Abstract：
BACKGROUND: There remains high variability in clinical outcomes when the same magnetic resonance image-guided focused ultrasound (MRgFUS) thalamotomy target is used for both essential tremor (ET) and tremor-dominant Parkinson\'s disease (TDPD).
OBJECTIVE: Our goal is to refine the MRgFUS thalamotomy target for TDPD versus ET.
METHODS: We retrospectively performed voxel-wise efficacy and structural connectivity mapping using 3-12-month post-procedure hand tremor scores for a multicenter cohort of 32 TDPD patients and a previously published cohort of 79 ET patients, and 24-hour T1-weighted post-MRgFUS brain images. We validated our findings using Unified Parkinson\'s Disease Rating Scale part III scores for an independent cohort of nine TDPD patients.
RESULTS: The post-MRgFUS clinical improvements were 45.9% ± 35.9%, 55.5% ± 36%, and 46.1% ± 18.6% for ET, multicenter TDPD and validation TDPD cohorts, respectively. The TDPD and ET efficacy maps differed significantly (ppermute < 0.05), with peak TDPD improvement (87%) at x = -13.5; y = -15.0; z = 1.5, ~3.5 mm anterior and 3 mm dorsal to the ET target. Discriminative connectivity projections were to the motor and premotor regions in TDPD, and to the motor and somatosensory regions in ET. The disorder-specific voxel-wise efficacy map could be used to estimate outcome in TDPD patients with high accuracy (R = 0.8; R2 = 0.64; P < 0.0001). The model was validated using the independent cohort of nine TDPD patients (R = 0.73; R2 = 0.53; P = 0.025-voxel analysis).
CONCLUSIONS: We demonstrated that the most effective MRgFUS thalamotomy target in TDPD is in the ventral intermediate nucleus/ventralis oralis posterior border region. This finding offers new insights into the thalamic regions instrumental in tremor control, with pivotal implications for improving treatment outcomes. © 2024 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
OBJECTIVE: Our goal is to refine the MRgFUS thalamotomy target for TDPD versus ET.
METHODS: We retrospectively performed voxel-wise efficacy and structural connectivity mapping using 3-12-month post-procedure hand tremor scores for a multicenter cohort of 32 TDPD patients and a previously published cohort of 79 ET patients, and 24-hour T1-weighted post-MRgFUS brain images. We validated our findings using Unified Parkinson\'s Disease Rating Scale part III scores for an independent cohort of nine TDPD patients.
RESULTS: The post-MRgFUS clinical improvements were 45.9% ± 35.9%, 55.5% ± 36%, and 46.1% ± 18.6% for ET, multicenter TDPD and validation TDPD cohorts, respectively. The TDPD and ET efficacy maps differed significantly (ppermute < 0.05), with peak TDPD improvement (87%) at x = -13.5; y = -15.0; z = 1.5, ~3.5 mm anterior and 3 mm dorsal to the ET target. Discriminative connectivity projections were to the motor and premotor regions in TDPD, and to the motor and somatosensory regions in ET. The disorder-specific voxel-wise efficacy map could be used to estimate outcome in TDPD patients with high accuracy (R = 0.8; R2 = 0.64; P < 0.0001). The model was validated using the independent cohort of nine TDPD patients (R = 0.73; R2 = 0.53; P = 0.025-voxel analysis).
CONCLUSIONS: We demonstrated that the most effective MRgFUS thalamotomy target in TDPD is in the ventral intermediate nucleus/ventralis oralis posterior border region. This finding offers new insights into the thalamic regions instrumental in tremor control, with pivotal implications for improving treatment outcomes. © 2024 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
摘要：
背景：当相同的磁共振图像引导聚焦超声（MRgFUS）丘脑切开术目标用于原发性震颤（ET）和震颤为主的帕金森病（TDPD）时，临床结果仍然存在很大差异。
目标：我们的目标是完善TDPD与ET的MRgFUS丘脑切开术目标。
方法：我们对32名TDPD患者的多中心队列和先前发表的79名ET患者的队列，使用术后3-12个月的手震颤评分进行了逐体素疗效和结构连接图。和24小时T1加权后MRgFUS脑图像。我们使用统一的帕金森病评定量表第III部分评分对9名TDPD患者的独立队列进行了验证。
结果：MRgFUS后临床改善为45.9%±35.9%，55.5%±36%,ET为46.1%±18.6%，多中心TDPD和验证TDPD队列，分别。TDPD和ET功效图差异显著(ppermute<0.05)，在x=-13.5；y=-15.0；z=1.5，比ET目标前3毫米，背3毫米，TDPD改善峰值（87％）。判别连通性预测是针对TDPD中的运动和运动前区域，以及ET中的运动和体感区域。该疾病特异性逐体素功效图可用于高精度估计TDPD患者的预后(R=0.8;R2=0.64;P<0.0001)。该模型使用9名TDPD患者的独立队列进行了验证（R=0.73；R2=0.53；P=0.025-体素分析）。
结论：我们证明了TDPD中最有效的MRgFUS丘脑切开术目标是在腹侧中间核/口腹后界区。这一发现为有助于震颤控制的丘脑区域提供了新的见解，对改善治疗结果具有重要意义。©2024作者（S）。由WileyPeriodicalsLLC代表国际帕金森症和运动障碍协会出版的运动障碍。
目标：我们的目标是完善TDPD与ET的MRgFUS丘脑切开术目标。
方法：我们对32名TDPD患者的多中心队列和先前发表的79名ET患者的队列，使用术后3-12个月的手震颤评分进行了逐体素疗效和结构连接图。和24小时T1加权后MRgFUS脑图像。我们使用统一的帕金森病评定量表第III部分评分对9名TDPD患者的独立队列进行了验证。
结果：MRgFUS后临床改善为45.9%±35.9%，55.5%±36%,ET为46.1%±18.6%，多中心TDPD和验证TDPD队列，分别。TDPD和ET功效图差异显著(ppermute<0.05)，在x=-13.5；y=-15.0；z=1.5，比ET目标前3毫米，背3毫米，TDPD改善峰值（87％）。判别连通性预测是针对TDPD中的运动和运动前区域，以及ET中的运动和体感区域。该疾病特异性逐体素功效图可用于高精度估计TDPD患者的预后(R=0.8;R2=0.64;P<0.0001)。该模型使用9名TDPD患者的独立队列进行了验证（R=0.73；R2=0.53；P=0.025-体素分析）。
结论：我们证明了TDPD中最有效的MRgFUS丘脑切开术目标是在腹侧中间核/口腹后界区。这一发现为有助于震颤控制的丘脑区域提供了新的见解，对改善治疗结果具有重要意义。©2024作者（S）。由WileyPeriodicalsLLC代表国际帕金森症和运动障碍协会出版的运动障碍。
