Thalamic Nuclei

丘脑核
  • 文章类型: Journal Article
    目的:已知在阿尔茨海默病(AD)中受损的记忆过程由具有皮质下成分的大规模神经认知网络维持,包括丘脑.因此,我们的目的是在不同的AD阶段检查丘脑核的体积和功能变化。
    方法:诊断为20例AD痴呆(ADD)患者的MRI数据,30例遗忘型轻度认知障碍(MCI),并使用了30例主观认知障碍(SCI)。通过将丘脑分为前丘脑进行体积和功能连通性分析,中间,后部,外侧核和板内核组及其特定的亚核。
    结果:在AD的过程中,内侧群核的体积,尤其是中背内侧大细胞(MDm)核,减少。与SCI组相比,ADD和MCI中内侧组细胞核和MDm与额叶区域的功能连接均降低。与MCI组相比,ADD组与视觉区域的功能连接均增加。
    结论:我们的研究表明,丘脑的内侧组,特别是MDM,在AD中可能会受到影响。
    结论:特定丘脑核可能是研究AD结构和功能变化的关键解剖区域。
    OBJECTIVE: Memory processes known to be impaired in Alzheimer\'s disease (AD) are maintained by a large-scale neurocognitive network with subcortical components, including the thalamus. Therefore, we aimed to examine the volumetric and functional changes of the thalamic nuclei at different scales across AD stages.
    METHODS: MRI data of patients diagnosed with 20 AD dementia (ADD), 30 amnestic mild cognitive impairment (MCI), and 30 subjective cognitive impairment (SCI) were used. Volumetric and functional connectivity analyzes were performed by dividing the thalamus into anterior, medial, posterior, lateral and intralaminar nucleus groups and their specific subnuclei.
    RESULTS: In the course of AD, the volume of the medial group nuclei, especially the mediodorsal medial magnocellular (MDm) nucleus, decreases. Medial group nuclei and MDm functional connectivity with frontal areas were decreased both in ADD and MCI compared to SCI group, while both of them increased their functional connectivity with visual areas in the ADD group compared to the MCI group.
    CONCLUSIONS: Our study suggests that the medial group of the thalamus, and specifically the MDm, may be affected in AD.
    CONCLUSIONS: Specific thalamic nuclei may be a critical anatomical region for investigating structural and functional changes in AD.
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  • 文章类型: Journal Article
    早产后持续的丘脑体积减少是一个突出的发现。然而,早产是否对丘脑核体积有不同影响,以及核畸变是否与认知功能相关,目前尚不清楚.使用83名早产(≤32周妊娠;VP)和/或体重非常低(≤1,500g;VLBW)的成年人以及92名足月出生(≥37周妊娠)对照的T1加权MR图像,我们比较了六个亚区域的丘脑核体积(前,横向,腹侧,椎板内,中间,和pulvinar),年龄在26岁。为了表征体积畸变的功能相关性,使用韦氏成人智力量表通过全面智商评估认知表现,并使用多元线性回归分析与体积减少相关.与对照组相比,VP/VLBW成人的所有检查细胞核的丘脑体积均显着降低。提示整体而非局灶性损害。较低的细胞核体积与较高强度的新生儿治疗有关,表明出生后对压力暴露的脆弱性。此外,我们发现横向的单一结果,中间,和髓核体积与早产儿的全面智商有关,尽管在多个假设检验中没有幸存下来。这些发现提供了证据,表明在所有亚区域都可以观察到早产儿的丘脑体积较低,而不是集中在单个细胞核上。数据表明早产后所有核的丘脑异常发育的机制相同。
    Lasting thalamus volume reduction after preterm birth is a prominent finding. However, whether thalamic nuclei volumes are affected differentially by preterm birth and whether nuclei aberrations are relevant for cognitive functioning remains unknown. Using T1-weighted MR-images of 83 adults born very preterm (≤ 32 weeks\' gestation; VP) and/or with very low body weight (≤ 1,500 g; VLBW) as well as of 92 full-term born (≥ 37 weeks\' gestation) controls, we compared thalamic nuclei volumes of six subregions (anterior, lateral, ventral, intralaminar, medial, and pulvinar) across groups at the age of 26 years. To characterize the functional relevance of volume aberrations, cognitive performance was assessed by full-scale intelligence quotient using the Wechsler Adult Intelligence Scale and linked to volume reductions using multiple linear regression analyses. Thalamic volumes were significantly lower across all examined nuclei in VP/VLBW adults compared to controls, suggesting an overall rather than focal impairment. Lower nuclei volumes were linked to higher intensity of neonatal treatment, indicating vulnerability to stress exposure after birth. Furthermore, we found that single results for lateral, medial, and pulvinar nuclei volumes were associated with full-scale intelligence quotient in preterm adults, albeit not surviving correction for multiple hypotheses testing. These findings provide evidence that lower thalamic volume in preterm adults is observable across all subregions rather than focused on single nuclei. Data suggest the same mechanisms of aberrant thalamus development across all nuclei after premature birth.
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  • 文章类型: Journal Article
    丘脑和皮质之间的相互联系是哺乳动物前脑组织的最特征性特征之一。迄今为止,这条赛道只在海龟身上有记载。然而,爬行动物,包括海龟,从背侧丘脑到端脑有一条额外的路径。这终止于称为背室脊的姑息结构。然而,没有发现从背室脊到丘脑核的相互联系。由于来自丘脑的轴突通过基底核到达背室脊,基底核可能是相互联系的来源。因此,逆行示踪剂放置到背侧丘脑后,神经元的位置和分布被检查。确实在基底核中发现了逆行标记的神经元。解释这一观察结果的一种可能性是,在发育过程中存在与背室脊的联系,但后来在胚胎发生过程中被修剪。
    Reciprocal connections between the thalamus and the cortex are one of the most characteristic features of forebrain organization in mammals. To date, this circuit has been documented only in turtles. However, reptiles, including turtles, have an additional path from the dorsal thalamus to the telencephalon. This terminates in a pallial structure known as the dorsal ventricular ridge. Yet, no reciprocal connection from the dorsal ventricular ridge to thalamic nuclei has been uncovered. Since axons from the thalamus pass through the basal nuclei on route to the dorsal ventricular ridge, the basal nuclei might be a source of reciprocal connections. Accordingly, the location and distribution of neurons after retrograde tracer placement into the dorsal thalamus were examined. Retrogradely labeled neurons in the basal nuclei were indeed found. One possibility to explain this observation is that connections with the dorsal ventricular ridge are present during development but later pruned during embryogenesis.
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  • 文章类型: Journal Article
    丘脑网状核(TRN)是丘脑和新皮质之间的重要节点,以状态依赖的方式调节丘脑皮质节律和感觉加工。在包括癫痫在内的几种神经发育障碍中,TRN电路的中断也很突出。自闭症,注意缺陷。了解TRN和1阶丘脑核之间的连接方式和时间,如背外侧膝状核(dLGN),发展是缺乏的。我们使用小鼠视觉丘脑作为模型系统来研究组织,TRN和dLGN之间的神经支配模式和功能反应。遗传修饰的小鼠品系用于可视化和靶向这些丘脑内回路的前馈和反馈成分,并了解来自视网膜的外围输入如何影响其发育。通过TRN逆行追踪丘脑皮质(TC)传入显示,在成人中看到的特定于模态的组织,存在于围产期年龄,似乎不受周围输入的损失的影响。为了检查TRN和dLGN视觉区之间的腔内回路的形成和功能成熟,我们检查了每个原子核的投影何时到达,并使用急性丘脑切片制备以及光遗传学刺激来评估功能性突触反应的成熟。虽然丘脑皮质投射在出生时通过TRN,通过vGluT2标记确定的前馈轴突络脉,出现在产后第二个星期,密度在第三周增加。TRN中TC轴突侧支的光遗传学刺激表现为不频繁,在第1周结束时,兴奋性反应较弱。在第2-4周,反应变得更加普遍,在重复刺激期间,振幅增大并表现出突触抑制。从视觉TRN到dLGN的反馈预测早在出生后第2天就开始支配dLGN,在第1周出现弱抑制反应。在第2-4周,抑制反应持续增长,在重复刺激期间显示突触抑制。在此期间,TRN抑制开始抑制TC尖峰,在第4-6周影响最大。使用缺乏视网膜投影的突变小鼠表明,视网膜输入的缺失导致dLGN的TRN神经支配加速,但对从dLGN到TRN的前馈投影的发展影响很小。一起,这些实验揭示了在出生后早期年龄中如何以及何时出现丘脑内连接,并为了解丘脑皮质网络动力学的发展以及涉及TRN电路的神经发育疾病提供了基础知识。
    The thalamic reticular nucleus (TRN) serves as an important node between the thalamus and neocortex, regulating thalamocortical rhythms and sensory processing in a state dependent manner. Disruptions in TRN circuitry also figures prominently in several neurodevelopmental disorders including epilepsy, autism, and attentional defects. An understanding of how and when connections between TRN and 1st order thalamic nuclei, such as the dorsal lateral geniculate nucleus (dLGN), develop is lacking. We used the mouse visual thalamus as a model system to study the organization, pattern of innervation and functional responses between TRN and the dLGN. Genetically modified mouse lines were used to visualize and target the feedforward and feedback components of these intra-thalamic circuits and to understand how peripheral input from the retina impacts their development.Retrograde tracing of thalamocortical (TC) afferents through TRN revealed that the modality-specific organization seen in the adult, is present at perinatal ages and seems impervious to the loss of peripheral input. To examine the formation and functional maturation of intrathalamic circuits between the visual sector of TRN and dLGN, we examined when projections from each nuclei arrive, and used an acute thalamic slice preparation along with optogenetic stimulation to assess the maturation of functional synaptic responses. Although thalamocortical projections passed through TRN at birth, feedforward axon collaterals determined by vGluT2 labeling, emerged during the second postnatal week, increasing in density through the third week. Optogenetic stimulation of TC axon collaterals in TRN showed infrequent, weak excitatory responses near the end of week 1. During weeks 2-4, responses became more prevalent, grew larger in amplitude and exhibited synaptic depression during repetitive stimulation. Feedback projections from visual TRN to dLGN began to innervate dLGN as early as postnatal day 2 with weak inhibitory responses emerging during week 1. During week 2-4, inhibitory responses continued to grow larger, showing synaptic depression during repetitive stimulation. During this time TRN inhibition started to suppress TC spiking, having its greatest impact by week 4-6. Using a mutant mouse that lacks retinofugal projections revealed that the absence of retinal input led to an acceleration of TRN innervation of dLGN but had little impact on the development of feedforward projections from dLGN to TRN. Together, these experiments reveal how and when intrathalamic connections emerge during early postnatal ages and provide foundational knowledge to understand the development of thalamocortical network dynamics as well as neurodevelopmental diseases that involve TRN circuitry.
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  • 文章类型: Journal Article
    背景:丘脑是一种系统发育良好的结构。已知密集接触皮质区域,近年来,它在将感觉信息传递到纹状体复合体中的作用已被广泛重新考虑。
    方法:丘脑的束旁核(Pf)与注意力向显着感觉刺激的方向有关。在刺激驱动的寻求奖励任务中,我们试图表征大鼠Pf神经元的电生理活动。
    结果:我们观察到任务中所有事件的兴奋性反应优于抑制性反应。与按杠杆和收集奖励相比,神经元对刺激的反应更强烈,证实了Pf在感觉信息处理中的强烈参与。长时间的使用使我们能够比较动物参与行动时和不参与行动时的试验之间的神经元对刺激的反应。我们区分了两种具有相反反应的神经元群体:MOTIV神经元对刺激的反应更强烈,然后是行为反应。相反,动机-当动物对刺激没有反应时,神经元反应更强烈。此外,MOTIVE-神经元的兴奋潜伏期比MOTIV+神经元短。
    结论:通过这种编码,Pf可以根据动机水平对传递到纹状体的环境刺激进行早期选择。
    BACKGROUND: The thalamus is a phylogenetically well-preserved structure. Known to densely contact cortical regions, its role in the transmission of sensory information to the striatal complex has been widely reconsidered in recent years.
    METHODS: The parafascicular nucleus of the thalamus (Pf) has been implicated in the orientation of attention toward salient sensory stimuli. In a stimulus-driven reward-seeking task, we sought to characterize the electrophysiological activity of Pf neurons in rats.
    RESULTS: We observed a predominance of excitatory over inhibitory responses for all events in the task. Neurons responded more strongly to the stimulus compared to lever-pressing and reward collecting, confirming the strong involvement of the Pf in sensory information processing. The use of long sessions allowed us to compare neuronal responses to stimuli between trials when animals were engaged in action and those when they were not. We distinguished two populations of neurons with opposite responses: MOTIV+ neurons responded more intensely to stimuli followed by a behavioral response than those that were not. Conversely, MOTIV- neurons responded more strongly when the animal did not respond to the stimulus. In addition, the latency of excitation of MOTIV- neurons was shorter than that of MOTIV+ neurons.
    CONCLUSIONS: Through this encoding, the Pf could perform an early selection of environmental stimuli transmitted to the striatum according to motivational level.
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  • 文章类型: Journal Article
    背景:丘脑在特发性宫颈肌张力障碍(iCD)的病理生理学中起着核心作用;然而,在此结构中发生的改变的性质在很大程度上仍然难以捉摸。使用结构磁共振成像(MRI)方法,我们检查了iCD患者的丘脑亚区/核区异常是否存在差异.
    方法:收集了37例iCD患者和37例健康对照(HC)的结构MRI数据。基于FreeSurfer程序对每个半球中的25个丘脑核进行自动分割。分析了iCD患者组间丘脑核体积的差异及其与临床信息的关系。
    结果:与HC相比,主要在中央内侧的丘脑核体积显着减少,中心,外侧膝状,内侧膝状,内侧腹侧,paracentral,旁肌,半生,在iCD患者中发现了腹内侧核(P<0.05,错误发现率得到纠正)。然而,iCD组丘脑核体积改变与临床特征无统计学意义的相关性.
    结论:本研究强调了iCD与丘脑体积变化相关的神经生物学机制。
    BACKGROUND: The thalamus has a central role in the pathophysiology of idiopathic cervical dystonia (iCD); however, the nature of alterations occurring within this structure remain largely elusive. Using a structural magnetic resonance imaging (MRI) approach, we examined whether abnormalities differ across thalamic subregions/nuclei in patients with iCD.
    METHODS: Structural MRI data were collected from 37 patients with iCD and 37 healthy controls (HCs). Automatic parcellation of 25 thalamic nuclei in each hemisphere was performed based on the FreeSurfer program. Differences in thalamic nuclei volumes between groups and their relationships with clinical information were analysed in patients with iCD.
    RESULTS: Compared to HCs, a significant reduction in thalamic nuclei volume primarily in central medial, centromedian, lateral geniculate, medial geniculate, medial ventral, paracentral, parafascicular, paratenial, and ventromedial nuclei was found in patients with iCD (P < 0.05, false discovery rate corrected). However, no statistically significant correlations were observed between altered thalamic nuclei volumes and clinical characteristics in iCD group.
    CONCLUSIONS: This study highlights the neurobiological mechanisms of iCD related to thalamic volume changes.
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  • 文章类型: Journal Article
    社会记忆已经在人类和其他动物中发展起来,以识别熟悉的物种,并且对于它们的生存和繁殖至关重要。这里,我们证明了感觉丘脑网状核(sTRNPvalb)中的小白蛋白阳性神经元对于小鼠记忆特异性是必要且足够的。sTRNPvalb神经元从后顶叶皮层(PPC)接受谷氨酸能投射,通过抑制束旁丘脑核(PF)来传递个体信息。抑制PPCCaMKII→sTRNPvalb→PF回路的小鼠表现出区分熟悉的特异性与新型特异性的能力。更引人注目的是,具有高电生理兴奋性和复杂的树突状树枝化的sTRNPvalb神经元子集参与上述皮质丘脑途径并存储社会记忆。单细胞RNA测序揭示了这些亚群细胞的生化基础,是蛋白质合成的强大激活。这些发现阐明了sTRNPvalb神经元通过协调迄今未知的皮质丘脑回路和抑制性记忆印迹来调节社会记忆。
    Social memory has been developed in humans and other animals to recognize familiar conspecifics and is essential for their survival and reproduction. Here, we demonstrated that parvalbumin-positive neurons in the sensory thalamic reticular nucleus (sTRNPvalb) are necessary and sufficient for mice to memorize conspecifics. sTRNPvalb neurons receiving glutamatergic projections from the posterior parietal cortex (PPC) transmit individual information by inhibiting the parafascicular thalamic nucleus (PF). Mice in which the PPCCaMKII→sTRNPvalb→PF circuit was inhibited exhibited a disrupted ability to discriminate familiar conspecifics from novel ones. More strikingly, a subset of sTRNPvalb neurons with high electrophysiological excitability and complex dendritic arborizations is involved in the above corticothalamic pathway and stores social memory. Single-cell RNA sequencing revealed the biochemical basis of these subset cells as a robust activation of protein synthesis. These findings elucidate that sTRNPvalb neurons modulate social memory by coordinating a hitherto unknown corticothalamic circuit and inhibitory memory engram.
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  • 文章类型: Journal Article
    丘脑被认为是眼睑痉挛神经机制的关键区域。然而,以前的研究认为它是单一的,均质结构,无视关于不同丘脑核的潜在有用信息。在这里,我们的目的是研究(i)眼睑痉挛和眼睑痉挛-口下颌肌张力障碍患者的丘脑亚区/核区灰质体积是否不同;(ii)异常丘脑核区之间的因果关系;(iii)这些异常特征是否可用作神经影像学生物标志物,以区分眼睑痉挛患者和眼睑痉挛-口下颌肌张力障碍患者和健康对照组.收集了56例眼睑痉挛患者的结构MRI数据,20例眼睑痉挛-口下颌肌张力障碍和58例健康对照。分析了肌张力障碍患者组间丘脑核体积的差异及其与临床信息的关系。采用格兰杰因果关系分析探讨异常丘脑核之间的因果关系。使用支持向量机来测试这些异常特征是否可以区分患有不同形式的肌张力障碍的患者以及患有肌张力障碍的患者与健康对照。与健康对照相比,眼睑痉挛患者表现出外侧膝状核和髓下核的灰质体积减少,而眼睑痉挛-口下颌肌张力障碍的患者在腹侧前核和腹侧外侧前核显示灰质体积减少。眼睑痉挛患者的髓下核萎缩和眼睑痉挛-口下颌肌张力障碍患者的腹外侧前核萎缩与临床严重程度和疾病持续时间呈负相关,分别。提出的机器学习方案在区分眼睑痉挛患者与健康对照方面具有很高的准确性(准确性:0.89),健康对照组的眼睑痉挛-口下颌肌张力障碍患者(准确度:0.82)和眼睑痉挛-口下颌肌张力障碍患者的眼睑痉挛(准确度:0.94)。最重要的是,Granger因果关系分析显示,在眼睑痉挛患者中,从髓下核萎缩的进行性驱动途径延伸到外侧膝状核萎缩,然后延伸到腹侧外侧前核萎缩,临床严重程度增加。这些发现表明,丘脑的髓下核是眼睑痉挛的局灶性起源,延伸至下颌下核萎缩,随后延伸至腹侧外侧前核,导致不自主的下面部和咀嚼运动,称为眼睑痉挛-口下颌肌张力障碍。此外,我们的结果也为眼睑痉挛和眼睑痉挛-口下颌肌张力障碍患者的神经调节尤其是深部脑刺激提供了潜在的靶点.
    The thalamus is considered a key region in the neuromechanisms of blepharospasm. However, previous studies considered it as a single, homogeneous structure, disregarding potentially useful information about distinct thalamic nuclei. Herein, we aimed to examine (i) whether grey matter volume differs across thalamic subregions/nuclei in patients with blepharospasm and blepharospasm-oromandibular dystonia; (ii) causal relationships among abnormal thalamic nuclei; and (iii) whether these abnormal features can be used as neuroimaging biomarkers to distinguish patients with blepharospasm from blepharospasm-oromandibular dystonia and those with dystonia from healthy controls. Structural MRI data were collected from 56 patients with blepharospasm, 20 with blepharospasm-oromandibular dystonia and 58 healthy controls. Differences in thalamic nuclei volumes between groups and their relationships to clinical information were analysed in patients with dystonia. Granger causality analysis was employed to explore the causal effects among abnormal thalamic nuclei. Support vector machines were used to test whether these abnormal features could distinguish patients with different forms of dystonia and those with dystonia from healthy controls. Compared with healthy controls, patients with blepharospasm exhibited reduced grey matter volume in the lateral geniculate and pulvinar inferior nuclei, whereas those with blepharospasm-oromandibular dystonia showed decreased grey matter volume in the ventral anterior and ventral lateral anterior nuclei. Atrophy in the pulvinar inferior nucleus in blepharospasm patients and in the ventral lateral anterior nucleus in blepharospasm-oromandibular dystonia patients was negatively correlated with clinical severity and disease duration, respectively. The proposed machine learning scheme yielded a high accuracy in distinguishing blepharospasm patients from healthy controls (accuracy: 0.89), blepharospasm-oromandibular dystonia patients from healthy controls (accuracy: 0.82) and blepharospasm from blepharospasm-oromandibular dystonia patients (accuracy: 0.94). Most importantly, Granger causality analysis revealed that a progressive driving pathway from pulvinar inferior nuclear atrophy extends to lateral geniculate nuclear atrophy and then to ventral lateral anterior nuclear atrophy with increasing clinical severity in patients with blepharospasm. These findings suggest that the pulvinar inferior nucleus in the thalamus is the focal origin of blepharospasm, extending to pulvinar inferior nuclear atrophy and subsequently extending to the ventral lateral anterior nucleus causing involuntary lower facial and masticatory movements known as blepharospasm-oromandibular dystonia. Moreover, our results also provide potential targets for neuromodulation especially deep brain stimulation in patients with blepharospasm and blepharospasm-oromandibular dystonia.
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  • 文章类型: Journal Article
    目的:丘脑萎缩可作为多发性硬化症(MS)中神经变性的替代指标。一些数据指向可能比其他受影响更大的丘脑核。然而,MS进化过程中它们的变化动态以及驱动它们差异变化的机制仍然不确定。
    方法:我们将1,123名MS患者与相同数量的健康对照组配对,全部用常规3D-T1MRI扫描。为了突出丘脑核水平的主要萎缩区域,我们验证了一种由基于深度学习的序列合成组成的分割策略,用于自动多图集分割。然后,通过基于寿命的方法,我们可以对四个主要丘脑核群的动力学进行建模。
    结果:所有分析都集中在后部和内侧组的萎缩率高于前部和外侧组。我们还证明,当特定位于相关的丘脑皮质突起内时,局灶性MS白质病变与核组的萎缩有关。受影响最严重的后部组的体积,但也包括前路组,与整个丘脑的体积相比,与临床残疾的相关性更好。
    结论:这些发现表明,在MS的整个过程中,邻近第三脑室的丘脑核更容易发生神经变性,因为区域因素增强了断开效应。因为这些信息甚至可以从标准T1加权MRI中获得,这为将来监测MS患者铺平了道路。
    OBJECTIVE: Thalamic atrophy can be used as a proxy for neurodegeneration in multiple sclerosis (MS). Some data point toward thalamic nuclei that could be affected more than others. However, the dynamic of their changes during MS evolution and the mechanisms driving their differential alterations are still uncertain.
    METHODS: We paired a large cohort of 1,123 patients with MS with the same number of healthy controls, all scanned with conventional 3D-T1 MRI. To highlight the main atrophic regions at the thalamic nuclei level, we validated a segmentation strategy consisting of deep learning-based synthesis of sequences, which were used for automatic multiatlas segmentation. Then, through a lifespan-based approach, we could model the dynamics of the 4 main thalamic nuclei groups.
    RESULTS: All analyses converged toward a higher rate of atrophy for the posterior and medial groups compared with the anterior and lateral groups. We also demonstrated that focal MS white matter lesions were associated with atrophy of groups of nuclei when specifically located within the associated thalamocortical projections. The volumes of the most affected posterior group, but also of the anterior group, were better associated with clinical disability than the volume of the whole thalamus.
    CONCLUSIONS: These findings point toward the thalamic nuclei adjacent to the third ventricle as more susceptible to neurodegeneration during the entire course of MS through potentiation of disconnection effects by regional factors. Because this information can be obtained even from standard T1-weighted MRI, this paves the way toward such an approach for future monitoring of patients with MS.
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  • 文章类型: Journal Article
    目的:响应性神经刺激(RNS)是美国FDA批准的一种神经调节形式,用于治疗不适合切除或难以切除的局灶性发作性耐药癫痫(DRE)患者。然而,FDA批准仅适用于有1个或2个癫痫灶的患者.最近的文献表明,丘脑RNS在Lennox-Gastaut综合征和多灶性癫痫患者中的可能疗效。作者假设,对于多灶性或区域性发作的DRE患者,丘脑核的RNS可能可有效减少癫痫发作。
    方法:作者对2016年7月至2023年9月在德克萨斯儿童医院接受RNS设备管理的所有患者进行了回顾性图表回顾,在丘脑核中至少有一个有源电极,并在移植后随访≥12个月。患者或其护理人员传达的信息提供了有关临床发作频率变化的数据,生活质量(QOL),着床前基线访视和最后一次办公室访视(LOV)之间的癫痫发作严重程度。
    结果:13例患者(年龄8-24岁)在丘脑核中发现了活跃的RNS导线(11个中心和2个前核)。在LOV,46%的患者报告50%-100%的临床癫痫发作减少(归类为反应者),15%报告减少25%-49%,38%报告<25%减少或无变化。此外,42%的患者报告生活质量主观改善,58%报告癫痫发作严重程度改善。局灶性皮质发育不良(FCD)患者反应强烈:5例中的3例(60%)报告癫痫发作负担减少≥80%,癫痫发作严重程度和生活质量得到改善。多灶性癫痫和双侧丘脑皮质导联的患者也表现良好,所有3例报告癫痫发作减少≥50%。
    结论:丘脑核的RNS在减少多灶性或区域性DRE患者的癫痫发作负担方面显示出有希望的结果,特别是在双侧丘脑皮质构型或解决潜在的FCD时。
    OBJECTIVE: Responsive neurostimulation (RNS) is a US FDA-approved form of neuromodulation to treat patients with focal-onset drug-resistant epilepsy (DRE) who are ineligible for or whose condition is refractory to resection. However, the FDA approval only extends to use in patients with one or two epileptogenic foci. Recent literature has shown possible efficacy of thalamic RNS in patients with Lennox-Gastaut syndrome and multifocal epilepsy. The authors hypothesized that RNS of thalamic nuclei may be effective in seizure reduction for patients with multifocal or regionalized-onset DRE.
    METHODS: The authors performed a retrospective chart review of all patients who had an RNS device managed at Texas Children\'s Hospital between July 2016 and September 2023, with at least one active electrode in the thalamic nuclei and ≥ 12 months of postimplantation follow-up. Information conveyed by the patient or their caregiver provided data on the change in the clinical seizure frequency, quality of life (QOL), and seizure severity between the preimplantation baseline visit and the last office visit (LOV).
    RESULTS: Thirteen patients (ages 8-24 years) were identified with active RNS leads in thalamic nuclei (11 centromedian and 2 anterior nucleus). At LOV, 46% of patients reported 50%-100% clinical seizure reduction (classified as responders), 15% reported 25%-49% reduction, and 38% reported < 25% reduction or no change. Additionally, 42% of patients reported subjective improvement in QOL and 58% reported improved seizure severity. Patients with focal cortical dysplasia (FCD) responded strongly: 3 of 5 (60%) reported ≥ 80% reduction in seizure burden and improvement in seizure severity and QOL. Patients with multifocal epilepsy and bilateral thalamocortical leads also did well, with all 3 reporting ≥ 50% reduction in seizures.
    CONCLUSIONS: RNS of thalamic nuclei shows promising results in reducing seizure burden for patients with multifocal or regional-onset DRE, particularly in a bilateral thalamocortical configuration or when addressing an underlying FCD.
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