individual subject level, we employed deep learning to decode neural features predictive of task performance indexed by single-trial reaction time. These models were subsequently aggregated across participants to identify predictive brain regions based on AAL atlas and FIND functional network parcellations. Through this approach, we show that fluctuations in beta (12-30 Hz) and gamma (30-80 Hz) power reflective of increased top-down attentional control and local neuronal processing within relevant large-scale networks can accurately predict single-trial task performance. We next performed connectomic profiling of these highly predictive nodes to examine task-related engagement of distributed functional networks, revealing exclusive recruitment of the dorsal default mode network during shifts in attention. The identification of distinct substreams within the default mode system supports a key role for this network in cognitive flexibility and attention in children. Furthermore, convergence of our results onto consistent functional networks despite significant inter-subject variability in electrode implantations supports a broader role for deep learning applied to intracranial electrodes in the study of human attention.
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Affiliation(s)
- Nebras M Warsi
- Division of Neurosurgery, The Hospital for Sick Children, 555 University Ave., Toronto, Ontario, Canada; Department of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Simeon M Wong
- Department of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada; Program in Neuroscience and Mental Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jürgen Germann
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Alexandre Boutet
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada; Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Olivia N Arski
- Program in Neuroscience and Mental Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Lauren Erdman
- Vector Institute for Artificial Intelligence, University Health Network, Toronto, Ontario, Canada
| | - Han Yan
- Division of Neurosurgery, The Hospital for Sick Children, 555 University Ave., Toronto, Ontario, Canada
| | - Hrishikesh Suresh
- Division of Neurosurgery, The Hospital for Sick Children, 555 University Ave., Toronto, Ontario, Canada; Department of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| | | | - Aaron Loh
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada; Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Gavin J B Elias
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada; Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Elizabeth Kerr
- Department of Psychology, The Hospital for Sick Children, University of Toronto, 555 University Ave., Toronto, Ontario, Canada, M5G 1X8
| | - Mary Lou Smith
- Department of Psychology, The Hospital for Sick Children, University of Toronto, 555 University Ave., Toronto, Ontario, Canada, M5G 1X8
| | - Ayako Ochi
- Division of Neurosurgery, The Hospital for Sick Children, 555 University Ave., Toronto, Ontario, Canada
| | - Hiroshi Otsubo
- Division of Neurosurgery, The Hospital for Sick Children, 555 University Ave., Toronto, Ontario, Canada
| | - Roy Sharma
- Division of Neurosurgery, The Hospital for Sick Children, 555 University Ave., Toronto, Ontario, Canada
| | - Puneet Jain
- Division of Neurosurgery, The Hospital for Sick Children, 555 University Ave., Toronto, Ontario, Canada
| | - Elizabeth Donner
- Division of Neurosurgery, The Hospital for Sick Children, 555 University Ave., Toronto, Ontario, Canada
| | - Andres M Lozano
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - O Carter Snead
- Division of Neurosurgery, The Hospital for Sick Children, 555 University Ave., Toronto, Ontario, Canada
| | - George M Ibrahim
- Division of Neurosurgery, The Hospital for Sick Children, 555 University Ave., Toronto, Ontario, Canada; Department of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada; Program in Neuroscience and Mental Health, Hospital for Sick Children, Toronto, Ontario, Canada.
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14
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Elias GJB, Germann J, Boutet A, Beyn ME, Giacobbe P, Song HN, Choi KS, Mayberg HS, Kennedy SH, Lozano AM. Local neuroanatomical and tract-based proxies of optimal subcallosal cingulate deep brain stimulation. Brain Stimul 2023; 16:1259-1272. [PMID: 37611657 DOI: 10.1016/j.brs.2023.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 08/02/2023] [Accepted: 08/19/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND Deep brain stimulation of the subcallosal cingulate area (SCC-DBS) is a promising neuromodulatory therapy for treatment-resistant depression (TRD). Biomarkers of optimal target engagement are needed to guide surgical targeting and stimulation parameter selection and to reduce variance in clinical outcome. OBJECTIVE/HYPOTHESIS We aimed to characterize the relationship between stimulation location, white matter tract engagement, and clinical outcome in a large (n = 60) TRD cohort treated with SCC-DBS. A smaller cohort (n = 22) of SCC-DBS patients with differing primary indications (bipolar disorder/anorexia nervosa) was utilized as an out-of-sample validation cohort. METHODS Volumes of tissue activated (VTAs) were constructed in standard space using high-resolution structural MRI and individual stimulation parameters. VTA-based probabilistic stimulation maps (PSMs) were generated to elucidate voxelwise spatial patterns of efficacious stimulation. A whole-brain tractogram derived from Human Connectome Project diffusion-weighted MRI data was seeded with VTA pairs, and white matter streamlines whose overlap with VTAs related to outcome ('discriminative' streamlines; Puncorrected < 0.05) were identified using t-tests. Linear modelling was used to interrogate the potential clinical relevance of VTA overlap with specific structures. RESULTS PSMs varied by hemisphere: high-value left-sided voxels were located more anterosuperiorly and squarely in the lateral white matter, while the equivalent right-sided voxels fell more posteroinferiorly and involved a greater proportion of grey matter. Positive discriminative streamlines localized to the bilateral (but primarily left) cingulum bundle, forceps minor/rostrum of corpus callosum, and bilateral uncinate fasciculus. Conversely, negative discriminative streamlines mostly belonged to the right cingulum bundle and bilateral uncinate fasciculus. The best performing linear model, which utilized information about VTA volume overlap with each of the positive discriminative streamline bundles as well as the negative discriminative elements of the right cingulum bundle, explained significant variance in clinical improvement in the primary TRD cohort (R = 0.46, P < 0.001) and survived repeated 10-fold cross-validation (R = 0.50, P = 0.040). This model was also able to predict outcome in the out-of-sample validation cohort (R = 0.43, P = 0.047). CONCLUSION(S) These findings reinforce prior indications of the importance of white matter engagement to SCC-DBS treatment success while providing new insights that could inform surgical targeting and stimulation parameter selection decisions.
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Affiliation(s)
- Gavin J B Elias
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, M5T 2S8, Canada; Krembil Research Institute, University of Toronto, Toronto, M5T 0S8, Canada
| | - Jürgen Germann
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, M5T 2S8, Canada; Krembil Research Institute, University of Toronto, Toronto, M5T 0S8, Canada
| | - Alexandre Boutet
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, M5T 2S8, Canada; Krembil Research Institute, University of Toronto, Toronto, M5T 0S8, Canada; Joint Department of Medical Imaging, University of Toronto, Toronto, M5T 1W7, Canada
| | - Michelle E Beyn
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, M5T 2S8, Canada
| | - Peter Giacobbe
- Department of Psychiatry, Sunnybrook Health Sciences Centre and University of Toronto, Toronto, M4N 3M5, Canada
| | - Ha Neul Song
- Nash Family Center for Advanced Circuit Therapeutics, Mount Sinai West, Icahn School of Medicine at Mount Sinai, New York, NY, 10019, USA
| | - Ki Sueng Choi
- Nash Family Center for Advanced Circuit Therapeutics, Mount Sinai West, Icahn School of Medicine at Mount Sinai, New York, NY, 10019, USA; Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Helen S Mayberg
- Nash Family Center for Advanced Circuit Therapeutics, Mount Sinai West, Icahn School of Medicine at Mount Sinai, New York, NY, 10019, USA; Departments of Neurology and Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Sidney H Kennedy
- Krembil Research Institute, University of Toronto, Toronto, M5T 0S8, Canada; ASR Suicide and Depression Studies Unit, St. Michael's Hospital, University of Toronto, M5B 1M8, Canada; Department of Psychiatry, University Health Network and University of Toronto, Toronto, M5T 2S8, Canada
| | - Andres M Lozano
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, M5T 2S8, Canada; Krembil Research Institute, University of Toronto, Toronto, M5T 0S8, Canada.
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15
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Venetucci Gouveia F, Germann J, Elias GJB, Boutet A, Loh A, Lopez Rios AL, Torres Diaz C, Contreras Lopez WO, Martinez RCR, Fonoff ET, Benedetti-Isaac JC, Giacobbe P, Arango Pava PM, Yan H, Ibrahim GM, Lipsman N, Lozano A, Hamani C. Multi-centre analysis of networks and genes modulated by hypothalamic stimulation in patients with aggressive behaviours. eLife 2023; 12:84566. [PMID: 37212456 DOI: 10.7554/elife.84566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 05/14/2023] [Indexed: 05/23/2023] Open
Abstract
Deep brain stimulation targeting the posterior hypothalamus (pHyp-DBS) is being investigated as a treatment for refractory aggressive behaviour, but its mechanisms of action remain elusive. We conducted an integrated imaging analysis of a large multi-centre dataset, incorporating the volume of activated tissue modelling, probabilistic mapping, normative connectomics, and atlas-derived transcriptomics. Ninety-one percent of the patients responded positively to treatment, with a more striking improvement recorded in the pediatric population. Probabilistic mapping revealed an optimized surgical target within the posterior-inferior-lateral region of the posterior hypothalamic area. Normative connectomic analyses identified fibre tracts and interconnected brain areas associated with sensorimotor function, emotional regulation, and monoamine production. Functional connectivity between the target, periaqueductal gray and key limbic areas - together with patient age - were highly predictive of treatment outcome. Transcriptomic analysis showed that genes involved in mechanisms of aggressive behaviour, neuronal communication, plasticity and neuroinflammation might underlie this functional network.
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Affiliation(s)
| | - Jurgen Germann
- Department of Surgery, University Health Network, Toronto, Canada
| | - Gavin J B Elias
- Department of Surgery, University Health Network, Toronto, Canada
| | - Alexandre Boutet
- Department of Surgery, University Health Network, Toronto, Canada
| | - Aaron Loh
- Department of Surgery, University Health Network, Toronto, Canada
| | - Adriana Lucia Lopez Rios
- Department of Functional and Stereotactic Neurosurgery, University Hospital San Vicente Fundación, Medellin, Colombia
| | | | | | | | | | - Juan Carlos Benedetti-Isaac
- Stereotactic and Functional Neurosurgery Division, International Misericordia Clinic, Barranquilla, Colombia
| | | | - Pablo M Arango Pava
- Servicio de Neuocirugia Funcional y Esterotaxia, Clinica Comuneros Bucaramanga, Bucaramanga, Colombia
| | - Han Yan
- Department of Surgery, University of Toronto, Toronto, Canada
| | - George M Ibrahim
- Division of Neurosurgery, Hospital for Sick Children, Toronto, Canada
| | - Nir Lipsman
- Sunnybrook Research Institute, Toronto, Canada
| | - Andres Lozano
- Department of Surgery, University Health Network, Toronto, Canada
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16
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Balachandar A, Boutet A, Vetkas A, Germann J, Chan IY, Mikulis D, Munhoz RP, Fasano A, Kalia SK, Lozano AM. Reply to: Glioblastoma, IDH-Wildtype, CNS WHO Grade 4, Associated with Deep Brain Stimulation in a Patient with Essential Tremor: Report of a Case with Molecular Characterization and Review of the Literature. Mov Disord Clin Pract 2023; 10:529-530. [PMID: 36949794 PMCID: PMC10026296 DOI: 10.1002/mdc3.13673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 01/19/2023] [Indexed: 01/28/2023] Open
Affiliation(s)
- Arjun Balachandar
- Division of Neurology, Department of MedicineUniversity of TorontoTorontoOntarioCanada
| | - Alexandre Boutet
- Joint Department of Medical ImagingUniversity of TorontoTorontoOntarioCanada
| | - Artur Vetkas
- Department of Neurosurgery, Toronto Western Hospital, UHNUniversity of TorontoTorontoOntarioCanada
| | - Jurgen Germann
- Department of Neurosurgery, Toronto Western Hospital, UHNUniversity of TorontoTorontoOntarioCanada
| | - Ian Y.M. Chan
- Department of Diagnostic ImagingTrillium Health PartnersMississaugaOntarioCanada
| | - David Mikulis
- Joint Department of Medical ImagingUniversity of TorontoTorontoOntarioCanada
| | - Renato P. Munhoz
- Krembil Research InstituteTorontoOntarioCanada
- Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Division of NeurologyUniversity of TorontoTorontoOntarioCanada
| | - Alfonso Fasano
- Krembil Research InstituteTorontoOntarioCanada
- Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Division of NeurologyUniversity of TorontoTorontoOntarioCanada
| | - Suneil K. Kalia
- Department of Neurosurgery, Toronto Western Hospital, UHNUniversity of TorontoTorontoOntarioCanada
- Krembil Research InstituteTorontoOntarioCanada
| | - Andres M. Lozano
- Department of Neurosurgery, Toronto Western Hospital, UHNUniversity of TorontoTorontoOntarioCanada
- Krembil Research InstituteTorontoOntarioCanada
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17
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Schulder M, Mishra A, Mammis A, Horn A, Boutet A, Blomstedt P, Chabardes S, Flouty O, Lozano AM, Neimat JS, Ponce F, Starr PA, Krauss JK, Hariz M, Chang JW. Advances in Technical Aspects of Deep Brain Stimulation Surgery. Stereotact Funct Neurosurg 2023; 101:112-134. [PMID: 36809747 PMCID: PMC10184879 DOI: 10.1159/000529040] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 12/19/2022] [Indexed: 02/24/2023]
Abstract
BACKGROUND Deep brain stimulation has become an established technology for the treatment of patients with a wide variety of conditions, including movement disorders, psychiatric disorders, epilepsy, and pain. Surgery for implantation of DBS devices has enhanced our understanding of human physiology, which in turn has led to advances in DBS technology. Our group has previously published on these advances, proposed future developments, and examined evolving indications for DBS. SUMMARY The crucial roles of structural MR imaging pre-, intra-, and post-DBS procedure in target visualization and confirmation of targeting are described, with discussion of new MR sequences and higher field strength MRI enabling direct visualization of brain targets. The incorporation of functional and connectivity imaging in procedural workup and their contribution to anatomical modelling is reviewed. Various tools for targeting and implanting electrodes, including frame-based, frameless, and robot-assisted, are surveyed, and their pros and cons are described. Updates on brain atlases and various software used for planning target coordinates and trajectories are presented. The pros and cons of asleep versus awake surgery are discussed. The role and value of microelectrode recording and local field potentials are described, as well as the role of intraoperative stimulation. Technical aspects of novel electrode designs and implantable pulse generators are presented and compared.
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Affiliation(s)
- Michael Schulder
- Department of Neurosurgery, Zucker School of Medicine at Hofstra/Northwell, New York, New York, USA
| | - Akash Mishra
- Department of Neurosurgery, Zucker School of Medicine at Hofstra/Northwell, New York, New York, USA,
| | - Antonios Mammis
- Department of Neurosurgery, New York University Grossman School of Medicine, New York, New York, USA
| | - Andres Horn
- Center for Brain Circuit Therapeutics, Department of Neurology, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,MGH Neurosurgery and Center for Neurotechnology and Neurorecovery (CNTR), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité, Universität zu Berlin, Berlin, Germany
| | - Alexandre Boutet
- Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Patric Blomstedt
- Department of Clinical Neuroscience, University of Umea, Umea, Sweden
| | - Stephan Chabardes
- Department of Neurosurgery, Grenoble-Alpes University Hospital, Grenoble, France
| | - Oliver Flouty
- Department of Neurosurgery, University of South Florida, Tampa, Florida, USA
| | - Andres M Lozano
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Joseph S Neimat
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, USA
| | - Francisco Ponce
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Philip A Starr
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Joachim K Krauss
- Department of Neurosurgery, Medical School Hannover, Hannover, Germany
| | - Marwan Hariz
- Department of Clinical Neuroscience, University of Umea, Umea, Sweden.,UCL-Queen Square Institute of Neurology, London, UK
| | - Jin Woo Chang
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Republic of Korea
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18
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Vetkas A, Germann J, Boutet A, Samuel N, Sarica C, Yamamoto K, Santyr B, Cheyuo C, Conner CR, Lang SM, Lozano AM, Ibrahim GM, Valiante T, Kongkham PN, Kalia SK. Laser interstitial thermal therapy for the treatment of insular lesions: A systematic review. Front Neurol 2023; 13:1024075. [PMID: 36686528 PMCID: PMC9845884 DOI: 10.3389/fneur.2022.1024075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 12/02/2022] [Indexed: 01/06/2023] Open
Abstract
Background The surgical treatment of insular lesions has been historically associated with high morbidity. Laser interstitial thermal therapy (LITT) has been increasingly used in the treatment of insular lesions, commonly neoplastic or epileptogenic. Stereotaxis is used to guide laser probes to the insula where real-time magnetic resonance thermometry defines lesion creation. There is an absence of previously published reviews on insular LITT, despite a rapid uptake in use, making further study imperative. Methods Here we present a systematic review of the PubMed and Scopus databases, examining the reported clinical indications, outcomes, and adverse effects of insular LITT. Results A review of the literature revealed 10 retrospective studies reporting on 53 patients (43 pediatric and 10 adults) that were treated with insular LITT. 87% of cases were for the treatment of epilepsy, with 89% of patients achieving seizure outcomes of Engle I-III following treatment. The other 13% of cases reported on insular tumors and radiological improvement was seen in all cases following treatment. All but one study reported adverse events following LITT with a rate of 37%. The most common adverse events were transient hemiparesis (29%) and transient aphasia (6%). One patient experienced an intracerebral hemorrhage, which required a decompressive hemicraniectomy, with subsequent full recovery. Conclusion This systematic review highlights the suitability of LITT for the treatment of both insular seizure foci and insular tumors. Despite the growing use of this technique, prospective studies remain absent in the literature. Future work should directly evaluate the efficacy of LITT with randomized and controlled trials.
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Affiliation(s)
- Artur Vetkas
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, ON, Canada,Neurology Clinic, Department of Neurosurgery, Tartu University Hospital, University of Tartu, Tartu, Estonia,*Correspondence: Artur Vetkas ✉
| | - Jürgen Germann
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Alexandre Boutet
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, ON, Canada,Joint Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Nardin Samuel
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Can Sarica
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Kazuaki Yamamoto
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Brendan Santyr
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, ON, Canada,Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Cletus Cheyuo
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Christopher R. Conner
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Stefan M. Lang
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Andres M. Lozano
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, ON, Canada,Krembil Research Institute, Toronto, ON, Canada
| | - George M. Ibrahim
- Division of Pediatric Neurosurgery, Sick Kids Toronto, University of Toronto, Toronto, ON, Canada
| | - Taufik Valiante
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, ON, Canada,CRANIA, University Health Network and University of Toronto, Toronto, ON, Canada,The KITE Research Institute, University Health Network, Toronto, ON, Canada
| | - Paul N. Kongkham
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Suneil K. Kalia
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, ON, Canada,CRANIA, University Health Network and University of Toronto, Toronto, ON, Canada,The KITE Research Institute, University Health Network, Toronto, ON, Canada
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19
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Balachandar A, Boutet A, Vetkas A, Germann J, Chan IY, Mikulis D, Munhoz RP, Fasano A, Kalia SK, Lozano AM. The Role of Safe MRI in Diagnosing an Unusual Case of High-Grade Glioma Adjacent to Globus Pallidus Interna DBS Electrode. Mov Disord Clin Pract 2023; 10:138-140. [PMID: 36704068 PMCID: PMC9847298 DOI: 10.1002/mdc3.13574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/31/2022] [Accepted: 09/06/2022] [Indexed: 01/29/2023] Open
Affiliation(s)
- Arjun Balachandar
- Division of Neurology, Department of MedicineUniversity of TorontoTorontoOntarioCanada
| | - Alexandre Boutet
- Joint Department of Medical ImagingUniversity of TorontoTorontoOntarioCanada
| | - Artur Vetkas
- Department of Neurosurgery, Toronto Western Hospital, UHNUniversity of TorontoTorontoOntarioCanada
| | - Jurgen Germann
- Department of Neurosurgery, Toronto Western Hospital, UHNUniversity of TorontoTorontoOntarioCanada
| | - Ian Y.M. Chan
- Joint Department of Medical ImagingUniversity of TorontoTorontoOntarioCanada
| | - David Mikulis
- Joint Department of Medical ImagingUniversity of TorontoTorontoOntarioCanada
| | - Renato P. Munhoz
- Krembil Research InstituteTorontoOntarioCanada
- Division of Neurology, Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHNUniversity of TorontoTorontoOntarioCanada
| | - Alfonso Fasano
- Krembil Research InstituteTorontoOntarioCanada
- Division of Neurology, Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHNUniversity of TorontoTorontoOntarioCanada
| | - Suneil K. Kalia
- Department of Neurosurgery, Toronto Western Hospital, UHNUniversity of TorontoTorontoOntarioCanada
- Krembil Research InstituteTorontoOntarioCanada
| | - Andres M. Lozano
- Department of Neurosurgery, Toronto Western Hospital, UHNUniversity of TorontoTorontoOntarioCanada
- Krembil Research InstituteTorontoOntarioCanada
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20
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Song HN, Elias G, Germann J, Boutet A, Lozano A, Mayberg H, Choi KS. Tractography analysis of subcallosal cingulate DBS for treatment-resistant depression using normative connectome data. Brain Stimul 2023. [DOI: 10.1016/j.brs.2023.01.782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
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21
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Ríos AS, Oxenford S, Neudorfer C, Butenko K, Li N, Rajamani N, Boutet A, Elias GJB, Germann J, Loh A, Deeb W, Wang F, Setsompop K, Salvato B, Almeida LBD, Foote KD, Amaral R, Rosenberg PB, Tang-Wai DF, Wolk DA, Burke AD, Salloway S, Sabbagh MN, Chakravarty MM, Smith GS, Lyketsos CG, Okun MS, Anderson WS, Mari Z, Ponce FA, Lozano AM, Horn A. Optimal deep brain stimulation sites and networks for stimulation of the fornix in Alzheimer's disease. Nat Commun 2022; 13:7707. [PMID: 36517479 PMCID: PMC9751139 DOI: 10.1038/s41467-022-34510-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 10/27/2022] [Indexed: 12/15/2022] Open
Abstract
Deep brain stimulation (DBS) to the fornix is an investigational treatment for patients with mild Alzheimer's Disease. Outcomes from randomized clinical trials have shown that cognitive function improved in some patients but deteriorated in others. This could be explained by variance in electrode placement leading to differential engagement of neural circuits. To investigate this, we performed a post-hoc analysis on a multi-center cohort of 46 patients with DBS to the fornix (NCT00658125, NCT01608061). Using normative structural and functional connectivity data, we found that stimulation of the circuit of Papez and stria terminalis robustly associated with cognitive improvement (R = 0.53, p < 0.001). On a local level, the optimal stimulation site resided at the direct interface between these structures (R = 0.48, p < 0.001). Finally, modulating specific distributed brain networks related to memory accounted for optimal outcomes (R = 0.48, p < 0.001). Findings were robust to multiple cross-validation designs and may define an optimal network target that could refine DBS surgery and programming.
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Grants
- P30 AG066507 NIA NIH HHS
- P30 AG072979 NIA NIH HHS
- R01 MH130666 NIMH NIH HHS
- Deutsche Forschungsgemeinschaft (German Research Foundation)
- Received grants and personal fees from Medtronic and Boston Scientific, grants from Abbott/St. Jude, and Functional Neuromodulation outside the submitted work.
- Received grants from Functional Neuromodulation during conduct of this study, grants and personal fees from Avid/Lily, and Merck, personal fees from Jannsen, GE Healthcare, Biogen and Neuronix outside the submitted work.
- Receives personal fees from Elsai, Lilly, Roche Novartis and Biogen outside the submitted work.
- Received personal fees from Allergan, Biogen, Roche-Genentech, Cortexyme, Bracket, Sanofi, and other type of support from Brain Health Inc and uMethod Health outside of the submitted work.
- Received grants from Functional Neuromodulation Inc. during conduct of this study, from Avanir and Eli Lily and NFL Benefits Office outside of the submitted work.
- Received grants from NIH, Tourette Association of America Grant, Parkinson’s Alliance, Smallwood Foundation, and personal fees from Parkinson’s Foundation Medical Director, Books4Patients, American Academy of Neurology, Peerview, WebMD/Medscape, Mededicus, Movement Disorders Society, Taylor and Francis, Demos, Robert Rose and non-financial support from Medtronic outside of the submitted work.
- Received grants from Medtronic and Functional Neuromodulation during conduct of this study, personal fees from Medtronic, St. Jude, Boston Scientific, and Functional Neuromodulation outside of submitted work
- Deutsches Zentrum für Luft- und Raumfahrt (German Centre for Air and Space Travel)
- National Institutes of Health (R01 13478451, 1R01NS127892-01 & 2R01 MH113929) New Venture Fund (FFOR Seed Grant).
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Affiliation(s)
- Ana Sofía Ríos
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Simón Oxenford
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Clemens Neudorfer
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Konstantin Butenko
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Ningfei Li
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Nanditha Rajamani
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Alexandre Boutet
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, ON, M5T2S8, Canada
- Krembil Research Institute, University of Toronto, Toronto, ON, M5T2S8, Canada
- Joint Department of Medical Imaging, University of Toronto, Toronto, ON, M5T1W7, Canada
| | - Gavin J B Elias
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, ON, M5T2S8, Canada
- Krembil Research Institute, University of Toronto, Toronto, ON, M5T2S8, Canada
| | - Jurgen Germann
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, ON, M5T2S8, Canada
- Krembil Research Institute, University of Toronto, Toronto, ON, M5T2S8, Canada
| | - Aaron Loh
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, ON, M5T2S8, Canada
- Krembil Research Institute, University of Toronto, Toronto, ON, M5T2S8, Canada
| | - Wissam Deeb
- UMass Chan Medical School, Department of Neurology, Worcester, MA, 01655, USA
- UMass Memorial Health, Department of Neurology, Worcester, MA, 01655, USA
| | - Fuyixue Wang
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Harvard Medical School, Massachusetts General Hospital, Charlestown, MA, USA
- Harvard-MIT Health Sciences and Technology, MIT, Cambridge, MA, USA
| | - Kawin Setsompop
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Harvard Medical School, Massachusetts General Hospital, Charlestown, MA, USA
- Harvard-MIT Health Sciences and Technology, MIT, Cambridge, MA, USA
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - Bryan Salvato
- University of Florida Health Jacksonville, Jacksonville, FL, USA
| | - Leonardo Brito de Almeida
- Norman Fixel Institute for Neurological Diseases, Departments of Neurology and Neurosurgery, University of Florida, Gainesville, FL, USA
| | - Kelly D Foote
- Norman Fixel Institute for Neurological Diseases, Departments of Neurology and Neurosurgery, University of Florida, Gainesville, FL, USA
| | - Robert Amaral
- Cerebral Imaging Centre, Douglas Research Centre, Montreal, QC, Canada
| | - Paul B Rosenberg
- Department of Psychiatry and Behavioral Sciences and Richman Family Precision Medicine Center of Excellence, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - David F Tang-Wai
- Krembil Research Institute, University of Toronto, Toronto, ON, M5T2S8, Canada
- Department of Medicine, Division of Neurology, University Health Network and University of Toronto, Toronto, ON, M5T2S8, Canada
| | - David A Wolk
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Stephen Salloway
- Department of Psychiatry and Human Behavior and Neurology, Alpert Medical School of Brown University, Providence, RI, USA
- Memory & Aging Program, Butler Hospital, Providence, USA
| | | | - M Mallar Chakravarty
- Cerebral Imaging Centre, Douglas Research Centre, Montreal, QC, Canada
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Biological and Biomedical Engineering, McGill University, Montreal, QC, Canada
| | - Gwenn S Smith
- Department of Psychiatry and Behavioral Sciences and Richman Family Precision Medicine Center of Excellence, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Constantine G Lyketsos
- Department of Psychiatry and Behavioral Sciences and Richman Family Precision Medicine Center of Excellence, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Michael S Okun
- Norman Fixel Institute for Neurological Diseases, Departments of Neurology and Neurosurgery, University of Florida, Gainesville, FL, USA
| | | | - Zoltan Mari
- Johns Hopkins School of Medicine, Baltimore, MD, USA
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA
| | | | - Andres M Lozano
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, ON, M5T2S8, Canada
- Krembil Research Institute, University of Toronto, Toronto, ON, M5T2S8, Canada
| | - Andreas Horn
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
- Center for Brain Circuit Therapeutics, Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA.
- Departments of Neurology and Neurosurgery, Massachusetts General Hospital, Boston, MA, USA.
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22
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Yamamoto K, Sarica C, Loh A, Vetkas A, Samuel N, Milano V, Zemmar A, Germann J, Cheyuo C, Boutet A, Elias GJ, Ito H, Taira T, Lozano AM. Magnetic resonance-guided focused ultrasound for the treatment of tremor. Expert Rev Neurother 2022; 22:849-861. [PMID: 36469578 DOI: 10.1080/14737175.2022.2147826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Magnetic resonance-guided focused ultrasound (MRgFUS) is an emerging treatment for tremor and other movement disorders. An incisionless therapy, it is becoming increasingly common worldwide. However, given MRgFUS' relative novelty, there remain limited data on its benefits and adverse effects. AREAS COVERED We review the current state of evidence of MRgFUS for tremor, highlight its challenges, and discuss future perspectives. EXPERT OPINION Essential tremor (ET) has been the major indication for MRgFUS since a milestone randomized controlled trial (RCT) in 2016, with substantial evidence attesting to the efficacy and acceptable safety profile of this treatment. Patients with other tremor etiologies are also being treated with MRgFUS, with studies - including an RCT - suggesting parkinsonian tremor in particular responds well to this intervention. Additionally, targets other than the ventral intermediate nucleus, such as the subthalamic nucleus and internal segment of the globus pallidus, have been reported to improve parkinsonian symptoms beyond tremor, including rigidity and bradykinesia. Although MRgFUS is encumbered by certain unique technical challenges, it nevertheless offers significant advantages compared to alternative neurosurgical interventions for tremor. The fast-growing interest in this treatment modality will likely lead to further scientific and technological advancements that could optimize and expand its therapeutic potential.
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Affiliation(s)
- Kazuaki Yamamoto
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Ontario, Canada
| | - Can Sarica
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Ontario, Canada
| | - Aaron Loh
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Ontario, Canada
| | - Artur Vetkas
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Ontario, Canada.,Department of Neurosurgery, School of Medicine, University of Tartu, Estonia
| | - Nardin Samuel
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Ontario, Canada
| | - Vanessa Milano
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Ontario, Canada
| | - Ajmal Zemmar
- Department of Neurosurgery, University of Louisville, School of Medicine, KY, USA.,Department of Neurosurgery, Henan University People's Hospital, Henan University School of Medicine, China
| | - Jürgen Germann
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Ontario, Canada
| | - Cletus Cheyuo
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Ontario, Canada
| | - Alexandre Boutet
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Ontario, Canada.,Joint Department of Medical Imaging, University of Toronto, Ontario, Canada
| | - Gavin Jb Elias
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Ontario, Canada
| | - Hisashi Ito
- Department of Neurology, Shonantobu General Hospital, Japan.,Department of Neurology, Shonan Fujisawa Tokushukai Hospital, Japan
| | - Takaomi Taira
- Department of Neurosurgery, Tokyo Women's Medical University, Japan
| | - Andres M Lozano
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Ontario, Canada.,Krembil Research Institute, Toronto, Ontario, Canada
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23
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Yan H, Elkaim LM, Venetucci Gouveia F, Huber JF, Germann J, Loh A, Benedetti-Isaac JC, Doshi PK, Torres CV, Segar DJ, Elias GJB, Boutet A, Cosgrove GR, Fasano A, Lozano AM, Kulkarni AV, Ibrahim GM. Deep brain stimulation for extreme behaviors associated with autism spectrum disorder converges on a common pathway: a systematic review and connectomic analysis. J Neurosurg 2022; 137:699-708. [PMID: 35061980 DOI: 10.3171/2021.11.jns21928] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 11/16/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Individuals with autism spectrum disorder (ASD) may display extreme behaviors such as self-injury or aggression that often become refractory to psychopharmacology or behavioral intervention. Deep brain stimulation (DBS) is a surgical alternative that modulates brain circuits that have yet to be clearly elucidated. In the current study the authors performed a connectomic analysis to identify brain circuitry engaged by DBS for extreme behaviors associated with ASD. METHODS A systematic review was performed to identify prior reports of DBS as a treatment for extreme behaviors in patients with ASD. Individual patients' perioperative imaging was collected from corresponding authors. DBS electrode localization and volume of tissue activated modeling were performed. Volumes of tissue activated were used as seed points in high-resolution normative functional and structural imaging templates. The resulting individual functional and structural connectivity maps were pooled to identify networks and pathways that are commonly engaged by all targets. RESULTS Nine patients with ASD who were receiving DBS for symptoms of aggression or self-injurious behavior were identified. All patients had some clinical improvement with DBS. Connectomic analysis of 8 patients (from the systematic review and unpublished clinical data) demonstrated a common anatomical area of shared circuitry within the anterior limb of the internal capsule. Functional analysis of 4 patients identified a common network of distant brain areas including the amygdala, insula, and anterior cingulate engaged by DBS. CONCLUSIONS This study presents a comprehensive synopsis of the evidence for DBS in the treatment of extreme behaviors associated with ASD. Using network mapping, the authors identified key circuitry common to DBS targets.
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Affiliation(s)
- Han Yan
- 1Division of Neurosurgery, Department of Surgery, University of Toronto
- 2Division of Neurosurgery, The Hospital for Sick Children, Toronto
- 3Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario
| | - Lior M Elkaim
- 4Division of Neurosurgery, McGill University, Montreal, Quebec
| | | | - Joelene F Huber
- 6Divisions of Paediatric Medicine and Developmental Paediatrics, Department of Paediatrics, The Hospital for Sick Children, Toronto
| | | | - Aaron Loh
- 7University Health Network, Toronto, Ontario, Canada
| | - Juan Carlos Benedetti-Isaac
- 8Stereotactic and Functional Neurosurgery Division, International Misericordia Clinic, Barranquilla, Colombia
| | - Paresh K Doshi
- 9Department of Stereotactic and Functional Neurosurgery, Jaslok Hospital and Research Centre, Mumbai, India
| | - Cristina V Torres
- 10Department of Neurosurgery, University Hospital La Princesa, Madrid, Spain
| | - David J Segar
- 11Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Alexandre Boutet
- 7University Health Network, Toronto, Ontario, Canada
- 12Joint Department of Medical Imaging, University of Toronto
| | - G Rees Cosgrove
- 11Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Alfonso Fasano
- 13Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, Toronto
- 14Division of Neurology, University of Toronto
- 15Krembil Brain Institute, Toronto
| | - Andres M Lozano
- 7University Health Network, Toronto, Ontario, Canada
- 12Joint Department of Medical Imaging, University of Toronto
| | - Abhaya V Kulkarni
- 1Division of Neurosurgery, Department of Surgery, University of Toronto
- 2Division of Neurosurgery, The Hospital for Sick Children, Toronto
- 3Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario
| | - George M Ibrahim
- 1Division of Neurosurgery, Department of Surgery, University of Toronto
- 2Division of Neurosurgery, The Hospital for Sick Children, Toronto
- 16Institute of Biomedical Engineering, University of Toronto; and
- 17Institute of Medical Science, University of Toronto, Ontario, Canada
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24
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Yamamoto K, Sarica C, Elias GJB, Boutet A, Germann J, Loh A, Joel SE, Bigioni L, Gwun D, Gramer R, Li SX, Zemmar A, Vetkas A, Algarni M, Devenyi G, Chakravarty M, Hynynen K, Scantlebury N, Schwartz ML, Lozano AM, Fasano A. Ipsilateral and axial tremor response to focused ultrasound thalamotomy for essential tremor: clinical outcomes and probabilistic mapping. J Neurol Neurosurg Psychiatry 2022; 93:jnnp-2021-328459. [PMID: 35995551 DOI: 10.1136/jnnp-2021-328459] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 05/25/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND MR-guided focused ultrasound (MRgFUS) thalamotomy has been shown to be a safe and effective treatment for essential tremor (ET). OBJECTIVE To investigate the effects of MRgFUS in patients with ET with an emphasis on ipsilateral-hand and axial tremor subscores. METHODS Tremor scores and adverse effects of 100 patients treated between 2012 and 2018 were assessed at 1 week, 3, 12, and 24 months. A subgroup analysis of ipsilateral-hand tremor responders (defined as patients with ≥30% improvement at any time point) and non-responders was performed. Correlations and predictive factors for improvement were analysed. Weighted probabilistic maps of improvement were generated. RESULTS Significant improvement in axial, contralateral-hand and total tremor scores was observed at all study visits from baseline (p<0.0001). There was no significant improvement in ipsilateral subscores. A subset of patients (n=20) exhibited group-level ipsilateral-hand improvement that remained significant through all follow-ups (p<0.001). Multivariate regression analysis revealed that higher baseline scores predict better improvement in ipsilateral-hand and axial tremor. Probabilistic maps demonstrated that the lesion hotspot for axial improvement was situated more medially than that for contralateral improvement. CONCLUSION MRgFUS significantly improved axial, contralateral-hand and total tremor scores. In a subset of patients, a consistent group-level treatment effect was observed for ipsilateral-hand tremor. While ipsilateral improvement seemed to be less directly related to lesion location, a spatial relationship between lesion location and axial and contralateral improvement was observed that proved consistent with the somatotopic organisation of the ventral intermediate nucleus. TRIAL REGISTRATION NUMBERS NCT01932463, NCT01827904, and NCT02252380.
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Affiliation(s)
- Kazuaki Yamamoto
- Division of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Can Sarica
- Division of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Gavin J B Elias
- Division of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Alexandre Boutet
- Division of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada
- Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Jurgen Germann
- Division of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Aaron Loh
- Division of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada
| | | | - Luca Bigioni
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Dave Gwun
- Division of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Robert Gramer
- Division of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada
| | | | - Ajmal Zemmar
- Department of Neurosurgery, University of Louisville School of Medicine, Louisville, Kentucky, USA
- Department of Neurosurgery, Henan Provincial People's Hospital, Zhengzhou, Henan, China
| | - Artur Vetkas
- Division of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada
- Department of Neurosurgery, University of Tartu, Tartu, Tartumaa, Estonia
| | - Musleh Algarni
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Gabriel Devenyi
- Cerebral Imaging Center, Douglas Mental Health University Institute, Montreal, Quebec, Canada
- Departments of Psychiatry and Biological and Biomedical Engineering, McGill University, Montreal, Quebec, Canada
| | - Mallar Chakravarty
- Cerebral Imaging Center, Douglas Mental Health University Institute, Montreal, Quebec, Canada
- Departments of Psychiatry and Biological and Biomedical Engineering, McGill University, Montreal, Quebec, Canada
| | - Kullervo Hynynen
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - Nadia Scantlebury
- Division of Neurosurgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Michael L Schwartz
- Division of Neurosurgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Andres M Lozano
- Division of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada
- Krembil Research Institute, Toronto, Ontario, Canada
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Toronto, Ontario, Canada
- Krembil Research Institute, Toronto, Ontario, Canada
- Division of Neurology, University of Toronto, Toronto, Ontario, Canada
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25
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Allegrini B, Jedele S, David Nguyen L, Mignotet M, Rapetti-Mauss R, Etchebest C, Fenneteau O, Loubat A, Boutet A, Thomas C, Durin J, Petit A, Badens C, Garçon L, Da Costa L, Guizouarn H. New KCNN4 Variants Associated With Anemia: Stomatocytosis Without Erythrocyte Dehydration. Front Physiol 2022; 13:918620. [PMID: 36003639 PMCID: PMC9393219 DOI: 10.3389/fphys.2022.918620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 05/27/2022] [Indexed: 11/13/2022] Open
Abstract
The K+ channel activated by the Ca2+, KCNN4, has been shown to contribute to red blood cell dehydration in the rare hereditary hemolytic anemia, the dehydrated hereditary stomatocytosis. We report two de novo mutations on KCNN4, We reported two de novo mutations on KCNN4, V222L and H340N, characterized at the molecular, cellular and clinical levels. Whereas both mutations were shown to increase the calcium sensitivity of the K+ channel, leading to channel opening for lower calcium concentrations compared to WT KCNN4 channel, there was no obvious red blood cell dehydration in patients carrying one or the other mutation. The clinical phenotype was greatly different between carriers of the mutated gene ranging from severe anemia for one patient to a single episode of anemia for the other patient or no documented sign of anemia for the parents who also carried the mutation. These data compared to already published KCNN4 mutations question the role of KCNN4 gain-of-function mutations in hydration status and viability of red blood cells in bloodstream.
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Affiliation(s)
- B. Allegrini
- Université Côte d’Azur, CNRS, INSERM, iBV, Nice, France
| | - S. Jedele
- Université Paris Cité and Université des Antilles, Inserm, BIGR, Paris, France
| | - L. David Nguyen
- Université Paris Cité, Paris, France
- AP-HP, Service d’Hématologie Biologique, Hôpital R. Debré, Paris, France
| | - M. Mignotet
- Université Côte d’Azur, CNRS, INSERM, iBV, Nice, France
| | | | - C. Etchebest
- Université Paris Cité and Université des Antilles, Inserm, BIGR, Paris, France
| | - O. Fenneteau
- AP-HP, Service d’Hématologie Biologique, Hôpital R. Debré, Paris, France
| | - A. Loubat
- Université Côte d’Azur, CNRS, INSERM, iBV, Nice, France
| | - A. Boutet
- Hôpital Saint Nazaire, Saint-Nazaire, France
| | - C. Thomas
- CHU Nantes, Service Oncologie-hématologie et Immunologie Pédiatrique, Nantes, France
| | - J. Durin
- Sorbonne Université, AP-HP, Hôpital Armand Trousseau, Service d'Hématologie Oncologie Pédiatrique, Paris, France
| | - A. Petit
- Sorbonne Université, AP-HP, Hôpital Armand Trousseau, Service d'Hématologie Oncologie Pédiatrique, Paris, France
| | - C. Badens
- Aix Marseille Univ, INSERM, MMG, Marseille, France
- AP-HM, Department of Genetic, Marseille, France
| | - L. Garçon
- Université Picardie Jules Verne, Unité EA4666 Hematim, Amiens, France
- CHU Amiens, Service d'Hématologie Biologique, Amiens, France
| | - L. Da Costa
- Université Paris Cité, Paris, France
- AP-HP, Service d’Hématologie Biologique, Hôpital R. Debré, Paris, France
- Université Picardie Jules Verne, Unité EA4666 Hematim, Amiens, France
| | - H. Guizouarn
- Université Côte d’Azur, CNRS, INSERM, iBV, Nice, France
- *Correspondence: H. Guizouarn,
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26
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Germann J, Loh A, Dudek C, Chow C, Boutet A, Lozano A, Mansouri A. NEIM-04 LEVERAGING NOVEL NEUROIMAGING TECHNIQUES TO LINK BRAIN METASTASES AND LOCAL GENE EXPRESSION. Neurooncol Adv 2022. [PMCID: PMC9354220 DOI: 10.1093/noajnl/vdac078.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Metastases are the most prevalent adult brain tumour, most commonly arising from lung, breast, or melanoma primaries. Studies have suggested that different primary tumor types may have predilection for seeding to specific brain regions. One hypothesis is that the interaction of the genomic environment within specific brain region(s) and seeding tumor cells is ideal for supporting this process. The recent availability of neuroimaging based transcriptomic atlases make it feasible to test this hypothesis. In this proof-of-concept study, we leverage the Allen atlas to evaluate whether variance in location among different tumour subtypes can be explained by normative gene expression. Manual segmentation was done on contrast-enhanced T1-weighted MRIs in 31 patients with brain metastases and known primary tumour [breast (n=7), lung (n=14), genitourinary (n=5) and melanoma (n=5)]. Segmented lesions were transformed to template brain space. First, odds-ratio maps were created for each primary tumour subtype. These maps delineate brain regions that were preferentially engaged by each subtype. Consistent with prior literature, odds-ratio maps demonstrated a preference for metastases to seed to different brain regions according to primary tumour subtype, e.g. lung - cerebellum, melanoma - frontal and temporal lobes. Next, mapping our lesions on the Allen atlas of normative gene expression, we identified significant (p<0.01) differences in the local expression of certain genes– such as LEPROT and ITPKA – related to the spatial pattern of breast, lung, genitourinary, and melanoma. This novel approach integrates imaging and transcriptomic techniques that could be used towards an improved understanding of neuro-oncologic processes. Crucially, this approach would allow investigators to leverage conventional anatomical images – acquired as part of a patient’s normal clinical course and in the absence of tissue samples – to better understand cancer mechanics. This has potential ramifications for therapeutic decision-making. Large-scale prospective studies are underway.
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Affiliation(s)
- Jurgen Germann
- Division of Neurosurgery, Department of Surgery, University of Toronto , Toronto , Canada
| | - Aaron Loh
- Division of Neurosurgery, Department of Surgery, University of Toronto , Toronto , Canada
| | - Cain Dudek
- Department of Neurosurgery, Penn State Hershey Medical Center, Penn State University , Hershey, PA , USA
| | - Clement Chow
- Division of Neurosurgery, Department of Surgery, University of Toronto , Toronto , Canada
| | - Alexandre Boutet
- Division of Neurosurgery, Department of Surgery, University of Toronto , Toronto , Canada
- Joint Department of Medical Imaging, University of Toronto , Toronto , Canada
| | - Andres Lozano
- Division of Neurosurgery, Department of Surgery, University of Toronto , Toronto , Canada
- Krembil Brain Institute , Toronto , Canada
| | - Alireza Mansouri
- Department of Neurosurgery, Penn State Hershey Medical Center, Penn State University , Hershey, PA , USA
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27
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Loh A, Elias GJB, Germann J, Boutet A, Gwun D, Yamamoto K, Sarica C, Azevedo P, Zemmar A, Pinto J, Naheed A, Kalia SK, Hodaie M, Munhoz RP, Lozano AM, Fasano A. Neural correlates of optimal deep brain stimulation for cervical dystonia. Ann Neurol 2022; 92:418-424. [PMID: 35785489 DOI: 10.1002/ana.26450] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 06/30/2022] [Accepted: 07/01/2022] [Indexed: 11/08/2022]
Abstract
Fifteen subjects with cervical dystonia and good outcome following pallidal deep brain stimulation underwent resting-state functional magnetic resonance imaging under three conditions: stimulation using a priori clinically determined optimal settings (ON-Op), non-optimal settings (ON-NOp), and stimulation off (OFF). ON-Op>OFF and ON-Op>ON-NOp were both associated with significant deactivation within sensorimotor cortex (changes not seen with ON-NOp>OFF). Brain responses to stimulation were related to individual long-term clinical improvement (R=0.73 , R2 =0.53, p=0.001). The relationship was consistent when this model included four additional patients with generalized or truncal dystonia. These findings highlight the potential for immediate imaging-based biomarkers of clinical efficacy. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Aaron Loh
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Canada
| | - Gavin J B Elias
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Canada
| | - Jürgen Germann
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Canada
| | - Alexandre Boutet
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Canada.,Joint Department of Medical Imaging, University of Toronto, Toronto, Canada
| | - Dave Gwun
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Canada
| | - Kazuaki Yamamoto
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Canada
| | - Can Sarica
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Canada
| | - Paula Azevedo
- Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital and Division of Neurology, UHN, Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Ajmal Zemmar
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Canada.,Department of Neurosurgery, People's Hospital of Zhengzhou University, Henan Provincial People´s Hospital, Henan University People's Hospital, Henan University School of Medicine, 7 Weiwu Road, Zhengzhou, China, 450000.,Department of Neurosurgery, University of Louisville, School of Medicine, 200 Abraham Flexner Way, Louisville, KY, 40202, USA
| | - Jessica Pinto
- Joint Department of Medical Imaging, University of Toronto, Toronto, Canada
| | - Asma Naheed
- Joint Department of Medical Imaging, University of Toronto, Toronto, Canada
| | - Suneil K Kalia
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Canada.,Krembil Research Institute, Toronto, Ontario, Canada.,Center for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, Ontario, Canada
| | - Mojgan Hodaie
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Canada.,Krembil Research Institute, Toronto, Ontario, Canada
| | - Renato P Munhoz
- Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital and Division of Neurology, UHN, Division of Neurology, University of Toronto, Toronto, Ontario, Canada.,Krembil Research Institute, Toronto, Ontario, Canada
| | - Andres M Lozano
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Canada.,Krembil Research Institute, Toronto, Ontario, Canada
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital and Division of Neurology, UHN, Division of Neurology, University of Toronto, Toronto, Ontario, Canada.,Krembil Research Institute, Toronto, Ontario, Canada.,Center for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, Ontario, Canada
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28
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Loh A, Boutet A, Germann J, Al-Fatly B, Elias GJB, Neudorfer C, Krotz J, Wong EHY, Parmar R, Gramer R, Paff M, Horn A, Chen JJ, Azevedo P, Fasano A, Munhoz RP, Hodaie M, Kalia SK, Kucharczyk W, Lozano AM. A Functional Connectome of Parkinson's Disease Patients Prior to Deep Brain Stimulation: A Tool for Disease-Specific Connectivity Analyses. Front Neurosci 2022; 16:804125. [PMID: 35812235 PMCID: PMC9263841 DOI: 10.3389/fnins.2022.804125] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 05/26/2022] [Indexed: 11/24/2022] Open
Affiliation(s)
- Aaron Loh
- Krembil Neuroscience Center, University Health Network, Toronto, ON, Canada
| | - Alexandre Boutet
- Krembil Neuroscience Center, University Health Network, Toronto, ON, Canada
- Joint Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Jürgen Germann
- Krembil Neuroscience Center, University Health Network, Toronto, ON, Canada
| | - Bassam Al-Fatly
- Movement Disorders and Neuromodulation Unit, Department of Neurology With Experimental Neurology, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Gavin J. B. Elias
- Krembil Neuroscience Center, University Health Network, Toronto, ON, Canada
| | - Clemens Neudorfer
- Krembil Neuroscience Center, University Health Network, Toronto, ON, Canada
| | - Jillian Krotz
- Baycrest Health Sciences, Rotman Research Institute, Toronto, ON, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
| | - Emily H. Y. Wong
- Krembil Neuroscience Center, University Health Network, Toronto, ON, Canada
| | - Roohie Parmar
- Krembil Neuroscience Center, University Health Network, Toronto, ON, Canada
| | - Robert Gramer
- Krembil Neuroscience Center, University Health Network, Toronto, ON, Canada
| | - Michelle Paff
- Krembil Neuroscience Center, University Health Network, Toronto, ON, Canada
| | - Andreas Horn
- Movement Disorders and Neuromodulation Unit, Department of Neurology With Experimental Neurology, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - J. Jean Chen
- Baycrest Health Sciences, Rotman Research Institute, Toronto, ON, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
| | - Paula Azevedo
- Division of Neurology, Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Alfonso Fasano
- Division of Neurology, Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
- Krembil Brain Institute, University Health Network, Toronto, ON, Canada
- Center for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, ON, Canada
| | - Renato P. Munhoz
- Division of Neurology, Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
- Krembil Brain Institute, University Health Network, Toronto, ON, Canada
| | - Mojgan Hodaie
- Krembil Neuroscience Center, University Health Network, Toronto, ON, Canada
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Suneil K. Kalia
- Krembil Neuroscience Center, University Health Network, Toronto, ON, Canada
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Walter Kucharczyk
- Joint Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Andres M. Lozano
- Krembil Neuroscience Center, University Health Network, Toronto, ON, Canada
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
- *Correspondence: Andres M. Lozano
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29
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Boutet A, Loh A, Germann J, Machnowska M, Scantlebury N, Vetkas A, Elias GJB, Lozano AM, Katzberg HD, Fasano A, Schwartz ML. A Cautionary Tale of Magnetic Resonance-Guided Focused Ultrasound Thalamotomy-Induced White Matter Lesions. Mov Disord 2022; 37:1953-1955. [PMID: 35616482 DOI: 10.1002/mds.29040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 04/04/2022] [Accepted: 04/12/2022] [Indexed: 11/08/2022] Open
Affiliation(s)
- Alexandre Boutet
- Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Aaron Loh
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Jurgen Germann
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Matylda Machnowska
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Nadia Scantlebury
- Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Artur Vetkas
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Neurology Clinic, Department of Neurosurgery, Tartu University Hospital, University of Tartu, Tartu, Estonia
| | - Gavin J B Elias
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Andres M Lozano
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Krembil Brain Institute, Toronto, Ontario, Canada.,Center for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, Ontario, Canada
| | - Hans D Katzberg
- Division of Neurology, University Health Network, Division of Neurology, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Alfonso Fasano
- Krembil Brain Institute, Toronto, Ontario, Canada.,Center for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, Ontario, Canada.,Division of Neurology, University of Toronto, Toronto, Ontario, Canada.,Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Centre, Toronto Western Hospital, UHN, Toronto, Ontario, Canada
| | - Michael L Schwartz
- Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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30
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Vetkas A, Fomenko A, Germann J, Sarica C, Iorio-Morin C, Samuel N, Yamamoto K, Milano V, Cheyuo C, Zemmar A, Elias G, Boutet A, Loh A, Santyr B, Gwun D, Tasserie J, Kalia SK, Lozano AM. Response: Letter to the Editor: Deep brain stimulation targets in epilepsy: Systematic review and meta-analysis of anterior and centromedian thalamic nuclei and hippocampus. Epilepsia 2022; 63:1885-1886. [PMID: 35514031 DOI: 10.1111/epi.17272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 04/26/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Artur Vetkas
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada.,Neurology clinic, Department of Neurosurgery, Tartu University Hospital, University of Tartu, Tartu, Estonia
| | - Anton Fomenko
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada.,Section of Neurosurgery, Health Sciences Centre, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jürgen Germann
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Can Sarica
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Christian Iorio-Morin
- Division of Neurosurgery, Centre de recherché du CHUS, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Nardin Samuel
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Kazuaki Yamamoto
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Vanessa Milano
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Cletus Cheyuo
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Ajmal Zemmar
- Department of Neurosurgery, University of Louisville, School of Medicine, KY, USA
| | - Gavin Elias
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Alexandre Boutet
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada.,Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Aaron Loh
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Brendan Santyr
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada.,Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Dave Gwun
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Jordy Tasserie
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Suneil K Kalia
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada.,Krembil Research Institute, Toronto, Ontario, Canada
| | - Andres M Lozano
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada.,Krembil Research Institute, Toronto, Ontario, Canada
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31
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Loh A, Boutet A, Chow CT, Elias GJB, Germann J, Kucharczyk W, Lozano AM. Letter: Unforeseen Hurdles Associated With Magnetic Resonance Imaging in Patients With Deep Brain Stimulation Devices. Neurosurgery 2022; 90:e129. [PMID: 35199650 DOI: 10.1227/neu.0000000000001887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 12/16/2021] [Indexed: 11/19/2022] Open
Affiliation(s)
- Aaron Loh
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Canada
| | - Alexandre Boutet
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Canada
- Joint Department of Medical Imaging, University of Toronto, Toronto, Canada
| | - Clement T Chow
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Canada
| | - Gavin J B Elias
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Canada
| | - Jürgen Germann
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Canada
| | - Walter Kucharczyk
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Canada
- Joint Department of Medical Imaging, University of Toronto, Toronto, Canada
| | - Andres M Lozano
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Canada
- Krembil Research Institute, Toronto, Canada
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32
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Loh A, Gwun D, Chow CT, Boutet A, Tasserie J, Germann J, Santyr B, Elias G, Yamamoto K, Sarica C, Vetkas A, Zemmar A, Madhavan R, Fasano A, Lozano AM. Probing responses to deep brain stimulation with functional magnetic resonance imaging. Brain Stimul 2022; 15:683-694. [PMID: 35447378 DOI: 10.1016/j.brs.2022.03.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 03/24/2022] [Accepted: 03/30/2022] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Deep brain stimulation (DBS) is an established treatment for certain movement disorders and has additionally shown promise for various psychiatric, cognitive, and seizure disorders. However, the mechanisms through which stimulation exerts therapeutic effects are incompletely understood. A technique that may help to address this knowledge gap is functional magnetic resonance imaging (fMRI). This is a non-invasive imaging tool which permits the observation of DBS effects in vivo. OBJECTIVE The objective of this review was to provide a comprehensive overview of studies in which fMRI during active DBS was performed, including studied disorders, stimulated brain regions, experimental designs, and the insights gleaned from stimulation-evoked fMRI responses. METHODS We conducted a systematic review of published human studies in which fMRI was performed during active stimulation in DBS patients. The search was conducted using PubMED and MEDLINE. RESULTS The rate of fMRI DBS studies is increasing over time, with 37 studies identified overall. The median number of DBS patients per study was 10 (range = 1-67, interquartile range = 11). Studies examined fMRI responses in various disease cohorts, including Parkinson's disease (24 studies), essential tremor (3 studies), epilepsy (3 studies), obsessive-compulsive disorder (2 studies), pain (2 studies), Tourette syndrome (1 study), major depressive disorder, anorexia, and bipolar disorder (1 study), and dementia with Lewy bodies (1 study). The most commonly stimulated brain region was the subthalamic nucleus (24 studies). Studies showed that DBS modulates large-scale brain networks, and that stimulation-evoked fMRI responses are related to the site of stimulation, stimulation parameters, patient characteristics, and therapeutic outcomes. Finally, a number of studies proposed fMRI-based biomarkers for DBS treatment, highlighting ways in which fMRI could be used to confirm circuit engagement and refine DBS therapy. CONCLUSION A review of the literature reflects an exciting and expanding field, showing that the combination of DBS and fMRI represents a uniquely powerful tool for simultaneously manipulating and observing neural circuitry. Future work should focus on relatively understudied disease cohorts and stimulated regions, while focusing on the prospective validation of putative fMRI-based biomarkers.
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Affiliation(s)
- Aaron Loh
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Canada
| | - David Gwun
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Canada
| | - Clement T Chow
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Canada
| | - Alexandre Boutet
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Canada; Joint Department of Medical Imaging, University of Toronto, Toronto, Canada
| | - Jordy Tasserie
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Canada
| | - Jürgen Germann
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Canada
| | - Brendan Santyr
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Canada
| | - Gavin Elias
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Canada
| | - Kazuaki Yamamoto
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Canada
| | - Can Sarica
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Canada
| | - Artur Vetkas
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Canada; Department of Neurosurgery, Tartu University Hospital, University of Tartu, Tartu, Estonia
| | - Ajmal Zemmar
- Department of Neurosurgery, Henan University School of Medicine, Zhengzhou, China; Department of Neurosurgery, University of Louisville, Louisville, KY, United States
| | | | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital and Division of Neurology, UHN, Division of Neurology, University of Toronto, Toronto, Ontario, Canada; Center for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, Ontario, Canada
| | - Andres M Lozano
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Canada; Krembil Research Institute, Toronto, Ontario, Canada.
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33
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Vetkas A, Germann J, Elias G, Loh A, Boutet A, Yamamoto K, Sarica C, Samuel N, Milano V, Fomenko A, Santyr B, Tasserie J, Gwun D, Jung HH, Valiante T, Ibrahim GM, Wennberg R, Kalia SK, Lozano AM. Identifying the neural network for neuromodulation in epilepsy through connectomics and graphs. Brain Commun 2022; 4:fcac092. [PMID: 35611305 PMCID: PMC9123846 DOI: 10.1093/braincomms/fcac092] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 12/13/2021] [Accepted: 03/31/2022] [Indexed: 02/01/2023] Open
Abstract
Deep brain stimulation is a treatment option for patients with drug-resistant epilepsy. The precise mechanism of neuromodulation in epilepsy is unknown, and biomarkers are needed for optimizing treatment. The aim of this study was to describe the neural network associated with deep brain stimulation targets for epilepsy and to explore its potential application as a novel biomarker for neuromodulation. Using seed-to-voxel functional connectivity maps, weighted by seizure outcomes, brain areas associated with stimulation were identified in normative resting state functional scans of 1000 individuals. To pinpoint specific regions in the normative epilepsy deep brain stimulation network, we examined overlapping areas of functional connectivity between the anterior thalamic nucleus, centromedian thalamic nucleus, hippocampus and less studied epilepsy deep brain stimulation targets. Graph network analysis was used to describe the relationship between regions in the identified network. Furthermore, we examined the associations of the epilepsy deep brain stimulation network with disease pathophysiology, canonical resting state networks and findings from a systematic review of resting state functional MRI studies in epilepsy deep brain stimulation patients. Cortical nodes identified in the normative epilepsy deep brain stimulation network were in the anterior and posterior cingulate, medial frontal and sensorimotor cortices, frontal operculum and bilateral insulae. Subcortical nodes of the network were in the basal ganglia, mesencephalon, basal forebrain and cerebellum. Anterior thalamic nucleus was identified as a central hub in the network with the highest betweenness and closeness values, while centromedian thalamic nucleus and hippocampus showed average centrality values. The caudate nucleus and mammillothalamic tract also displayed high centrality values. The anterior cingulate cortex was identified as an important cortical hub associated with the effect of deep brain stimulation in epilepsy. The neural network of deep brain stimulation targets shared hubs with known epileptic networks and brain regions involved in seizure propagation and generalization. Two cortical clusters identified in the epilepsy deep brain stimulation network included regions corresponding to resting state networks, mainly the default mode and salience networks. Our results were concordant with findings from a systematic review of resting state functional MRI studies in patients with deep brain stimulation for epilepsy. Our findings suggest that the various epilepsy deep brain stimulation targets share a common cortico-subcortical network, which might in part underpin the antiseizure effects of stimulation. Interindividual differences in this network functional connectivity could potentially be used as biomarkers in selection of patients, stimulation parameters and neuromodulation targets.
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Affiliation(s)
- Artur Vetkas
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
- Neurology clinic, Department of Neurosurgery, Tartu University Hospital, University of Tartu, Tartu, Estonia
| | - Jürgen Germann
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Gavin Elias
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Aaron Loh
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Alexandre Boutet
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
- Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Kazuaki Yamamoto
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Can Sarica
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Nardin Samuel
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Vanessa Milano
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Anton Fomenko
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
- Section of Neurosurgery, Health Sciences Centre, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Brendan Santyr
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Jordy Tasserie
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Dave Gwun
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Hyun Ho Jung
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Taufik Valiante
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
- Krembil Research Institute, Toronto, Ontario, Canada
- CRANIA, University Health Network and University of Toronto, Toronto, ON, M5G 2A2, Canada
- The KITE Research Institute, University Health Network, Toronto, ON, M5G 2A2, Canada
| | - George M Ibrahim
- Division of Pediatric Neurosurgery, Sick Kids Toronto, University of Toronto, Toronto, ON, Canada
| | - Richard Wennberg
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
- Krembil Research Institute, Toronto, Ontario, Canada
| | - Suneil K Kalia
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
- Krembil Research Institute, Toronto, Ontario, Canada
- CRANIA, University Health Network and University of Toronto, Toronto, ON, M5G 2A2, Canada
- The KITE Research Institute, University Health Network, Toronto, ON, M5G 2A2, Canada
| | - Andres M Lozano
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
- Krembil Research Institute, Toronto, Ontario, Canada
- CRANIA, University Health Network and University of Toronto, Toronto, ON, M5G 2A2, Canada
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34
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Germann J, Boutet A, Elias GJ, Gouveia FV, Loh A, Giacobbe P, Bhat V, Kucharczyk W, Lozano AM. Brain Structures and Networks Underlying Treatment Response to Deep Brain Stimulation Targeting the Inferior Thalamic Peduncle in Obsessive-Compulsive Disorder. Stereotact Funct Neurosurg 2022; 100:236-243. [DOI: 10.1159/000523826] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 02/23/2022] [Indexed: 12/17/2022]
Abstract
<b><i>Background:</i></b> Obsessive-compulsive disorder (OCD) is a debilitating disease with a lifetime prevalence of 2–3%. Neuromodulatory treatments have been successfully used in severe cases. Deep brain stimulation (DBS) targeting the inferior thalamic peduncle (ITP) has been shown to successfully alleviate symptoms in OCD patients; however, the brain circuits implicated remain unclear. Here, we investigate the efficacious neural substrates following ITP-DBS for OCD. <b><i>Methods:</i></b> High-quality normative structural and functional connectomics and voxel-wise probabilistic mapping techniques were applied to assess the neural substrates of OCD symptom alleviation in a cohort of 5 ITP-DBS patients. <b><i>Results:</i></b> The region of most efficacious stimulation was located in the regions of the ITP and bed nucleus of the stria terminalis. Both functional and structural connectomics analyses demonstrated that successful symptom alleviation involved a brain network encompassing the bilateral amygdala and prefrontal regions. <b><i>Limitations:</i></b> The main limitation is the small size of the ITP-DBS cohort. While the findings are highly consistent and significant, these should be validated in larger studies. <b><i>Conclusions:</i></b> These results identify a tripartite brain network – composed of the bilateral amygdala and prefrontal regions 24 and 46 – whose engagement is associated with greater symptom improvement. They also provide information for optimizing targeting and identifying network components critically involved in ITP-DBS treatment response. Amygdala engagement in particular seems to be a key component for clinical benefits and could constitute a biomarker for treatment optimization.
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Lizárraga KJ, Gnanamanogaran B, Al‐Ozzi TM, Cohn M, Tomlinson G, Boutet A, Elias GJ, Germann J, Soh D, Kalia SK, Hodaie M, Munhoz RP, Marras C, Hutchison WD, Lozano AM, Lang AE, Fasano A. Lateralized Subthalamic Stimulation for Axial Dysfunction in Parkinson's Disease: A Randomized Trial. Mov Disord 2022; 37:1079-1087. [DOI: 10.1002/mds.28953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 01/18/2022] [Accepted: 01/20/2022] [Indexed: 12/19/2022] Open
Affiliation(s)
- Karlo J. Lizárraga
- The Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic Toronto Western Hospital, University Hospital Network and Division of Neurology, Department of Medicine, University of Toronto Toronto Ontario Canada
- Motor Physiology and Neuromodulation Program, Division of Movement Disorders, Department of Neurology and Center for Health and Technology University of Rochester Rochester New York USA
| | - Bhairavei Gnanamanogaran
- The Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic Toronto Western Hospital, University Hospital Network and Division of Neurology, Department of Medicine, University of Toronto Toronto Ontario Canada
- University of Toronto Toronto Ontario Canada
| | - Tameem M. Al‐Ozzi
- University of Toronto Toronto Ontario Canada
- Krembil Research Institute Toronto Ontario Canada
- Departments of Surgery and Physiology University of Toronto Toronto Ontario Canada
| | - Melanie Cohn
- Krembil Research Institute Toronto Ontario Canada
- Department of Psychology University of Toronto Toronto Ontario Canada
| | - George Tomlinson
- Institute of Health Policy, Management and Evaluation University of Toronto Toronto Ontario Canada
- University Health Network Toronto Ontario Canada
| | - Alexandre Boutet
- University Health Network Toronto Ontario Canada
- Joint Department of Medical Imaging University of Toronto Toronto Ontario Canada
- Division of Neurosurgery, Department of Surgery University Health Network and University of Toronto Toronto Ontario Canada
| | - Gavin J.B. Elias
- University Health Network Toronto Ontario Canada
- Division of Neurosurgery, Department of Surgery University Health Network and University of Toronto Toronto Ontario Canada
| | - Jürgen Germann
- University Health Network Toronto Ontario Canada
- Division of Neurosurgery, Department of Surgery University Health Network and University of Toronto Toronto Ontario Canada
| | - Derrick Soh
- The Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic Toronto Western Hospital, University Hospital Network and Division of Neurology, Department of Medicine, University of Toronto Toronto Ontario Canada
- Alfred Hospital Melbourne Victoria Australia
| | - Suneil K. Kalia
- Krembil Research Institute Toronto Ontario Canada
- Division of Neurosurgery, Department of Surgery University Health Network and University of Toronto Toronto Ontario Canada
- Center for Advancing Neurotechnological Innovation to Application (CRANIA) Toronto Ontario Canada
| | - Mojgan Hodaie
- Krembil Research Institute Toronto Ontario Canada
- Division of Neurosurgery, Department of Surgery University Health Network and University of Toronto Toronto Ontario Canada
| | - Renato P. Munhoz
- The Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic Toronto Western Hospital, University Hospital Network and Division of Neurology, Department of Medicine, University of Toronto Toronto Ontario Canada
- Krembil Research Institute Toronto Ontario Canada
| | - Connie Marras
- The Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic Toronto Western Hospital, University Hospital Network and Division of Neurology, Department of Medicine, University of Toronto Toronto Ontario Canada
- Krembil Research Institute Toronto Ontario Canada
| | - William D. Hutchison
- Krembil Research Institute Toronto Ontario Canada
- Departments of Surgery and Physiology University of Toronto Toronto Ontario Canada
- Division of Neurosurgery, Department of Surgery University Health Network and University of Toronto Toronto Ontario Canada
- Center for Advancing Neurotechnological Innovation to Application (CRANIA) Toronto Ontario Canada
| | - Andres M. Lozano
- Krembil Research Institute Toronto Ontario Canada
- Division of Neurosurgery, Department of Surgery University Health Network and University of Toronto Toronto Ontario Canada
| | - Anthony E. Lang
- The Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic Toronto Western Hospital, University Hospital Network and Division of Neurology, Department of Medicine, University of Toronto Toronto Ontario Canada
- Krembil Research Institute Toronto Ontario Canada
| | - Alfonso Fasano
- The Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic Toronto Western Hospital, University Hospital Network and Division of Neurology, Department of Medicine, University of Toronto Toronto Ontario Canada
- Krembil Research Institute Toronto Ontario Canada
- Center for Advancing Neurotechnological Innovation to Application (CRANIA) Toronto Ontario Canada
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Vetkas A, Fomenko A, Germann J, Sarica C, Iorio-Morin C, Samuel N, Yamamoto K, Milano V, Cheyuo C, Zemmar A, Elias G, Boutet A, Loh A, Santyr B, Gwun D, Tasserie J, Kalia SK, Lozano AM. Deep brain stimulation targets in epilepsy: Systematic review and meta-analysis of anterior and centromedian thalamic nuclei and hippocampus. Epilepsia 2022; 63:513-524. [PMID: 34981509 DOI: 10.1111/epi.17157] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 12/13/2021] [Accepted: 12/13/2021] [Indexed: 12/11/2022]
Abstract
Deep brain stimulation (DBS) is a neuromodulatory treatment used in patients with drug-resistant epilepsy (DRE). The primary goal of this systematic review and meta-analysis is to describe recent advancements in the field of DBS for epilepsy, to compare the results of published trials, and to clarify the clinical utility of DBS in DRE. A systematic literature search was performed by two independent authors. Forty-four articles were included in the meta-analysis (23 for anterior thalamic nucleus [ANT], 8 for centromedian thalamic nucleus [CMT], and 13 for hippocampus) with a total of 527 patients. The mean seizure reduction after stimulation of the ANT, CMT, and hippocampus in our meta-analysis was 60.8%, 73.4%, and 67.8%, respectively. DBS is an effective and safe therapy in patients with DRE. Based on the results of randomized controlled trials and larger clinical series, the best evidence exists for DBS of the anterior thalamic nucleus. Further randomized trials are required to clarify the role of CMT and hippocampal stimulation. Our analysis suggests more efficient deep brain stimulation of ANT for focal seizures, wider use of CMT for generalized seizures, and hippocampal DBS for temporal lobe seizures. Factors associated with clinical outcome after DBS for epilepsy are electrode location, stimulation parameters, type of epilepsy, and longer time of stimulation. Recent advancements in anatomical targeting, functional neuroimaging, responsive neurostimulation, and sensing of local field potentials could potentially lead to improved outcomes after DBS for epilepsy and reduced sudden, unexpected death of patients with epilepsy. Biomarkers are needed for successful patient selection, targeting of electrodes and optimization of stimulation parameters.
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Affiliation(s)
- Artur Vetkas
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.,Neurology Clinic, Department of Neurosurgery, Tartu University Hospital, University of Tartu, Tartu, Estonia
| | - Anton Fomenko
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.,Section of Neurosurgery, Health Sciences Centre, University of Manitoba, Winnipeg, MB, Canada
| | - Jürgen Germann
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Can Sarica
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Christian Iorio-Morin
- Division of Neurosurgery, Centre de recherché du CHUS, University of Sherbrooke, Sherbrooke, QC, Canada
| | - Nardin Samuel
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Kazuaki Yamamoto
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Vanessa Milano
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Cletus Cheyuo
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Ajmal Zemmar
- Department of Neurosurgery, University of Louisville, School of Medicine, Louisville, KY, USA
| | - Gavin Elias
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Alexandre Boutet
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.,Joint Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Aaron Loh
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Brendan Santyr
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.,Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Dave Gwun
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Jordy Tasserie
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Suneil K Kalia
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.,Krembil Research Institute, Toronto, ON, Canada
| | - Andres M Lozano
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.,Krembil Research Institute, Toronto, ON, Canada
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Elias GJB, Germann J, Loh A, Boutet A, Pancholi A, Beyn ME, Bhat V, Woodside DB, Giacobbe P, Kennedy SH, Lozano AM. Habenular Involvement in Response to Subcallosal Cingulate Deep Brain Stimulation for Depression. Front Psychiatry 2022; 13:810777. [PMID: 35185654 PMCID: PMC8854862 DOI: 10.3389/fpsyt.2022.810777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 01/03/2022] [Indexed: 11/13/2022] Open
Abstract
The habenula (Hb) is a small, evolutionarily conserved epithalamic structure implicated in functions such as reward and mood regulation. Prior imaging work suggests that Hb's structural and functional properties may relate to treatment response in depression and other mood disorders. We used multimodal MRI techniques to investigate the potential involvement of Hb in response to subcallosal cingulate area deep brain stimulation (SCC-DBS) for treatment-resistant mood disorders. Using an automated segmentation technique, we compared Hb volume at baseline and at a subsequent post-operative timepoint (4.4 ± 3.0 years after surgery) in a cohort of 32 patients who received SCC-DBS. Clinical response to treatment (≥50% decrease in HAMD-17 from baseline to 12 months post-operation) was significantly associated with longitudinal Hb volume change: responders tended to have increased Hb volume over time, while non-responders showed decreased Hb volume (t = 2.4, p = 0.021). We additionally used functional MRI (fMRI) in a subcohort of SCC-DBS patients (n = 12) to investigate immediate within-patient changes in Hb functional connectivity associated with SCC-DBS stimulation. Active DBS was significantly associated with increased Hb connectivity to several prefrontal and corticolimbic regions (TFCE-adjusted p Bonferroni < 0.0001), many of which have been previously implicated in the neurocircuitry of depression. Taken together, our results suggest that Hb may play an important role in the antidepressant effect of SCC-DBS.
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Affiliation(s)
- Gavin J B Elias
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Jürgen Germann
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Aaron Loh
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Alexandre Boutet
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, ON, Canada.,Joint Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Aditya Pancholi
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Michelle E Beyn
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Venkat Bhat
- Centre for Mental Health and Krembil Research Centre, University Health Network, Toronto, ON, Canada
| | - D Blake Woodside
- Centre for Mental Health, University Health Network, Toronto, ON, Canada
| | - Peter Giacobbe
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Sidney H Kennedy
- Centre for Mental Health, University Health Network, Toronto, ON, Canada.,Krembil Research Institute, University of Toronto, Toronto, ON, Canada
| | - Andres M Lozano
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, ON, Canada.,Krembil Research Institute, University of Toronto, Toronto, ON, Canada
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Elias GJB, Germann J, Boutet A, Loh A, Li B, Pancholi A, Beyn ME, Naheed A, Bennett N, Pinto J, Bhat V, Giacobbe P, Woodside DB, Kennedy SH, Lozano AM. 3 T MRI of rapid brain activity changes driven by subcallosal cingulate deep brain stimulation. Brain 2021; 145:2214-2226. [PMID: 34919630 DOI: 10.1093/brain/awab447] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 11/08/2021] [Accepted: 11/18/2021] [Indexed: 11/14/2022] Open
Abstract
Deep brain stimulation targeting the subcallosal cingulate area (SCC-DBS), a hub with multiple axonal projections, has shown therapeutic potential for treatment-resistant mood disorders. While SCC-DBS drives long-term metabolic changes in corticolimbic circuits, the brain areas that are directly modulated by electrical stimulation of this region are not known. We used 3.0 Tesla functional MRI to map the topography of acute brain changes produced by stimulation in an initial cohort of twelve patients with fully implanted SCC-DBS devices. Four additional SCC-DBS patients were also scanned and employed as a validation cohort. Participants underwent resting state scans (n=78 acquisitions overall) during i) inactive DBS; ii) clinically optimal active DBS; iii) suboptimal active DBS. All scans were acquired within a single MRI session, each separated by a 5-minute washout period. Analysis of the amplitude of low frequency fluctuations (ALFF) in each sequence indicated that clinically optimal SCC-DBS reduced spontaneous brain activity in several areas, including bilateral dorsal anterior cingulate cortex (dACC), posterior cingulate cortex (PCC), precuneus, and left inferior parietal lobule (pBonferroni<0.0001). Stimulation-induced dACC signal reduction correlated with immediate within-session mood fluctuations, was greater at optimal versus suboptimal settings, and related to local cingulum bundle engagement. Moreover, linear modelling showed that immediate changes in dACC, PCC, and precuneus activity could predict individual long-term antidepressant improvement. A model derived from the primary cohort that incorporated ALFF changes in these three areas (along with pre-operative symptom severity) explained 55% of the variance in clinical improvement in that cohort. The same model also explained 93% of the variance in the out-of-sample validation cohort. Additionally all three brain areas exhibited significant changes in functional connectivity between active and inactive DBS states (pBonferroni<0.01). These results provide insight into the network-level mechanisms of SCC-DBS and point towards potential acute biomarkers of clinical response that could help to optimize and personalize this therapy.
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Affiliation(s)
- Gavin J B Elias
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Canada.,Krembil Research Institute, University of Toronto, Toronto, Canada
| | - Jürgen Germann
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Canada.,Krembil Research Institute, University of Toronto, Toronto, Canada
| | - Alexandre Boutet
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Canada.,Krembil Research Institute, University of Toronto, Toronto, Canada.,Joint Department of Medical Imaging, University of Toronto, Toronto, Canada
| | - Aaron Loh
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Canada.,Krembil Research Institute, University of Toronto, Toronto, Canada
| | - Bryan Li
- Joint Department of Medical Imaging, University of Toronto, Toronto, Canada
| | - Aditya Pancholi
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Canada
| | - Michelle E Beyn
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Canada
| | - Asma Naheed
- Joint Department of Medical Imaging, University of Toronto, Toronto, Canada
| | - Nicole Bennett
- Joint Department of Medical Imaging, University of Toronto, Toronto, Canada
| | - Jessica Pinto
- Joint Department of Medical Imaging, University of Toronto, Toronto, Canada
| | - Venkat Bhat
- Department of Psychiatry, University Health Network and University of Toronto, Toronto, Canada
| | - Peter Giacobbe
- Department of Psychiatry, Sunnybrook Health Sciences Centre and University of Toronto, Toronto, Canada
| | - D Blake Woodside
- Department of Psychiatry, University Health Network and University of Toronto, Toronto, Canada
| | - Sidney H Kennedy
- Krembil Research Institute, University of Toronto, Toronto, Canada.,Department of Psychiatry, University Health Network and University of Toronto, Toronto, Canada
| | - Andres M Lozano
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Canada.,Krembil Research Institute, University of Toronto, Toronto, Canada
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Sasikumar S, Cohn M, Harmsen IE, Loh A, Cho SS, Sáenz-Farret M, Maciel R, Soh D, Boutet A, Germann J, Elias G, Youm A, Duncan K, Rowland NC, Strafella AP, Kalia SK, Lozano AM, Fasano A. Single-Trajectory Multiple-Target Deep Brain Stimulation for Parkinsonian Mobility and Cognition. Mov Disord 2021; 37:635-640. [PMID: 34806782 DOI: 10.1002/mds.28870] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 09/29/2021] [Accepted: 10/22/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Deep brain stimulation (DBS) of the nucleus basalis of Meynert (NBM) is an emerging target to potentially treat cognitive dysfunction. OBJECTIVES The aim of this study is to achieve feasibility and safety of globus pallidus pars interna (GPi) and NBM DBS in advanced PD with cognitive impairment. METHODS We performed a phase-II double-blind crossover pilot trial in six participants to assess safety and cognitive measures, the acute effect of NBM stimulation on attention, motor and neuropsychological data at one year, and neuroimaging biomarkers of NBM stimulation. RESULTS NBM DBS was well tolerated but did not improve cognition. GPi DBS improved dyskinesia and motor fluctuations (P = 0.04) at one year. NBM stimulation was associated with reduced right frontal and parietal glucose metabolism (P < 0.01) and increased low- and high-frequency power and functional connectivity. Volume of tissue activated in the left NBM was associated with stable cognition (P < 0.05). CONCLUSIONS Simultaneous GPi and NBM stimulation is safe and improves motor complications. NBM stimulation altered neuroimaging biomarkers but without lasting cognitive improvement. © 2021 International Parkinson and Movement Disorder Society.
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Affiliation(s)
| | - Melanie Cohn
- Department of Psychology, University of Toronto, Toronto, Ontario, Canada.,Krembil Brain Institute, Toronto, Ontario, Canada
| | - Irene E Harmsen
- Mitchell Goldhar MEG Unit, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.,Toronto Western Hospital, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
| | - Aaron Loh
- Toronto Western Hospital, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
| | - Sang Soo Cho
- Division of Brain, Imaging and Behaviour-Systems Neuroscience, Krembil Brain Institute, UHN, University of Toronto, Toronto, Ontario, Canada.,Department of Brain and Cognitive Sciences, Seoul National University, Seoul, Republic of Korea
| | - Michel Sáenz-Farret
- Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Centre, Toronto Western Hospital, UHN, Toronto, Ontario, Canada
| | - Ricardo Maciel
- Movement Disorders Unit, Hospital das Clínicas, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Derrick Soh
- Department of Neurology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Alexandre Boutet
- Toronto Western Hospital, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada.,Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Jürgen Germann
- Toronto Western Hospital, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
| | - Gavin Elias
- Toronto Western Hospital, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
| | - Ariana Youm
- Department of Psychology, University of Toronto, Toronto, Ontario, Canada
| | - Katherine Duncan
- Department of Psychology, University of Toronto, Toronto, Ontario, Canada
| | - Nathan C Rowland
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Antonio P Strafella
- Division of Neurology, University of Toronto, Toronto, Ontario, Canada.,Division of Brain, Imaging and Behaviour-Systems Neuroscience, Krembil Brain Institute, UHN, University of Toronto, Toronto, Ontario, Canada.,Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Centre, Toronto Western Hospital, UHN, Toronto, Ontario, Canada.,Brain Health Imaging Centre, Campbell Family Mental Health Research Institute, CAMH, University of Toronto, Toronto, Ontario, Canada
| | - Suneil K Kalia
- Krembil Brain Institute, Toronto, Ontario, Canada.,Toronto Western Hospital, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada.,Center for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, Ontario, Canada
| | - Andres M Lozano
- Krembil Brain Institute, Toronto, Ontario, Canada.,Toronto Western Hospital, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada.,Center for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, Ontario, Canada
| | - Alfonso Fasano
- Division of Neurology, University of Toronto, Toronto, Ontario, Canada.,Krembil Brain Institute, Toronto, Ontario, Canada.,Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Centre, Toronto Western Hospital, UHN, Toronto, Ontario, Canada.,Center for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, Ontario, Canada
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McInnis MC, Chow CT, Boutet A, Mafeld S, Granton J, McRae K, Donahoe L, de Perrot M. Global trends in chronic thromboembolic pulmonary hypertension clinical trials and dissemination of results. Pulm Circ 2021; 11:20458940211059994. [PMID: 34820116 PMCID: PMC8606729 DOI: 10.1177/20458940211059994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 10/24/2021] [Indexed: 11/16/2022] Open
Abstract
Treatment options for chronic thromboembolic pulmonary hypertension (CTEPH) are rapidly expanding. The purpose of this study is to identify trends in CTEPH clinical trials and the publication of results. We performed a worldwide review of completed and ongoing clinical trials through searching the ClinicalTrials.gov database and the World Health Organization International Clinical Trials Registry Platform for "CTEPH" and related terms. Entries were classified as pharmaceutical/procedural interventions (Group 1), all other clinical trials (Group 2) and patient registries (Group 3). Trial characteristics and national affiliation were recorded. PubMed was searched for related publications. There were 117 clinical trials registry entries after removing duplicates and non-target records. Group 1 comprised 29 pharmaceutical, 15 procedural, and four combined interventions starting in 2005, 2010, and 2016, respectively. Riociguat and balloon pulmonary angioplasty were the most frequent pharmaceutical and procedural interventions, respectively. The proportion of procedural trials increased over time from 0% of those in 2005-2009 to 29% in 2010-2014 and 54% in 2015-2020. There were 56 entries in Group 2 and 13 in Group 3. Japan was the most frequent national affiliation and the most frequent participating country, present in 28% of all trials. The proportion of entries with published results was highest with Group 3 (62%) and lowest with Group 1 (27%). Thirty percent of all publications occurred in 2020. In conclusion, CTEPH clinical trials are increasingly procedural based, with growth largely attributable to Japan and balloon pulmonary angioplasty. Most trials have not published, but results from balloon pulmonary angioplasty clinical trials are anticipated soon.
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Affiliation(s)
- Micheal C. McInnis
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Clement T. Chow
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Alexandre Boutet
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Sebastian Mafeld
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - John Granton
- Division of Respirology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Karen McRae
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
| | - Laura Donahoe
- Division of Thoracic Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Marc de Perrot
- Division of Thoracic Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
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De Vloo P, Lam E, Elias GJ, Boutet A, Sutandar K, Giacobbe P, Woodside DB, Lipsman N, Lozano A. Long-term follow-up of deep brain stimulation for anorexia nervosa. J Neurol Neurosurg Psychiatry 2021; 92:1135-1136. [PMID: 33687970 DOI: 10.1136/jnnp-2020-325711] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 01/20/2021] [Accepted: 02/10/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Philippe De Vloo
- Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada .,Department of Neurosurgery, KU Leuven, Leuven, Belgium
| | - Eileen Lam
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Gavin Jb Elias
- Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
| | - Alexandre Boutet
- Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada.,Medical Imaging, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Kalam Sutandar
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Peter Giacobbe
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - D Blake Woodside
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Nir Lipsman
- Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
| | - Andres Lozano
- Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
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Visanji NP, Ghani M, Yu E, Kakhki EG, Sato C, Moreno D, Naranian T, Poon YY, Abdollahi M, Naghibzadeh M, Rajalingam R, Lozano AM, Kalia SK, Hodaie M, Cohn M, Statucka M, Boutet A, Elias GJB, Germann J, Munhoz R, Lang AE, Gan-Or Z, Rogaeva E, Fasano A. Axial Impairment Following Deep Brain Stimulation in Parkinson's Disease: A Surgicogenomic Approach. J Parkinsons Dis 2021; 12:117-128. [PMID: 34602499 PMCID: PMC8842751 DOI: 10.3233/jpd-212730] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background: Postoperative outcome following deep brain stimulation (DBS) of the subthalamic nucleus is variable, particularly with respect to axial motor improvement. We hypothesized a genetic underpinning to the response to surgical intervention, termed “surgicogenomics”. Objective: We aimed to identify genetic variants associated with clinical heterogeneity in DBS outcome of Parkinson’s disease (PD) patients that could then be applied clinically to target selection leading to improved surgical outcome. Methods: Retrospective clinical data was extracted from 150 patient’s charts. Each individual was genotyped using the genome-wide NeuroX array tailored to study neurologic diseases. Genetic data were clustered based on surgical outcome assessed by comparing pre- and post-operative scores of levodopa equivalent daily dose and axial impairment at one and five years post-surgery. Allele frequencies were compared between patients with excellent vs. moderate/poor outcomes grouped using a priori defined cut-offs. We analyzed common variants, burden of rare coding variants, and PD polygenic risk score. Results: NeuroX identified 2,917 polymorphic markers at 113 genes mapped to known PD loci. The gene-burden analyses of 202 rare nonsynonymous variants suggested a nominal association of axial impairment with 14 genes (most consistent with CRHR1, IP6K2, and PRSS3). The strongest association with surgical outcome was detected between a reduction in levodopa equivalent daily dose and common variations tagging two linkage disequilibrium blocks with SH3GL2. Conclusion: Once validated in independent populations, our findings may be implemented to improve patient selection for DBS in PD.
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Affiliation(s)
- Naomi P Visanji
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | | | - Eric Yu
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montreal, Quebec, Canada.,The Department of Human Genetics, McGill University, Montreal, Quebec, Canada
| | - Erfan Ghani Kakhki
- DisorDATA Analytics, Ottawa, ON, Canada.,Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, ON, Canada
| | - Christine Sato
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, ON, Canada
| | - Danielle Moreno
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, ON, Canada
| | - Taline Naranian
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, Ontario, Canada
| | - Yu-Yan Poon
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, Ontario, Canada
| | - Maryam Abdollahi
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, Ontario, Canada
| | - Maryam Naghibzadeh
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, Ontario, Canada
| | - Rajasumi Rajalingam
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Andres M Lozano
- Department of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.,Krembil Brain Institute, Toronto, Ontario, Canada
| | - Suneil K Kalia
- Department of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.,Krembil Brain Institute, Toronto, Ontario, Canada.,CenteR for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, ON, Canada
| | - Mojgan Hodaie
- Department of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.,Krembil Brain Institute, Toronto, Ontario, Canada
| | - Melanie Cohn
- Krembil Brain Institute, Toronto, Ontario, Canada
| | | | - Alexandre Boutet
- Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Gavin J B Elias
- Department of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Jürgen Germann
- Department of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Renato Munhoz
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, Ontario, Canada.,Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Anthony E Lang
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, Ontario, Canada.,Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, ON, Canada.,Krembil Brain Institute, Toronto, Ontario, Canada.,Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Ziv Gan-Or
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montreal, Quebec, Canada.,The Department of Human Genetics, McGill University, Montreal, Quebec, Canada.,The Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
| | - Ekaterina Rogaeva
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, ON, Canada.,Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, Ontario, Canada.,Krembil Brain Institute, Toronto, Ontario, Canada.,Division of Neurology, University of Toronto, Toronto, Ontario, Canada.,CenteR for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, ON, Canada
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Paff M, Boutet A, Germann J, Elias GJB, Chow CT, Loh A, Kucharczyk W, Fasano A, Schwartz ML, Lozano AM. Focused Ultrasound Thalamotomy Sensory Side Effects Follow the Thalamic Structural Homunculus. Neurol Clin Pract 2021; 11:e497-e503. [PMID: 34484947 DOI: 10.1212/cpj.0000000000001013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 09/24/2020] [Indexed: 11/15/2022]
Abstract
Objective Focused ultrasound thalamotomy is an effective treatment for tremor; however, side effects may occur. The purpose of the present study was to investigate the spatial relationship between thalamotomies and specific sensory side effects and their functional connectivity with somatosensory cortex and relationship to the medial lemniscus (ML). Methods Sensory adverse effects were categorized into 4 groups based on the location of the disturbance: face/mouth/tongue numbness/paresthesia, hand-only paresthesia, hemibody/limb paresthesia, and dysgeusia. Then, areas of significant risk (ASRs) for each category were defined using voxel-wise mass univariate analysis and overlaid on corresponding odds ratio maps. The ASR associated with the maximum risk was used as a region of interest in a normative functional connectome to determine side effect-specific functional connectivity. Finally, each ASR was overlaid on the ML derived from normative template. Results Of 103 patients, 17 developed sensory side effects after thalamotomy persisting 3 months after the procedures. Lesions producing sensory side effects extended posteriorly into the principle sensory nucleus of the thalamus or below the thalamus in the ML. The topography of sensory adverse effects followed the known somatotopy of the ML and the sensory nucleus. Functional connectivity patterns between each sensory-specific thalamic seed and the primary somatosensory areas supported the role of the middle insula in processing of gustatory information and in multisensory integration. Conclusions Distinct regions in the sensory thalamus and its afferent connections rise to specific sensory disturbances. These findings demonstrate the relationship between the sensory thalamus, ML, and bilateral sensory cortical areas.
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Affiliation(s)
- Michelle Paff
- University Health Network (MP, AB, JG, GJBE, CTC, AL, WK, AML), Toronto; Joint Department of Medical Imaging (AB, WK), University of Toronto; Edmond J. Safra Program in Parkinson's Disease (AF), Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, and Division of Neurology (AF), University of Toronto; Krembil Brain Institute (AF); Division of Neurosurgery (MLS), Sunnybrook Health Sciences Center, University of Toronto; and Division of Neurosurgery (AML), Department of Surgery, Toronto Western Hospital and University of Toronto, Ontario, Canada
| | - Alexandre Boutet
- University Health Network (MP, AB, JG, GJBE, CTC, AL, WK, AML), Toronto; Joint Department of Medical Imaging (AB, WK), University of Toronto; Edmond J. Safra Program in Parkinson's Disease (AF), Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, and Division of Neurology (AF), University of Toronto; Krembil Brain Institute (AF); Division of Neurosurgery (MLS), Sunnybrook Health Sciences Center, University of Toronto; and Division of Neurosurgery (AML), Department of Surgery, Toronto Western Hospital and University of Toronto, Ontario, Canada
| | - Jürgen Germann
- University Health Network (MP, AB, JG, GJBE, CTC, AL, WK, AML), Toronto; Joint Department of Medical Imaging (AB, WK), University of Toronto; Edmond J. Safra Program in Parkinson's Disease (AF), Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, and Division of Neurology (AF), University of Toronto; Krembil Brain Institute (AF); Division of Neurosurgery (MLS), Sunnybrook Health Sciences Center, University of Toronto; and Division of Neurosurgery (AML), Department of Surgery, Toronto Western Hospital and University of Toronto, Ontario, Canada
| | - Gavin J B Elias
- University Health Network (MP, AB, JG, GJBE, CTC, AL, WK, AML), Toronto; Joint Department of Medical Imaging (AB, WK), University of Toronto; Edmond J. Safra Program in Parkinson's Disease (AF), Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, and Division of Neurology (AF), University of Toronto; Krembil Brain Institute (AF); Division of Neurosurgery (MLS), Sunnybrook Health Sciences Center, University of Toronto; and Division of Neurosurgery (AML), Department of Surgery, Toronto Western Hospital and University of Toronto, Ontario, Canada
| | - Clement T Chow
- University Health Network (MP, AB, JG, GJBE, CTC, AL, WK, AML), Toronto; Joint Department of Medical Imaging (AB, WK), University of Toronto; Edmond J. Safra Program in Parkinson's Disease (AF), Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, and Division of Neurology (AF), University of Toronto; Krembil Brain Institute (AF); Division of Neurosurgery (MLS), Sunnybrook Health Sciences Center, University of Toronto; and Division of Neurosurgery (AML), Department of Surgery, Toronto Western Hospital and University of Toronto, Ontario, Canada
| | - Aaron Loh
- University Health Network (MP, AB, JG, GJBE, CTC, AL, WK, AML), Toronto; Joint Department of Medical Imaging (AB, WK), University of Toronto; Edmond J. Safra Program in Parkinson's Disease (AF), Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, and Division of Neurology (AF), University of Toronto; Krembil Brain Institute (AF); Division of Neurosurgery (MLS), Sunnybrook Health Sciences Center, University of Toronto; and Division of Neurosurgery (AML), Department of Surgery, Toronto Western Hospital and University of Toronto, Ontario, Canada
| | - Walter Kucharczyk
- University Health Network (MP, AB, JG, GJBE, CTC, AL, WK, AML), Toronto; Joint Department of Medical Imaging (AB, WK), University of Toronto; Edmond J. Safra Program in Parkinson's Disease (AF), Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, and Division of Neurology (AF), University of Toronto; Krembil Brain Institute (AF); Division of Neurosurgery (MLS), Sunnybrook Health Sciences Center, University of Toronto; and Division of Neurosurgery (AML), Department of Surgery, Toronto Western Hospital and University of Toronto, Ontario, Canada
| | - Alfonso Fasano
- University Health Network (MP, AB, JG, GJBE, CTC, AL, WK, AML), Toronto; Joint Department of Medical Imaging (AB, WK), University of Toronto; Edmond J. Safra Program in Parkinson's Disease (AF), Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, and Division of Neurology (AF), University of Toronto; Krembil Brain Institute (AF); Division of Neurosurgery (MLS), Sunnybrook Health Sciences Center, University of Toronto; and Division of Neurosurgery (AML), Department of Surgery, Toronto Western Hospital and University of Toronto, Ontario, Canada
| | - Michael L Schwartz
- University Health Network (MP, AB, JG, GJBE, CTC, AL, WK, AML), Toronto; Joint Department of Medical Imaging (AB, WK), University of Toronto; Edmond J. Safra Program in Parkinson's Disease (AF), Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, and Division of Neurology (AF), University of Toronto; Krembil Brain Institute (AF); Division of Neurosurgery (MLS), Sunnybrook Health Sciences Center, University of Toronto; and Division of Neurosurgery (AML), Department of Surgery, Toronto Western Hospital and University of Toronto, Ontario, Canada
| | - Andres M Lozano
- University Health Network (MP, AB, JG, GJBE, CTC, AL, WK, AML), Toronto; Joint Department of Medical Imaging (AB, WK), University of Toronto; Edmond J. Safra Program in Parkinson's Disease (AF), Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, and Division of Neurology (AF), University of Toronto; Krembil Brain Institute (AF); Division of Neurosurgery (MLS), Sunnybrook Health Sciences Center, University of Toronto; and Division of Neurosurgery (AML), Department of Surgery, Toronto Western Hospital and University of Toronto, Ontario, Canada
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Elias GJB, Boutet A, Parmar R, Wong EHY, Germann J, Loh A, Paff M, Pancholi A, Gwun D, Chow CT, Gouveia FV, Harmsen IE, Beyn ME, Santarnecchi E, Fasano A, Blumberger DM, Kennedy SH, Lozano AM, Bhat V. Neuromodulatory treatments for psychiatric disease: A comprehensive survey of the clinical trial landscape. Brain Stimul 2021; 14:1393-1403. [PMID: 34461326 DOI: 10.1016/j.brs.2021.08.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 08/21/2021] [Accepted: 08/24/2021] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Numerous neuromodulatory therapies are currently under investigation or in clinical use for the treatment of psychiatric conditions. OBJECTIVE/HYPOTHESIS We sought to catalogue past and present human research studies on psychiatric neuromodulation and identify relevant trends in this field. METHODS ClinicalTrials.gov (https://www.clinicaltrials.gov/) and the International Clinical Trials Registry Platform (https://www.who.int/ictrp/en/) were queried in March 2020 for trials assessing the outcome of neuromodulation for psychiatric disorders. Relevant trials were categorized by variables such as neuromodulation modality, country, brain target, publication status, design, and funding source. RESULTS From 72,086 initial search results, 1252 unique trials were identified. The number of trials registered annually has consistently increased. Half of all trials were active and a quarter have translated to publications. The largest proportion of trials involved depression (45%), schizophrenia (18%), and substance use disorders (14%). Trials spanned 37 countries; China, the second largest contributor (13%) after the United States (28%), has increased its output substantially in recent years. Over 75% of trials involved non-convulsive non-invasive modalities (e.g., transcranial magnetic stimulation), while convulsive (e.g., electroconvulsive therapy) and invasive modalities (e.g., deep brain stimulation) were less represented. 72% of trials featured approved or cleared interventions. Characteristic inter-modality differences were observed with respect to enrollment size, trial design/phase, and funding. Dorsolateral prefrontal cortex accounted for over half of focal neuromodulation trial targets. The proportion of trials examining biological correlates of neuromodulation has increased. CONCLUSION(S) These results provide a comprehensive overview of the state of psychiatric neuromodulation research, revealing the growing scope and internationalism of this field.
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Affiliation(s)
- Gavin J B Elias
- Division of Neurosurgery, Department of Surgery, University Health Network & University of Toronto, Toronto, Canada; Krembil Research Institute, University of Toronto, Toronto, Canada
| | - Alexandre Boutet
- Division of Neurosurgery, Department of Surgery, University Health Network & University of Toronto, Toronto, Canada; Krembil Research Institute, University of Toronto, Toronto, Canada; Joint Department of Medical Imaging, University of Toronto, Toronto, Canada
| | - Roohie Parmar
- Division of Neurosurgery, Department of Surgery, University Health Network & University of Toronto, Toronto, Canada
| | - Emily H Y Wong
- Division of Neurosurgery, Department of Surgery, University Health Network & University of Toronto, Toronto, Canada
| | - Jürgen Germann
- Division of Neurosurgery, Department of Surgery, University Health Network & University of Toronto, Toronto, Canada; Krembil Research Institute, University of Toronto, Toronto, Canada
| | - Aaron Loh
- Division of Neurosurgery, Department of Surgery, University Health Network & University of Toronto, Toronto, Canada; Krembil Research Institute, University of Toronto, Toronto, Canada
| | - Michelle Paff
- Division of Neurosurgery, Department of Surgery, University Health Network & University of Toronto, Toronto, Canada
| | - Aditya Pancholi
- Division of Neurosurgery, Department of Surgery, University Health Network & University of Toronto, Toronto, Canada
| | - Dave Gwun
- Division of Neurosurgery, Department of Surgery, University Health Network & University of Toronto, Toronto, Canada
| | - Clement T Chow
- Division of Neurosurgery, Department of Surgery, University Health Network & University of Toronto, Toronto, Canada
| | - Flavia Venetucci Gouveia
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre & University of Toronto, Toronto, Canada
| | - Irene E Harmsen
- Division of Neurosurgery, Department of Surgery, University Health Network & University of Toronto, Toronto, Canada; Krembil Research Institute, University of Toronto, Toronto, Canada
| | - Michelle E Beyn
- Division of Neurosurgery, Department of Surgery, University Health Network & University of Toronto, Toronto, Canada
| | - Emiliano Santarnecchi
- Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, United States
| | - Alfonso Fasano
- Krembil Research Institute, University of Toronto, Toronto, Canada; Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, University Health Network, Toronto, Canada; Center for Advancing Neurotechnological Innovation to Application, Toronto, Canada
| | - Daniel M Blumberger
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, University Health Network & University of Toronto, Toronto, Canada
| | - Sidney H Kennedy
- Krembil Research Institute, University of Toronto, Toronto, Canada; Department of Psychiatry, University Health Network & University of Toronto, Toronto, Canada; Centre for Depression & Suicide Studies, St. Michael's Hospital & University of Toronto, Toronto, Canada
| | - Andres M Lozano
- Division of Neurosurgery, Department of Surgery, University Health Network & University of Toronto, Toronto, Canada; Krembil Research Institute, University of Toronto, Toronto, Canada
| | - Venkat Bhat
- Krembil Research Institute, University of Toronto, Toronto, Canada; Department of Psychiatry, University Health Network & University of Toronto, Toronto, Canada; Centre for Depression & Suicide Studies, St. Michael's Hospital & University of Toronto, Toronto, Canada.
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Germann J, Mameli M, Elias GJB, Loh A, Taha A, Gouveia FV, Boutet A, Lozano AM. Deep Brain Stimulation of the Habenula: Systematic Review of the Literature and Clinical Trial Registries. Front Psychiatry 2021; 12:730931. [PMID: 34484011 PMCID: PMC8415908 DOI: 10.3389/fpsyt.2021.730931] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 07/21/2021] [Indexed: 11/13/2022] Open
Abstract
The habenula is a small bilateral epithalamic structure that plays a key role in the regulation of the main monoaminergic systems. It is implicated in many aspects of behavior such as reward processing, motivational behavior, behavioral adaptation, and sensory integration. A role of the habenula has been indicated in the pathophysiology of a number of neuropsychiatric disorders such as depression, addiction, obsessive-compulsive disorder, and bipolar disorder. Neuromodulation of the habenula using deep brain stimulation (DBS) as potential treatment has been proposed and a first successful case of habenula DBS was reported a decade ago. To provide an overview of the current state of habenula DBS in human subjects for the treatment of neuropsychiatric disorders we conducted a systematic review of both the published literature using PUBMED and current and past registered clinical trials using ClinicalTrials.gov as well as the International Clinical Trials Registry Platform. Using PRISMA guidelines five articles and five registered clinical trials were identified. The published articles detailed the results of habenula DBS for the treatment of schizophrenia, depression, obsessive-compulsive disorder, and bipolar disorder. Four are single case studies; one reports findings in two patients and positive clinical outcome is described in five of the six patients. Of the five registered clinical trials identified, four investigate habenula DBS for the treatment of depression and one for obsessive-compulsive disorder. One trial is listed as terminated, one is recruiting, two are not yet recruiting and the status of the fifth is unknown. The planned enrollment varies between 2 to 13 subjects and four of the five are open label trials. While the published studies suggest a potential role of habenula DBS for a number of indications, future trials and studies are necessary. The outcomes of the ongoing clinical trials will provide further valuable insights. Establishing habenula DBS, however, will depend on successful randomized clinical trials to confirm application and clinical benefit of this promising intervention.
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Affiliation(s)
- Jürgen Germann
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Manuel Mameli
- The Department of Fundamental Neuroscience, The University of Lausanne, Lausanne, Switzerland
- INSERM, UMR-S 839, Paris, France
| | - Gavin J. B. Elias
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Aaron Loh
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Alaa Taha
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Flavia Venetucci Gouveia
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Alexandre Boutet
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, ON, Canada
- Joint Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Andres M. Lozano
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, ON, Canada
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Elias GJB, Loh A, Gwun D, Pancholi A, Boutet A, Neudorfer C, Germann J, Namasivayam A, Gramer R, Paff M, Lozano AM. Deep brain stimulation of the brainstem. Brain 2021; 144:712-723. [PMID: 33313788 DOI: 10.1093/brain/awaa374] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 07/31/2020] [Accepted: 08/17/2020] [Indexed: 01/02/2023] Open
Abstract
Deep brain stimulation (DBS) of the subthalamic nucleus, pallidum, and thalamus is an established therapy for various movement disorders. Limbic targets have also been increasingly explored for their application to neuropsychiatric and cognitive disorders. The brainstem constitutes another DBS substrate, although the existing literature on the indications for and the effects of brainstem stimulation remains comparatively sparse. The objective of this review was to provide a comprehensive overview of the pertinent anatomy, indications, and reported stimulation-induced acute and long-term effects of existing white and grey matter brainstem DBS targets. We systematically searched the published literature, reviewing clinical trial articles pertaining to DBS brainstem targets. Overall, 164 studies describing brainstem DBS were identified. These studies encompassed 10 discrete structures: periaqueductal/periventricular grey (n = 63), pedunculopontine nucleus (n = 48), ventral tegmental area (n = 22), substantia nigra (n = 9), mesencephalic reticular formation (n = 7), medial forebrain bundle (n = 8), superior cerebellar peduncles (n = 3), red nucleus (n = 3), parabrachial complex (n = 2), and locus coeruleus (n = 1). Indications for brainstem DBS varied widely and included central neuropathic pain, axial symptoms of movement disorders, headache, depression, and vegetative state. The most promising results for brainstem DBS have come from targeting the pedunculopontine nucleus for relief of axial motor deficits, periaqueductal/periventricular grey for the management of central neuropathic pain, and ventral tegmental area for treatment of cluster headaches. Brainstem DBS has also acutely elicited numerous motor, limbic, and autonomic effects. Further work involving larger, controlled trials is necessary to better establish the therapeutic potential of DBS in this complex area.
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Affiliation(s)
- Gavin J B Elias
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Canada
| | - Aaron Loh
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Canada
| | - Dave Gwun
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Canada
| | - Aditya Pancholi
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Canada
| | - Alexandre Boutet
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Canada.,Joint Department of Medical Imaging, University of Toronto, Toronto, Canada
| | - Clemens Neudorfer
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Canada
| | - Jürgen Germann
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Canada
| | - Andrew Namasivayam
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Canada
| | - Robert Gramer
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Canada
| | - Michelle Paff
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Canada
| | - Andres M Lozano
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Canada
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Yamamoto K, Elias GJB, Beyn ME, Zemmar A, Loh A, Sarica C, Germann J, Parmar R, Wong EHY, Boutet A, Kalia S, Hodaie M, Lozano AM. Neuromodulation for Pain: A Comprehensive Survey and Systematic Review of Clinical Trials and Connectomic Analysis of Brain Targets. Stereotact Funct Neurosurg 2021; 100:14-25. [PMID: 34380132 DOI: 10.1159/000517873] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 05/28/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Chronic pain is a debilitating condition that imposes a tremendous burden on health-care systems around the world. While frontline treatments for chronic pain involve pharmacological and psychological approaches, neuromodulation can be considered for treatment-resistant cases. Neuromodulatory approaches for pain are diverse in both modality and target and their mechanism of action is incompletely understood. OBJECTIVES The objectives of this study were to (i) understand the current landscape of pain neuromodulation research through a comprehensive survey of past and current registered clinical trials (ii) investigate the network underpinnings of these neuromodulatory treatments by performing a connectomic mapping analysis of cortical and subcortical brain targets that have been stimulated for pain relief. METHODS A search for clinical trials involving pain neuromodulation was conducted using 2 major trial databases (ClinicalTrials.gov and the International Clinical Trials Registry Platform). Trials were categorized by variables and analyzed to gain an overview of the contemporary research landscape. Additionally, a connectomic mapping analysis was performed to investigate the network connectivity patterns of analgesic brain stimulation targets using a normative connectome based on a functional magnetic resonance imaging dataset. RESULTS In total, 487 relevant clinical trials were identified. Noninvasive cortical stimulation and spinal cord stimulation trials represented 49.3 and 43.7% of this count, respectively, while deep brain stimulation trials accounted for <3%. The mapping analysis revealed that superficial target connectomics overlapped with deep target connectomics, suggesting a common pain network across the targets. CONCLUSIONS Research for pain neuromodulation is a rapidly growing field. Our connectomic network analysis reinforced existing knowledge of the pain matrix, identifying both well-described hubs and more obscure structures. Further studies are needed to decode the circuits underlying pain relief and determine the most effective targets for neuromodulatory treatment.
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Affiliation(s)
- Kazuaki Yamamoto
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Ontario, Canada,
| | - Gavin J B Elias
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Michelle E Beyn
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Ajmal Zemmar
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Ontario, Canada
- Department of Neurosurgery, People's Hospital of Zhengzhou University, Henan Provincial People's Hospital, Henan University People's Hospital, Henan University School of Medicine, Zhengzhou, China
| | - Aaron Loh
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Can Sarica
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Jürgen Germann
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Roohie Parmar
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Emily H Y Wong
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Alexandre Boutet
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Ontario, Canada
- Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Suneil Kalia
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Mojgan Hodaie
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Andres M Lozano
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Ontario, Canada
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48
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Elias GJB, Germann J, Boutet A, Pancholi A, Beyn ME, Bhatia K, Neudorfer C, Loh A, Rizvi SJ, Bhat V, Giacobbe P, Woodside DB, Kennedy SH, Lozano AM. Structuro-functional surrogates of response to subcallosal cingulate deep brain stimulation for depression. Brain 2021; 145:362-377. [PMID: 34324658 DOI: 10.1093/brain/awab284] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 06/01/2021] [Accepted: 07/07/2021] [Indexed: 11/14/2022] Open
Abstract
Subcallosal cingulate deep brain stimulation (SCC-DBS) produces long-term clinical improvement in approximately half of patients with severe treatment-resistant depression (TRD). We hypothesized that both structural and functional brain attributes may be important in determining responsiveness to this therapy. In a TRD SCC-DBS cohort, we retrospectively examined baseline and longitudinal differences in MRI-derived brain volume (n = 65) and 18F-fluorodeoxyglucose-PET glucose metabolism (n = 21) between responders and non-responders. Support-vector machines (SVMs) were subsequently trained to classify patients' response status based on extracted baseline imaging features. A machine learning model incorporating pre-operative frontopolar, precentral/frontal opercular, and orbitofrontal local volume values classified binary response status (12 months) with 83% accuracy (leave-one-out cross-validation (LOOCV): 80% accuracy) and explained 32% of the variance in continuous clinical improvement. It was also predictive in an out-of-sample SCC-DBS cohort (n = 21) with differing primary indications (bipolar disorder/anorexia nervosa) (76% accuracy). Adding pre-operative glucose metabolism information from rostral anterior cingulate cortex and temporal pole improved model performance, enabling it to predict response status in the TRD cohort with 86% accuracy (LOOCV: 81% accuracy) and explain 67% of clinical variance. Response-related patterns of metabolic and structural post-DBS change were also observed, especially in anterior cingulate cortex and neighbouring white matter. Areas where responders differed from non-responders - both at baseline and longitudinally - largely overlapped with depression-implicated white matter tracts, namely uncinate fasciculus, cingulum bundle, and forceps minor/rostrum of corpus callosum. The extent of patient-specific engagement of these same tracts (according to electrode location and stimulation parameters) also served as a predictor of TRD response status (72% accuracy; LOOCV: 70% accuracy) and augmented performance of the volume-based (88% accuracy; LOOCV: 82% accuracy) and combined volume/metabolism-based SVMs (100% accuracy; LOOCV: 94% accuracy). Taken together, these results indicate that responders and non-responders to SCC-DBS exhibit differences in brain volume and metabolism, both pre- and post-surgery. Baseline imaging features moreover predict response to treatment (particularly when combined with information about local tract engagement) and could inform future patient selection and other clinical decisions.
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Affiliation(s)
- Gavin J B Elias
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, M5T 2S8, Canada.,Krembil Research Institute, University of Toronto, Toronto, M5T 0S8, Canada
| | - Jürgen Germann
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, M5T 2S8, Canada.,Krembil Research Institute, University of Toronto, Toronto, M5T 0S8, Canada
| | - Alexandre Boutet
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, M5T 2S8, Canada.,Krembil Research Institute, University of Toronto, Toronto, M5T 0S8, Canada.,Joint Department of Medical Imaging, University of Toronto, Toronto, M5T 1W7, Canada
| | - Aditya Pancholi
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, M5T 2S8, Canada
| | - Michelle E Beyn
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, M5T 2S8, Canada
| | - Kartik Bhatia
- Joint Department of Medical Imaging, University of Toronto, Toronto, M5T 1W7, Canada
| | - Clemens Neudorfer
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, M5T 2S8, Canada
| | - Aaron Loh
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, M5T 2S8, Canada.,Krembil Research Institute, University of Toronto, Toronto, M5T 0S8, Canada
| | - Sakina J Rizvi
- ASR Suicide and Depression Studies Unit, St. Michael's Hospital, University of Toronto, M5B 1M8, Canada.,Department of Psychiatry, University Health Network and University of Toronto, Toronto, M5T 2S8, Canada
| | - Venkat Bhat
- ASR Suicide and Depression Studies Unit, St. Michael's Hospital, University of Toronto, M5B 1M8, Canada.,Department of Psychiatry, University Health Network and University of Toronto, Toronto, M5T 2S8, Canada
| | - Peter Giacobbe
- Department of Psychiatry, Sunnybrook Health Sciences Centre and University of Toronto, Toronto, M4N 3M5, Canada
| | - D Blake Woodside
- ASR Suicide and Depression Studies Unit, St. Michael's Hospital, University of Toronto, M5B 1M8, Canada
| | - Sidney H Kennedy
- Krembil Research Institute, University of Toronto, Toronto, M5T 0S8, Canada.,ASR Suicide and Depression Studies Unit, St. Michael's Hospital, University of Toronto, M5B 1M8, Canada.,Department of Psychiatry, University Health Network and University of Toronto, Toronto, M5T 2S8, Canada
| | - Andres M Lozano
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, M5T 2S8, Canada.,Krembil Research Institute, University of Toronto, Toronto, M5T 0S8, Canada
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49
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Iorio-Morin C, Yamamoto K, Sarica C, Zemmar A, Levesque M, Brisebois S, Germann J, Loh A, Boutet A, Elias GJB, Azevedo P, Adam E, Patel U, Lenis M, Kalia SK, Hodaie M, Fasano A, Lozano AM. Bilateral Focused Ultrasound Thalamotomy for Essential Tremor (BEST-FUS Phase 2 Trial). Mov Disord 2021; 36:2653-2662. [PMID: 34288097 DOI: 10.1002/mds.28716] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 06/21/2021] [Accepted: 06/22/2021] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND In patients with medically refractory essential tremor, unilateral magnetic resonance-guided focused ultrasound thalamotomy can improve contralateral tremor. However, this procedure does not address ipsilateral symptoms. OBJECTIVE The objective of the current study was to determine whether bilateral thalamotomies can be performed with an acceptable safety profile where benefits outweigh adverse effects. METHODS We conducted a prospective, single-arm, single-blinded phase 2 trial of second-side magnetic resonance-guided focused ultrasound thalamotomy in patients with essential tremor. Patients were followed for 3 months. The primary outcome was the change in quality of life relative to baseline, as well as the answer to the question "Given what you know now, would you treat the second side again?". Secondary outcomes included tremor, gait, speech, and adverse effects. RESULTS Ten patients were analyzed. The study met both primary outcomes, with the intervention resulting in clinically significant improvement in quality of life at 3 months (mean Quality of Life in Essential Tremor score difference, 19.7; 95%CI, 8.0-31.4; P = 0.004) and all patients reporting that they would elect to receive the second-side treatment again. Tremor significantly improved in all patients. Seven experienced mild adverse effects, including 2 with transient gait impairment and a fall, 1 with dysarthria and dysphagia, and 1 with mild dysphagia persisting at 3 months. CONCLUSIONS Staged bilateral magnetic resonance-guided focused ultrasound thalamotomy can be performed with a reasonable safety profile similar to that seen with unilateral thalamotomy and improves the tremor and quality of life of patients with essential tremor. Longer-term follow-up and continued accrual in the phase 3 trial will be required to validate these findings. © 2021 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Christian Iorio-Morin
- Division of Neurosurgery, Department of Surgery, Université de Sherbrooke, Sherbrooke, Québec, Canada.,Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Kazuaki Yamamoto
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Can Sarica
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Ajmal Zemmar
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Neurosurgery, People's Hospital of Zhengzhou University, Henan Provincial People's Hospital, Henan University People's Hospital, Henan University School of Medicine, Zhengzhou, China
| | - Mathieu Levesque
- Division of Neurology, Department of Medicine, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Simon Brisebois
- Division of Otolaryngology - Head & Neck Surgery, Department of Surgery, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Jurgen Germann
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Aaron Loh
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Alexandre Boutet
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Gavin J B Elias
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Paula Azevedo
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, Ontario, Canada. Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Elizabeth Adam
- Division of Neurosurgery, Department of Surgery, Université de Sherbrooke, Sherbrooke, Québec, Canada.,Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Urmi Patel
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Martha Lenis
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Suneil K Kalia
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Krembil Brain Institute, Toronto, Ontario, Canada
| | - Mojgan Hodaie
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, Ontario, Canada. Division of Neurology, University of Toronto, Toronto, Ontario, Canada.,Krembil Brain Institute, Toronto, Ontario, Canada
| | - Andres M Lozano
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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50
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Soh D, Maciel R, Algarni M, Lizarraga K, Loh A, Germann J, Elias G, Boutet A, Munhoz RP, Kalia SK, Hodaie M, Lozano AM, Fasano A. Flexible vs. standard subthalamic stimulation in Parkinson disease: A double-blind proof-of-concept cross-over trial. Parkinsonism Relat Disord 2021; 89:93-97. [PMID: 34271424 DOI: 10.1016/j.parkreldis.2021.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 07/01/2021] [Accepted: 07/05/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Deep brain stimulation (DBS) of the subthalamus (STN) is effective for the treatment of cardinal motor signs of Parkinson disease (PD). Structures around the STN can suppress dyskinesia and tremor (zona incerta) and improve gait and balance (substantia nigra pars reticulata). OBJECTIVE Is the newer 8-contact linear lead connected to a 'flexible' DBS system superior to standard 4-contact stimulation in PD patients receiving STN DBS? METHODS After 3 months of open label programming, 10 patients were randomized to standard or flexible stimulation before crossing over to the other arm (3 months each period). Patients and assessors were blinded. RESULTS A trend to improvement in Patient Global Impression of Change scores was seen with standard to flexible stimulation and worsening from flexible to standard stimulation (mean ± SD: 0.7 ± 1.2 and -0.4 ± 1.5 respectively, p = 0.152). There was a significant reduction in the number of troublesome symptoms reported prior to DBS (2.6 ± 3.3 per patient), more so with flexible stimulation (0.4 ± 0.6 vs. 1.5 ± 1.6 with standard stimulation, p = 0.001 and p = 0.034). There was no significant difference between the flexible and standard stimulation groups. CONCLUSION Further studies confirming that flexible stimulation is superior to standard DBS are warranted.
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Affiliation(s)
- Derrick Soh
- Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Centre, Toronto Western Hospital, UHN, Toronto, Canada; Alfred Hospital, Melbourne, Victoria, Australia
| | - Ricardo Maciel
- Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Centre, Toronto Western Hospital, UHN, Toronto, Canada
| | - Musleh Algarni
- Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Centre, Toronto Western Hospital, UHN, Toronto, Canada
| | - Karlo Lizarraga
- Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Centre, Toronto Western Hospital, UHN, Toronto, Canada; Motor Physiology and Neuromodulation Program, Division of Movement Disorders and Center for Health + Technology (CHeT), Department of Neurology, University of Rochester, United States
| | - Aaron Loh
- Division of Neurosurgery, Department of Neurosurgery, Toronto Western Hospital, University of Toronto, Canada
| | - Jürgen Germann
- Division of Neurosurgery, Department of Neurosurgery, Toronto Western Hospital, University of Toronto, Canada
| | - Gavin Elias
- Division of Neurosurgery, Department of Neurosurgery, Toronto Western Hospital, University of Toronto, Canada
| | - Alexandre Boutet
- Division of Neurosurgery, Department of Neurosurgery, Toronto Western Hospital, University of Toronto, Canada; Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Renato P Munhoz
- Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Centre, Toronto Western Hospital, UHN, Toronto, Canada
| | - Suneil K Kalia
- Division of Neurosurgery, Department of Neurosurgery, Toronto Western Hospital, University of Toronto, Canada; Krembil Brain Institute, Toronto, Canada
| | - Mojgan Hodaie
- Division of Neurosurgery, Department of Neurosurgery, Toronto Western Hospital, University of Toronto, Canada; Krembil Brain Institute, Toronto, Canada
| | - Andres M Lozano
- Division of Neurosurgery, Department of Neurosurgery, Toronto Western Hospital, University of Toronto, Canada; Krembil Brain Institute, Toronto, Canada
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Centre, Toronto Western Hospital, UHN, Toronto, Canada; Krembil Brain Institute, Toronto, Canada; The Center for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, ON, Canada.
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