Global network modulation during thalamic stimulation for Tourette syndrome

Hang Joon Jo, Kevin W. McCairn, William S. Gibson, Paola Testini, Cong Zhi Zhao, Krzysztof R. Gorny, Joel P. Felmlee, Kirk Welker, Charles D. Blaha, Bryan Klassen, Hoon Ki Min, Kendall H Lee

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background and objectives: Deep brain stimulation (DBS) of the thalamus is a promising therapeutic alternative for treating medically refractory Tourette syndrome (TS). However, few human studies have examined its mechanism of action. Therefore, the networks that mediate the therapeutic effects of thalamic DBS remain poorly understood. Methods: Five participants diagnosed with severe medically refractory TS underwent bilateral thalamic DBS stereotactic surgery. Intraoperative fMRI characterized the blood oxygen level-dependent (BOLD) response evoked by thalamic DBS and determined whether the therapeutic effectiveness of thalamic DBS, as assessed using the Modified Rush Video Rating Scale test, would correlate with evoked BOLD responses in motor and limbic cortical and subcortical regions. Results: Our results reveal that thalamic stimulation in TS participants has wide-ranging effects that impact the frontostriatal, limbic, and motor networks. Thalamic stimulation induced suppression of motor and insula networks correlated with motor tic reduction, while suppression of frontal and parietal networks correlated with vocal tic reduction. These regions mapped closely to major regions of interest (ROI) identified in a nonhuman primate model of TS. Conclusions: Overall, these findings suggest that a critical factor in TS treatment should involve modulation of both frontostriatal and motor networks, rather than be treated as a focal disorder of the brain. Using the novel combination of DBS-evoked tic reduction and fMRI in human subjects, we provide new insights into the basal ganglia-cerebellar-thalamo-cortical network-level mechanisms that influence the effects of thalamic DBS. Future translational research should identify whether these network changes are cause or effect of TS symptoms.

Original languageEnglish (US)
Pages (from-to)502-509
Number of pages8
JournalNeuroImage: Clinical
Volume18
DOIs
StatePublished - Jan 1 2018

Fingerprint

Tourette Syndrome
Deep Brain Stimulation
Tics
Magnetic Resonance Imaging
Oxygen
Translational Medical Research
Brain Diseases
Therapeutic Uses
Basal Ganglia
Thalamus
Primates
Therapeutics

Keywords

  • Basal ganglia-cerebellar-thalamo-cortical networks
  • Deep brain stimulation
  • Functional magnetic resonance imaging
  • Neurological disorders
  • Vocal/motor tics

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Neurology
  • Clinical Neurology
  • Cognitive Neuroscience

Cite this

Jo, H. J., McCairn, K. W., Gibson, W. S., Testini, P., Zhao, C. Z., Gorny, K. R., ... Lee, K. H. (2018). Global network modulation during thalamic stimulation for Tourette syndrome. NeuroImage: Clinical, 18, 502-509. https://doi.org/10.1016/j.nicl.2018.02.018

Global network modulation during thalamic stimulation for Tourette syndrome. / Jo, Hang Joon; McCairn, Kevin W.; Gibson, William S.; Testini, Paola; Zhao, Cong Zhi; Gorny, Krzysztof R.; Felmlee, Joel P.; Welker, Kirk; Blaha, Charles D.; Klassen, Bryan; Min, Hoon Ki; Lee, Kendall H.

In: NeuroImage: Clinical, Vol. 18, 01.01.2018, p. 502-509.

Research output: Contribution to journalArticle

Jo, HJ, McCairn, KW, Gibson, WS, Testini, P, Zhao, CZ, Gorny, KR, Felmlee, JP, Welker, K, Blaha, CD, Klassen, B, Min, HK & Lee, KH 2018, 'Global network modulation during thalamic stimulation for Tourette syndrome', NeuroImage: Clinical, vol. 18, pp. 502-509. https://doi.org/10.1016/j.nicl.2018.02.018
Jo HJ, McCairn KW, Gibson WS, Testini P, Zhao CZ, Gorny KR et al. Global network modulation during thalamic stimulation for Tourette syndrome. NeuroImage: Clinical. 2018 Jan 1;18:502-509. https://doi.org/10.1016/j.nicl.2018.02.018
Jo, Hang Joon ; McCairn, Kevin W. ; Gibson, William S. ; Testini, Paola ; Zhao, Cong Zhi ; Gorny, Krzysztof R. ; Felmlee, Joel P. ; Welker, Kirk ; Blaha, Charles D. ; Klassen, Bryan ; Min, Hoon Ki ; Lee, Kendall H. / Global network modulation during thalamic stimulation for Tourette syndrome. In: NeuroImage: Clinical. 2018 ; Vol. 18. pp. 502-509.
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