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October 30, 2020Research

Focused Ultrasound Thalamotomy Sensory Side Effects Follow the Thalamic Structural Homonculus

Michelle Paff, Alexandre Boutet, Jürgen Germann, Gavin J. B. Elias, View ORCID ProfileClement T. Chow, Aaron Loh, Walter Kucharczyk, Alfonso Fasano, Michael L. Schwartz, Andres M. Lozano
First published October 30, 2020, DOI: https://doi.org/10.1212/CPJ.0000000000001013
Michelle Paff
1University Health Network, Toronto, Ontario, Canada
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Alexandre Boutet
1University Health Network, Toronto, Ontario, Canada
2Joint Department of Medical Imaging, University of Toronto, Ontario, Canada
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Jürgen Germann
1University Health Network, Toronto, Ontario, Canada
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Gavin J. B. Elias
1University Health Network, Toronto, Ontario, Canada
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Clement T. Chow
1University Health Network, Toronto, Ontario, Canada
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  • ORCID record for Clement T. Chow
Aaron Loh
1University Health Network, Toronto, Ontario, Canada
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Walter Kucharczyk
1University Health Network, Toronto, Ontario, Canada
2Joint Department of Medical Imaging, University of Toronto, Ontario, Canada
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Alfonso Fasano
3Edmond J. Safra Program in Parkinson’s Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, Division of Neurology, University of Toronto, Toronto, Ontario, Canada
4Krembil Brain Institute, Toronto, Ontario, Canada.
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Michael L. Schwartz
5Division of Neurosurgery, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada
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Andres M. Lozano
1University Health Network, Toronto, Ontario, Canada
6Division of Neurosurgery, Department of Surgery, Toronto Western Hospital and University of Toronto, Ontario, Canada
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Citation
Focused Ultrasound Thalamotomy Sensory Side Effects Follow the Thalamic Structural Homonculus
Michelle Paff, Alexandre Boutet, Jürgen Germann, Gavin J. B. Elias, Clement T. Chow, Aaron Loh, Walter Kucharczyk, Alfonso Fasano, Michael L. Schwartz, Andres M. Lozano
Neurol Clin Pract Oct 2020, 10.1212/CPJ.0000000000001013; DOI: 10.1212/CPJ.0000000000001013

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Abstract

Introduction: Focused ultrasound thalamotomy is an effective treatment for tremor, however, side effects may occur. The purpose of the present study was to investigate the spatial relationship between thalamotomies and specific sensory side effects as well as their functional connectivity with somatosensory cortex and relationship to the medial lemniscus (ML).

Methods: Sensory adverse effects were categorized into four groups based on the location of the disturbance: face/mouth/tongue numbness/paresthesia, hand-only paresthesia, hemi-body/limb paresthesia, and dysgeusia. Then, areas of significant risk (ASR) for each category were defined using voxel-wise mass univariate analysis and overlaid on corresponding odds ratio maps. The ASR area associated with the maximum risk was used as a region-of-interest in a normative functional connectome to determine side-effect specific functional connectivity. Finally, each ASR was overlaid on the medial lemniscus derived from normative template.

Results: Of 103 patients, 17 developed sensory side effects after thalamotomy persisting 3 months after the procedures. Lesions producing sensory side effects extended posteriorly into the principle sensory nucleus of the thalamus or below the thalamus in the ML. The topography of sensory adverse effects followed the know somatotopy of the ML and the sensory nucleus. Functional connectivity patterns between each sensory-specific thalamic seed and the primary somatosensory areas supported the role of the middle insula in processing of gustatory information and in multisensory integration.

Discussion: Distinct regions in the sensory thalamus and its afferent connections rise to specific sensory disturbances. These findings demonstrate the relationship between the sensory thalamus, ML, and bilateral sensory cortical areas.

  • Received June 25, 2020.
  • Accepted September 24, 2020.
  • © 2020 American Academy of Neurology

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