Article
Connectivity patterns of different targets for DBS in Tourette syndrome
DBS-Zielpunkte Konnektivitätsmuster bei Patienten mit Tourette Syndrom
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Authors
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Petra Heiden
- Universitätsklinikum Köln, Klinik für Stereotaxie und Funktionelle Neurochirurgie, Köln, Deutschland
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Moritz Hoevels
- Universitätsklinikum Köln, Klinik für Stereotaxie und Funktionelle Neurochirurgie, Köln, Deutschland
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Veerle Visser-Vandewalle
- Universitätsklinikum Köln, Klinik für Stereotaxie und funktionelle Neurochirurgie, Köln, Deutschland
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Pablo Andrade
- Universitätsklinikum Köln, Klinik für Stereotaxie und Funktionelle Neurochirurgie, Köln, Deutschland
| Published: | June 4, 2021 |
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Outline
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Objective: Deep brain stimulation (DBS) is an effective therapy option for patients with treatment refractory Tourette syndrome (TS). Since the first TS case treated with DBS in 1999, several targets have been explored reporting similar success rates. Currently, imaging techniques like probabilistic tractography and normative human connectome data (HCP) have contributed to identify connectivity profiles associated with better outcome for individual targets. The objective of this study is to analyze the connectivity profiles of different DBS targets for TS in order to assist preoperative planning. Further, we compare these connectivity patterns based on HCP and probabilistic tractography using datasets of TS patients.
Methods: We generated volumes of tissue activated (VTA) at standard target coordinates for the centromedial nucleus/nucleus ventrooralis internus (CM/Voi), the CM/parafascicular (CM/Pf), the anteromedial globus pallidus internus (amGPi), the posteroventral GPi (pvGPi), the ventral anterior/ventrolateral thalamus (VA/VL), and the nucleus accumbens/anterior limb of the internal capsule (Nacc/ALIC) based on literature. Probabilistic tractography was performed from the targets to different limbic and motor areas based on diffusion tensor imaging of TS patients. The same connections were analyzed using HCP and connectomic atlases of TS patients using LEAD connectome.
Results: Our analysis showed significant differences among the connectivity profiles of standard DBS targets (p<0.01). The thalamic targets VA/VL showed the strongest connection to the motor cortex and the supplementary motor areas, while CM/Voi had higher connectivity to the prefrontal cortex. Out of the pallidal targets the connectivity profile of pvGPi was more associated with the motor cortex, but also showed high connectivity to the amygdala, while amGPi had stronger connection to the prefrontal cortex. Nacc/ALIC had the weakest connection to the motor cortex.
Conclusion: This analysis shows that the connectivity profiles of different DBS targets to main motor and limbic areas differ significantly. This should be considered when planning DBS for TS patients, probably based on the clinical profile of the patient.
