Right Brodmann area 18 predicts tremor arrest after Vim radiosurgery: a voxel-based morphometry study
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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.
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.
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).
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.
KeywordsTremor Ventro-intermediate nucleus Voxel-based morphometry Visual association area Radiosurgery Thalamotomy
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).
Compliance with ethical standards
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.
The study was approved by the local ethics committee of Timone University Hospital, Marseille, France. Patient consent was acquired in all cases.
- 15.Elias WJ, Lipsman N, Ondo WG, Ghanouni P, Kim YG, Lee W, Schwartz M, Hynynen K, Lozano AM, Shah BB, Huss D, Dallapiazza RF, Gwinn R, Witt J, Ro S, Eisenberg HM, Fishman PS, Gandhi D, Halpern CH, Chuang R, Butts Pauly K, Tierney TS, Hayes MT, Cosgrove GR, Yamaguchi T, Abe K, Taira T, Chang JW (2016) A randomized trial of focused ultrasound Thalamotomy for essential tremor. N Engl J Med 375:730–739CrossRefPubMedGoogle Scholar
- 31.Popa T, Russo M, Vidailhet M, Roze E, Lehericy S, Bonnet C, Apartis E, Legrand AP, Marais L, Meunier S, Gallea C (2013) Cerebellar rTMS stimulation may induce prolonged clinical benefits in essential tremor, and subjacent changes in functional connectivity: An open label trial. Brain Stimul 6:175–179CrossRefPubMedGoogle Scholar
- 32.Quattrone A, Cerasa A, Messina D, Nicoletti G, Hagberg GE, Lemieux L, Novellino F, Lanza P, Arabia G, Salsone M (2008) Essential head tremor is associated with cerebellar vermis atrophy: A volumetric and voxel-based morphometry MR imaging study. AJNR Am J Neuroradiol 29:1692–1697CrossRefPubMedGoogle Scholar
- 37.Tuleasca C, Pralong E, Najdenovska E, Cuadra MB, Marques JRF, Vingerhoets F, Regis J, Bloch J, Levivier M (2017) Deep brain stimulation after previous gamma knife thalamotomy of the vim for essential tremor is feasible! Clinical, electrophysiological and radiological findings. Acta Neurochir 159:1371–1373CrossRefPubMedGoogle Scholar
- 38.Tuleasca C, Witjas T, Najdenovska E, Verger A, Girard N, Champoudry J, Thiran JP, Van de Ville D, Bach Cuadra M, Levivier M, Guedj E, Régis J (2017) Assessing the clinical outcome of vim radiosurgery with voxel-based morphometry: Visual areas are linked with tremor arrest! Acta Neurochir. https://doi.org/10.1007/s00701-017-3317-7
- 40.Wintermark M, Huss DS, Shah BB, Tustison N, Druzgal TJ, Kassell N, Elias WJ (2014) Thalamic connectivity in patients with essential tremor treated with MR imaging-guided focused ultrasound: In vivo fiber tracking by using diffusion-tensor MR imaging. Radiology 272:202–209CrossRefPubMedGoogle Scholar
- 43.Zeki S, Watson JD, Lueck CJ, Friston KJ, Kennard C, Frackowiak RS (1991) A direct demonstration of functional specialization in human visual cortex. J Neurosci Off J Soc Neurosci 11:641–649Google Scholar
- 44.Zesiewicz TA, Elble R, Louis ED, Hauser RA, Sullivan KL, Dewey RB Jr, Ondo WG, Gronseth GS, Weiner WJ, Quality Standards Subcommittee of the American Academy of N (2005) Practice parameter: Therapies for essential tremor: Report of the quality standards Subcommittee of the American Academy of Neurology. Neurology 64:2008–2020CrossRefPubMedGoogle Scholar