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Modulation of Fibers to Motor Cortex during Thalamic DBS in Tourette Patients Correlates with Tic Reduction

1
Department of Stereotactic and Functional Neurosurgery, University Hospital of Cologne, 50397 Cologne, Germany
2
Department of Neurosurgery, University Hospital of Cologne, 50397 Cologne, Germany
3
Department of Neuroradiology, University Hospital of Cologne, 50397 Cologne, Germany
4
Department of Psychiatry and Psychotherapy, University Hospital of Cologne, 50397 Cologne, Germany
5
Department of Neurology, University Hospital of Cologne, 50397 Cologne, Germany
*
Author to whom correspondence should be addressed.
Brain Sci. 2020, 10(5), 302; https://doi.org/10.3390/brainsci10050302
Received: 12 April 2020 / Revised: 6 May 2020 / Accepted: 11 May 2020 / Published: 15 May 2020
(This article belongs to the Special Issue Deep Brain Stimulation and Tourette Syndrome)
Probabilistic tractography in Tourette syndrome (TS) patients have shown an alteration in the connectivity of the primary motor cortex and supplementary motor area with the striatum and thalamus, suggesting an abnormal connectivity of the cortico-striatum-thalamocortical-pathways in TS. Deep brain stimulation (DBS) of the centromedian nucleus–nucleus ventrooralis internus (CM-Voi complex) in the thalamus is an effective treatment for refractory TS patients. We investigated the connectivity of activated fibers from CM-Voi to the motor cortex and its correlation between these projections and their clinical outcome. Seven patients with TS underwent CM-Voi-DBS surgery and were clinically evaluated preoperatively and six months postoperatively. We performed diffusion tensor imaging to display the activated fibers projecting from the CM-Voi to the different motor cortex regions of interest. These analyses showed that the extent of tic reduction during DBS is associated with the degree of stimulation-dependent connectivity between CM-Voi and the motor cortex, and in particular, an increased density of projections to the presupplementary motor area (preSMA). Non-responder patients displayed the largest amount of active fibers projecting into cortical areas other than motor cortex compared to responder patients. These findings support the notion that an abnormal connectivity of thalamocortical pathways underlies TS, and that modulation of these circuits through DBS could restore the function and reduce symptoms. View Full-Text
Keywords: Tourette syndrome; deep brain stimulation; connectivity, tractography; imaging Tourette syndrome; deep brain stimulation; connectivity, tractography; imaging
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Andrade, P.; Heiden, P.; Hoevels, M.; Schlamann, M.; Baldermann, J.C.; Huys, D.; Visser-Vandewalle, V. Modulation of Fibers to Motor Cortex during Thalamic DBS in Tourette Patients Correlates with Tic Reduction. Brain Sci. 2020, 10, 302.

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