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Right Brodmann area 18 predicts tremor arrest after Vim radiosurgery: a voxel-based morphometry study

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Abstract

Introduction

Drug-resistant essential tremor (ET) can benefit from open standard stereotactic procedures, such as deep-brain stimulation or radiofrequency thalamotomy. Non-surgical candidates can be offered either high-focused ultrasound (HIFU) or radiosurgery (RS). All procedures aim to target the same thalamic site, the ventro-intermediate nucleus (e.g., Vim). The mechanisms by which tremor stops after Vim RS or HIFU remain unknown. We used voxel-based morphometry (VBM) on pretherapeutic neuroimaging data and assessed which anatomical site would best correlate with tremor arrest 1 year after Vim RS.

Methods

Fifty-two patients (30 male, 22 female; mean age 71.6 years, range 49–82) with right-sided ET benefited from left unilateral Vim RS in Marseille, France. Targeting was performed in a uniform manner, using 130 Gy and a single 4-mm collimator. Neurological (pretherapeutic and 1 year after) and neuroimaging (baseline) assessments were completed. Tremor score on the treated hand (TSTH) at 1 year after Vim RS was included in a statistical parametric mapping analysis of variance (ANOVA) model as a continuous variable with pretherapeutic neuroimaging data. Pretherapeutic gray matter density (GMD) was further correlated with TSTH improvement. No a priori hypothesis was used in the statistical model.

Results

The only statistically significant region was right Brodmann area (BA) 18 (visual association area V2, p = 0.05, cluster size Kc = 71). Higher baseline GMD correlated with better TSTH improvement at 1 year after Vim RS (Spearman’s rank correlation coefficient = 0.002).

Conclusions

Routine baseline structural neuroimaging predicts TSTH improvement 1 year after Vim RS. The relevant anatomical area is the right visual association cortex (BA 18, V2). The question whether visual areas should be included in the targeting remains open.

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Funding

This work was supported by Timone University Hospital, the Swiss National Science Foundation SNSF-205321-157,040, the Centre d’Imagerie BioMédicale (CIBM) of the University of Lausanne (UNIL), the University of Geneva (UniGe), the Centre Hospitalier Universitaire Vaudois (CHUV) and the Leenaards and Jeantet Foundations.This work was carried out thanks to the support of the A*MIDEX project (no. ANR-11-IDEX-0001-02) funded by the "Investissements d’Avenir" French Government program, managed by the French National Research Agency (ANR).

Author information

Author notes

  1. Tatiana Witjas, Dimitri Van de Ville, Eric Guedj and Jean Régis contributed equally to the present study

Authors and Affiliations

  1. Department of Clinical Neuroscience, Neurosurgery Service and Gamma Knife Center, Centre Hospitalier Universitaire Vaudois (CHUV), Rue du Bugnon 44-46, BH-08, 1011, Lausanne, Switzerland

    Constantin Tuleasca & Marc Levivier

  2. Signal Processing Laboratory (LTS 5), Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland

    Constantin Tuleasca & Jean-Philippe Thiran

  3. Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland

    Constantin Tuleasca, Jean-Philippe Thiran & Marc Levivier

  4. Department of Neurology and Movement Disorders, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille Université, Timone University Hospital, Marseille, France

    Tatiana Witjas

  5. Institut de Neurosciences de la Timone, UMR 7289, CNRS Aix-Marseille Université, Marseille, France

    Tatiana Witjas, Antoine Verger & Eric Guedj

  6. Faculty of Medicine, University of Geneva, Geneva, Switzerland

    Dimitri Van de Ville

  7. Medical Image Processing Laboratory, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland

    Elena Najdenovska & Meritxell Bach Cuadra

  8. Radiology Department, Center for Biomedical Imaging (CIBM), Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland

    Antoine Verger & Eric Guedj

  9. Department of Nuclear Medicine, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille Université, Timone University Hospital, Marseille, France

    Antoine Verger & Eric Guedj

  10. CERIMED, Aix-Marseille Université, Marseille, France

    Nadine Girard

  11. AMU, CRMBM UMR CNRS 7339, Faculté de Médecine et APHM, Department of Diagnostic and Interventionnal Neuroradiology, Hopital Timone, Marseille, France

    Jerome Champoudry & Jean Régis

  12. Stereotactic and Functional Neurosurgery Service and Gamma Knife Unit, CHU Timone, Marseille, France

    Dimitri Van de Ville

  13. Radiology Department, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland

    Jean-Philippe Thiran

Authors
  1. Constantin Tuleasca
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  2. Tatiana Witjas
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  3. Dimitri Van de Ville
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  4. Elena Najdenovska
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  5. Antoine Verger
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  6. Nadine Girard
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  7. Jerome Champoudry
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  8. Jean-Philippe Thiran
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  9. Meritxell Bach Cuadra
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  10. Marc Levivier
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  11. Eric Guedj
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  12. Jean Régis
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Corresponding author

Correspondence to Constantin Tuleasca.

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Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical approval

The study was approved by the local ethics committee of Timone University Hospital, Marseille, France. Patient consent was acquired in all cases.

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Comments

Fifty-two patients with right-sided ET were treated with left unilateral Vim Gamma Knife (Vim) thalamotomy. Targeting was performed using 130 Gy and a single 4-mm collimator. Pre-therapeutic gray matter density in T1-weighted MRI (GMD) was correlated with tremor score improvement of the treated hand (TSTH) at 1 year after Vim RS as a continuous variable. As the only statistically significant anatomical region, higher baseline GMD in right Brodmann area 18 (visual association area V2) correlated with better TSTH improvement.

This article shows a very interesting relation between unsuspected anatomical visual association areas (BA18, V2) and tremor arrest in general by demonstrating a correlation between pre-therapeutic T1w imaging in visual association areas and outcome of left unilateral radiosurgical Vim lesions in patients with right-sided essential tremor.

Bodo Lippitz

Hamburg, Germany

This study is from a leading group in the field of radiosurgery for functional disorders. The authors were able to recruit a remarkable number of patients treated with an innovative method for a rare disease. No a priori hypothesis was used in the statistical model, which is a very important strength of the study. Also, the hypothesis that the visual areas are linked to the motor ones, as sensory guidance of the movement of the hand and fingers, appears sound and sheds new light on the understanding of the visuospatial network.

Alfredo Conti

Messina, Italy

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Tuleasca, C., Witjas, T., Van de Ville, D. et al. Right Brodmann area 18 predicts tremor arrest after Vim radiosurgery: a voxel-based morphometry study. Acta Neurochir 160, 603–609 (2018). https://doi.org/10.1007/s00701-017-3391-x

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  • DOI: https://doi.org/10.1007/s00701-017-3391-x

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