-
Epilepsia Jun 2024In patients with drug-resistant epilepsy (DRE) who are not candidates for resective surgery, various thalamic nuclei, including the anterior, centromedian, and pulvinar... (Review)
Review
In patients with drug-resistant epilepsy (DRE) who are not candidates for resective surgery, various thalamic nuclei, including the anterior, centromedian, and pulvinar nuclei, have been extensively investigated as targets for neuromodulation. However, the therapeutic effects of different targets for thalamic neuromodulation on various types of epilepsy are not well understood. Here, we present a 32-year-old patient with multifocal bilateral temporoparieto-occipital epilepsy and bilateral malformations of cortical development (MCDs) who underwent bilateral stereoelectroencephalographic (SEEG) recordings of the aforementioned three thalamic nuclei bilaterally. The change in the rate of interictal epileptiform discharges (IEDs) from baseline were compared in temporal, central, parietal, and occipital regions after direct electrical stimulation (DES) of each thalamic nucleus. A significant decrease in the rate of IEDs (33% from baseline) in the posterior quadrant regions was noted in the ipsilateral as well as contralateral hemisphere following DES of the pulvinar. A scoping review was also performed to better understand the current standpoint of pulvinar thalamic stimulation in the treatment of DRE. The therapeutic effect of neuromodulation can differ among thalamic nuclei targets and epileptogenic zones (EZs). In patients with multifocal EZs with extensive MCDs, personalized thalamic targeting could be achieved through DES with thalamic SEEG electrodes.
Topics: Humans; Adult; Pulvinar; Drug Resistant Epilepsy; Electroencephalography; Deep Brain Stimulation; Stereotaxic Techniques; Proof of Concept Study; Thalamus; Male; Electric Stimulation Therapy
PubMed: 38625609
DOI: 10.1111/epi.17986 -
Neurological Sciences : Official... May 2024This study aimed to examine the volumes of thalamic nuclei and the intrinsic thalamic network in patients with Wilson's disease (WDs), and to explore the correlation...
OBJECTIVE
This study aimed to examine the volumes of thalamic nuclei and the intrinsic thalamic network in patients with Wilson's disease (WDs), and to explore the correlation between these volumes and the severity of neurological symptoms.
METHODS
A total of 61 WDs and 33 healthy controls (HCs) were included in the study. The volumes of 25 bilateral thalamic nuclei were measured using structural imaging analysis with Freesurfer, and the intrinsic thalamic network was evaluated through structural covariance network (SCN) analysis.
RESULTS
The results indicated that multiple thalamic nuclei were smaller in WDs compared to HCs, including mediodorsal medial magnocellular (MDm), anterior ventral (AV), central median (CeM), centromedian (CM), lateral geniculate (LGN), limitans-suprageniculate (L-Sg), reuniens-medial ventral (MV), paracentral (Pc), parafascicular (Pf), paratenial (Pt), pulvinar anterior (PuA), pulvinar inferior (PuI), pulvinar medial (PuM), ventral anterior (VA), ventral anterior magnocellular (VAmc), ventral lateral anterior (VLa), ventral lateral posterior (VLp), ventromedial (VM), ventral posterolateral (VPL), and right middle dorsal intralaminar (MDI). The study also found a negative correlation between the UWDRS scores and the volume of the right MDm. The intrinsic thalamic network analysis showed abnormal topological properties in WDs, including increased mean local efficiency, modularity, normalized clustering coefficient, small-world index, and characteristic path length, and a corresponding decrease in mean node betweenness centrality. WDs with cerebral involvement had a lower modularity compared to HCs.
CONCLUSIONS
The findings suggest that the majority of thalamic nuclei in WDs exhibit significant volume reduction, and the atrophy of the right MDm is closely related to the severity of neurological symptoms. The intrinsic thalamic network in WDs demonstrated abnormal topological properties, indicating a close relationship with neurological impairment.
Topics: Humans; Hepatolenticular Degeneration; Thalamic Nuclei; Thalamus
PubMed: 38049551
DOI: 10.1007/s10072-023-07245-2 -
NeuroImage. Clinical 2024Impaired motion perception in schizophrenia has been associated with deficits in social-cognitive processes and with reduced activation of visual sensory regions,...
Impaired motion perception in schizophrenia has been associated with deficits in social-cognitive processes and with reduced activation of visual sensory regions, including the middle temporal area (MT+) and posterior superior temporal sulcus (pSTS). These findings are consistent with the recent proposal of the existence of a specific 'third visual pathway' specialized for social perception in which motion is a fundamental component. The third visual pathway transmits visual information from early sensory visual processing areas to the STS, with MT+ acting as a critical intermediary. We used functional magnetic resonance imaging to investigate functioning of this pathway during processing of naturalistic videos with explicit (real) motion and static images with implied motion cues. These measures were related to face emotion recognition and motion-perception, as measured behaviorally. Participants were 28 individuals with schizophrenia (Sz) and 20 neurotypical controls. Compared to controls, individuals with Sz showed reduced activation of third visual pathway regions (MT+, pSTS) in response to both real- and implied-motion stimuli. Dysfunction of early visual cortex and pulvinar were also associated with aberrant real-motion processing. Implied-motion stimuli additionally engaged a wide network of brain areas including parietal, motor and frontal nodes of the human mirror neuron system. The findings support concepts of MT+ as a mediator between visual sensory areas and higher-order brain and argue for greater focus on MT+ contributions to social-cognitive processing, in addition to its well-documented role in visual motion processing.
Topics: Humans; Schizophrenia; Visual Pathways; Temporal Lobe; Brain; Magnetic Resonance Imaging; Brain Mapping; Motion Perception; Photic Stimulation
PubMed: 38309185
DOI: 10.1016/j.nicl.2024.103570 -
The Journal of Neuropsychiatry and... 2024Traumatic brain injury (TBI) is a risk factor for suicide, but questions related to mechanisms remain unanswered. Impulsivity is a risk factor for suicide and is a...
OBJECTIVE
Traumatic brain injury (TBI) is a risk factor for suicide, but questions related to mechanisms remain unanswered. Impulsivity is a risk factor for suicide and is a common sequela of TBI. The authors explored the relationships between TBI and both suicidal ideation and suicide attempts and explored whether impulsivity and comorbid psychiatric diagnoses mediate these relationships.
METHODS
This cross-sectional retrospective chart review study included 164 veterans enrolled in a previous study. Sixty-nine veterans had no TBI history, and 95 had a TBI history (mild, N=44; moderate, N=13; severe, N=12; and unclear severity, N=26). To examine the associations between TBI and suicidal ideation or suicide attempts, as well as potential mediators of these relationships, chi-square tests, t tests, and logistic regression models were used.
RESULTS
Unadjusted analyses indicated that veterans with TBI were more likely to report suicidal ideation; however, in analyses controlling for mediators, this relationship was no longer significant. Among veterans with TBI, suicidal ideation was related most strongly to high impulsivity (odds ratio=15.35, 95% CI=2.43-96.79), followed by depression (odds ratio=5.73, 95% CI=2.53-12.99) and posttraumatic stress disorder (odds ratio=2.57, 95% CI=1.03-6.42). TBI was not related to suicide attempts, yet suicide attempts were related to high impulsivity (odds ratio=6.95, 95% CI=1.24-38.75) and depression (odds ratio=3.89, 95% CI=1.56-9.40).
CONCLUSIONS
These findings suggest that impulsivity, followed by psychiatric diagnoses, most strongly mediate the relationships between TBI and both suicidal ideation and suicide attempts. Impulsivity may be mechanistically related to, and serve as a future treatment target for, suicidality among veterans with TBI.
Topics: Humans; Suicide, Attempted; Suicidal Ideation; Veterans; Retrospective Studies; Cross-Sectional Studies; Impulsive Behavior; Risk Factors; Brain Injuries, Traumatic
PubMed: 38192217
DOI: 10.1176/appi.neuropsych.20230044 -
Cureus Jan 2024Understanding the role of the pulvinar nucleus may be critical for guiding circuit-targeted neurosurgical intervention in some patients. In this report, a 33-year-old...
Understanding the role of the pulvinar nucleus may be critical for guiding circuit-targeted neurosurgical intervention in some patients. In this report, a 33-year-old female presented with focal onset occipital epilepsy with secondary generalization and with a previously radiated arteriovenous malformation within the right primary visual cortex. Phase II monitoring demonstrated the pulvinar nucleus was not involved in subclinical seizures restricted to the primary visual cortex, but it did become involved in clinical events with more extensive seizure spread into higher visual cortical regions. She underwent responsive neurostimulation (RNS) with implantation of leads within the primary visual cortex. This case demonstrates the late propagation of epileptic activity from the visual cortex to the pulvinar nucleus and illustrates the pulvinar nucleus' connections with higher-order visual areas.
PubMed: 38371112
DOI: 10.7759/cureus.52534 -
Radiology Case Reports Mar 2024Sporadic Creutzfeldt-Jakob disease (sCJD) is an uncommon prion disease, also a fatal degenerative brain disorder. We aimed to illustrate 2 clinical cases, a 60-year-old...
Sporadic Creutzfeldt-Jakob disease (sCJD) is an uncommon prion disease, also a fatal degenerative brain disorder. We aimed to illustrate 2 clinical cases, a 60-year-old female and a 57-year-old male, who came to the hospital due to rapidly progressive cognitive decline. A 1.5T brain MRI in both patients detected cortical and basal ganglia signal abnormalities with diffuse, asymmetrical features. The patient underwent electroencephalography and cerebrospinal fluid tests, which showed abnormal waves and a positive 14-3-3 protein test in the CSF samples of both patients. According to the 2018 US Centers for Disease Control and Prevention (CDC) diagnostic criteria, we finally diagnosed these patients with sCJD.
PubMed: 38188942
DOI: 10.1016/j.radcr.2023.11.082 -
Neuroradiology Jun 2024Canavan disease (CD) is a rare autosomal recessive neurodegenerative disorder caused by a deficiency of aspartoacylase A, an enzyme that degrades N-acetylaspartate...
INTRODUCTION
Canavan disease (CD) is a rare autosomal recessive neurodegenerative disorder caused by a deficiency of aspartoacylase A, an enzyme that degrades N-acetylaspartate (NAA). The disease is characterized by progressive white matter degeneration, leading to intellectual disability, seizures, and death. This retrospective study aims to describe the full spectrum of magnetic resonance imaging (MRI) findings in a large case series of CD patients.
MATERIALS AND METHODS
MRI findings in 18 patients with confirmed CD were investigated, and the full spectrum of brain abnormalities was compared with the existing literature to provide new insights regarding the brain MRI findings in these patients. All the cases were proven based on genetic study or NAA evaluation in urine or brain.
RESULTS
Imaging analysis showed involvement of the deep and subcortical white matter as well as the globus pallidus in all cases, with sparing of the putamen, caudate, and claustrum. The study provides updates on the imaging characteristics of CD and validates some underreported findings such as the involvement of the lateral thalamus with sparing of the pulvinar, involvement of the internal capsules and corpus callosum, and cystic formation during disease progression.
CONCLUSION
To our knowledge, this is one of the largest case series of patients with CD which includes a detailed description of the brain MRI findings. The study confirmed many of the previously reported MRI findings but also identified abnormalities that were previously rarely or not described. We speculate that areas of ongoing myelination are particularly vulnerable to changes in CD.
PubMed: 38880823
DOI: 10.1007/s00234-024-03388-x -
Rinsho Shinkeigaku = Clinical Neurology Oct 2023A 76-year-old male patient was admitted to our hospital for the treatment of acute cerebral infarction in the right temporal stem, right lateral thalamus, and right...
A 76-year-old male patient was admitted to our hospital for the treatment of acute cerebral infarction in the right temporal stem, right lateral thalamus, and right pulvinar regions. Although his overall cognitive function was almost normal, he exhibited reduced visual sensitivity in the homonymous lower left quadrant of the visual field, left unilateral spatial neglect (USN), and simultanagnosia. Left USN improved 4 months after the onset of infarction; however, simultanagnosia persisted. To the best of our knowledge, this is the first case of simultanagnosia caused by cerebral infarction in the right temporal stem, right lateral thalamus, and right pulvinar regions.
Topics: Male; Humans; Aged; Pulvinar; Thalamus; Cerebral Infarction; Agnosia; Perceptual Disorders
PubMed: 37779025
DOI: 10.5692/clinicalneurol.cn-001846 -
Research Square Mar 2024Neuromodulation trials for PTSD have yielded mixed results, and the optimal neuroanatomical target remains unclear. We analyzed three datasets to study brain circuitry...
Neuromodulation trials for PTSD have yielded mixed results, and the optimal neuroanatomical target remains unclear. We analyzed three datasets to study brain circuitry causally linked to PTSD in military Veterans. After penetrating traumatic brain injury (n=193), lesions that reduced probability of PTSD were preferentially connected to a circuit including the medial prefrontal cortex (mPFC), amygdala, and anterolateral temporal lobe (cross-validation p=0.01). In Veterans without lesions (n=180), PTSD was specifically associated with connectivity within this circuit (p<0.01). Connectivity change within this circuit correlated with PTSD improvement after transcranial magnetic stimulation (TMS) (n=20) (p<0.01), even though the circuit was not directly targeted. Finally, we directly targeted this circuit with fMRI-guided accelerated TMS, leading to rapid resolution of symptoms in a patient with severe lifelong PTSD. All results were independent of depression severity. This lesion-based PTSD circuit may serve as a neuromodulation target for Veterans with PTSD.
PubMed: 38562753
DOI: 10.21203/rs.3.rs-3132332/v1 -
World Neurosurgery May 2024Geniculocalcarine fibers are thought to be exclusively ipsilateral. However, recent findings challenged this belief, revealing bilateral recruiting responses in...
BACKGROUND
Geniculocalcarine fibers are thought to be exclusively ipsilateral. However, recent findings challenged this belief, revealing bilateral recruiting responses in occipitotemporoparietal regions upon unilateral stimulation of the lateral geniculate nucleus (LGN) in humans. This raised the intriguing possibility of bilateral projections to primary visual areas (V1). This study sought to explore the hypothetical decussation of the geniculocalcarine tract.
METHODS
40 healthy individuals' 7T magnetic resonance images from the Human Connectome Project were examined. Employing MRtrix3 software with the constrained spherical deconvolution algorithm, scans were processed. LGN served as the seed region and contralateral regions of interest (splenium of the corpus callosum, posterior commissure, LGN, V1, pulvinar, and superior colliculus) were defined to reconstruct the hypothetical decussated fibers. Tractography included contralateral V1 as the target region in all segmentations, excluding ipsilateral V1 to eliminate fibers leading to or originating from this area. Additionally, a segmentation of the tract originating from LGN and projecting to the ipsilateral V1 was performed. Mean fraction anisotropy and mean diffusivity metrics were extracted from the density maps.
RESULTS
Observations revealed a substantial volume of decussated fibers between LGN and contralateral V1 via the splenium of the corpus callosum, albeit much smaller than ipsilateral fibers. The volume of ipsilateral fibers was similar in both sides. Left LGN-originating decussated fibers were more than double those originating from the right LGN. Tract segmentation to other regions of interests yielded no fibers.
CONCLUSIONS
This study suggests a partial decussation of the fibers between LGN and V1, likely constituting the geniculocalcarine tract.
PubMed: 38823444
DOI: 10.1016/j.wneu.2024.05.152