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Neuroimaging-based analysis of DBS outcomes in pediatric dystonia: Insights from the GEPESTIM registry.
Al-Fatly, Bassam; Giesler, Sabina J; Oxenford, Simon; Li, Ningfei; Dembek, Till A; Achtzehn, Johannes; Krause, Patricia; Visser-Vandewalle, Veerle; Krauss, Joachim K; Runge, Joachim; Tadic, Vera; Bäumer, Tobias; Schnitzler, Alfons; Vesper, Jan; Wirths, Jochen; Timmermann, Lars; Kühn, Andrea A; Koy, Anne.
Afiliación
  • Al-Fatly B; Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Neurology, Berlin, Germany. Electronic address: bassam.al-fatly@charite.de.
  • Giesler SJ; Department of Pediatrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
  • Oxenford S; Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Neurology, Berlin, Germany.
  • Li N; Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Neurology, Berlin, Germany.
  • Dembek TA; Department of Neurology, Faculty of Medicine, University of Cologne, Cologne, Germany.
  • Achtzehn J; Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Neurology, Berlin, Germany.
  • Krause P; Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Neurology, Berlin, Germany.
  • Visser-Vandewalle V; Department of Stereotactic and Functional Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
  • Krauss JK; Department of Neurosurgery, Hannover Medical School, Hannover, Germany.
  • Runge J; Department of Neurosurgery, Hannover Medical School, Hannover, Germany.
  • Tadic V; Department of Neurology, University Medical Center Schleswig Holstein, Lübeck Campus, Lübeck, Germany.
  • Bäumer T; Institute of System Motor Science, University Medical Center Schleswig Holstein, Lübeck Campus, Lübeck, Germany.
  • Schnitzler A; Department of Neurology, Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany; Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
  • Vesper J; Department of Neurology, Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
  • Wirths J; Department of Stereotactic and Functional Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
  • Timmermann L; Department of Neurology, University Hospital of Marburg, Marburg, Germany.
  • Kühn AA; Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Neurology, Berlin, Germany. Electronic address: andrea.kuehn@charite.de.
  • Koy A; Department of Pediatrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany; Center for Rare Diseases, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
Neuroimage Clin ; 39: 103449, 2023.
Article en En | MEDLINE | ID: mdl-37321142
INTRODUCTION: Deep brain stimulation (DBS) is an established treatment in patients of various ages with pharmaco-resistant neurological disorders. Surgical targeting and postoperative programming of DBS depend on the spatial location of the stimulating electrodes in relation to the surrounding anatomical structures, and on electrode connectivity to a specific distribution pattern within brain networks. Such information is usually collected using group-level analysis, which relies on the availability of normative imaging resources (atlases and connectomes). Analysis of DBS data in children with debilitating neurological disorders such as dystonia would benefit from such resources, especially given the developmental differences in neuroimaging data between adults and children. We assembled pediatric normative neuroimaging resources from open-access datasets in order to comply with age-related anatomical and functional differences in pediatric DBS populations. We illustrated their utility in a cohort of children with dystonia treated with pallidal DBS. We aimed to derive a local pallidal sweetspot and explore a connectivity fingerprint associated with pallidal stimulation to exemplify the utility of the assembled imaging resources. METHODS: An average pediatric brain template (the MNI brain template 4.5-18.5 years) was implemented and used to localize the DBS electrodes in 20 patients from the GEPESTIM registry cohort. A pediatric subcortical atlas, analogous to the DISTAL atlas known in DBS research, was also employed to highlight the anatomical structures of interest. A local pallidal sweetspot was modeled, and its degree of overlap with stimulation volumes was calculated as a correlate of individual clinical outcomes. Additionally, a pediatric functional connectome of 100 neurotypical subjects from the Consortium for Reliability and Reproducibility was built to allow network-based analyses and decipher a connectivity fingerprint responsible for the clinical improvements in our cohort. RESULTS: We successfully implemented a pediatric neuroimaging dataset that will be made available for public use as a tool for DBS analyses. Overlap of stimulation volumes with the identified DBS-sweetspot model correlated significantly with improvement on a local spatial level (R = 0.46, permuted p = 0.019). The functional connectivity fingerprint of DBS outcomes was determined to be a network correlate of therapeutic pallidal stimulation in children with dystonia (R = 0.30, permuted p = 0.003). CONCLUSIONS: Local sweetspot and distributed network models provide neuroanatomical substrates for DBS-associated clinical outcomes in dystonia using pediatric neuroimaging surrogate data. Implementation of this pediatric neuroimaging dataset might help to improve the practice and pave the road towards a personalized DBS-neuroimaging analyses in pediatric patients.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Trastornos Distónicos / Estimulación Encefálica Profunda / Distonía Tipo de estudio: Prognostic_studies Límite: Adult / Child / Humans Idioma: En Revista: Neuroimage Clin Año: 2023 Tipo del documento: Article Pais de publicación: Países Bajos

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Trastornos Distónicos / Estimulación Encefálica Profunda / Distonía Tipo de estudio: Prognostic_studies Límite: Adult / Child / Humans Idioma: En Revista: Neuroimage Clin Año: 2023 Tipo del documento: Article Pais de publicación: Países Bajos