Involvement of the ipsilateral-to-the-pain anterior-superior hypothalamic subunit in chronic cluster headache.

BACKGROUND: Despite hypothalamus has long being considered to be involved in the pathophysiology of cluster headache, the inconsistencies of previous neuroimaging studies and a limited understanding of the hypothalamic areas involved, impede a comprehensive interpretation of its involvement in this condition. METHODS: We used an automated algorithm to extract hypothalamic subunit volumes from 105 cluster headache patients (57 chronic and 48 episodic) and 59 healthy individuals; after correcting the measures for the respective intracranial volumes, we performed the relevant comparisons employing logist regression models. Only for subunits that emerged as abnormal, we calculated their correlation with the years of illness and the number of headache attacks per day, and the effects of lithium treatment. As a post-hoc approach, using the 7 T resting-state fMRI dataset from the Human Connectome Project, we investigated whether the observed abnormal subunit, comprising the paraventricular nucleus and preoptic area, shows robust functional connectivity with the mesocorticolimbic system, which is known to be modulated by oxytocin neurons in the paraventricular nucleus and that is is abnormal in chronic cluster headache patients. RESULTS: Patients with chronic (but not episodic) cluster headache, compared to control participants, present an increased volume of the anterior-superior hypothalamic subunit ipsilateral to the pain, which, remarkably, also correlates significantly with the number of daily attacks. The post-hoc approach showed that this hypothalamic area presents robust functional connectivity with the mesocorticolimbic system under physiological conditions. No evidence of the effects of lithium treatment on this abnormal subunit was found. CONCLUSIONS: We identified the ipsilateral-to-the-pain antero-superior subunit, where the paraventricular nucleus and preoptic area are located, as the key hypothalamic region of the pathophysiology of chronic cluster headache. The significant correlation between the volume of this area and the number of daily attacks crucially reinforces this interpretation. The well-known roles of the paraventricular nucleus in coordinating autonomic and neuroendocrine flow in stress adaptation and modulation of trigeminovascular mechanisms offer important insights into the understanding of the pathophysiology of cluster headache.

The Optimal Targeting for Focused Ultrasound Thalamotomy Differs between Dystonic and Essential Tremor: A 12-Month Prospective Pilot Study.

BACKGROUND: Magnetic resonance-guided focused ultrasound (MRgFUS) thalamotomy is increasingly used to treat drug-resistant essential tremor (ET). Data on MRgFUS thalamotomy in dystonic tremor (DT) are anecdotal. OBJECTIVES: To investigate efficacy, safety, and differences in target coordinates of MRgFUS thalamotomy in DT versus ET. METHODS: Ten patients with DT and 35 with ET who consecutively underwent MRgFUS thalamotomy were followed for 12 months. Although in both groups the initial surgical planning coordinates corresponded to the ventralis intermediate (Vim), the final target could be modified intraoperatively based on clinical response. RESULTS: Tremor significantly improved in both groups. The thalamic lesion was significantly more anterior in DT than ET. Considering both ET and DT groups, the more anterior the lesion, the lower the odds ratio for adverse events. CONCLUSIONS: MRgFUS thalamotomy is safe and effective in DT and ET. Compared to classical Vim coordinates used for ET, more anterior targeting should be considered for DT.

Magnetic Resonance-Guided Focused Ultrasound Thalamotomy May Spare Dopaminergic Therapy in Early-Stage Tremor-Dominant Parkinson's Disease: A Pilot Study.

BACKGROUND: Magnetic resonance-guided focused ultrasound (MRgFUS) thalamotomy is a safe and effective procedure for drug-resistant tremor in Parkinson's disease (PD). OBJECTIVE: The aim of this study was to demonstrate that MRgFUS ventralis intermedius thalamotomy in early-stage tremor-dominant PD may prevent an increase in dopaminergic medication 6 months after treatment compared with matched PD control subjects on standard medical therapy. METHODS: We prospectively enrolled patients with early-stage PD who underwent MRgFUS ventralis intermedius thalamotomy (PD-FUS) and patients treated with oral dopaminergic therapy (PD-ODT) with a 1:2 ratio. We collected demographic and clinical data at baseline and 6 and 12 months after thalamotomy. RESULTS: We included 10 patients in the PD-FUS group and 20 patients in the PD-ODT group. We found a significant increase in total levodopa equivalent daily dose and levodopa plus monoamine oxidase B inhibitors dose in the PD-ODT group 6 months after thalamotomy. CONCLUSIONS: In early-stage tremor-dominant PD, MRgFUS thalamotomy may be useful to reduce tremor and avoid the need to increase dopaminergic medications. © 2022 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

Stereotactic electroencephalography in humans reveals multisensory signal in early visual and auditory cortices.

Unequivocally demonstrating the presence of multisensory signals at the earliest stages of cortical processing remains challenging in humans. In our study, we relied on the unique spatio-temporal resolution provided by intracranial stereotactic electroencephalographic (SEEG) recordings in patients with drug-resistant epilepsy to characterize the signal extracted from early visual (calcarine and pericalcarine) and auditory (Heschl's gyrus and planum temporale) regions during a simple audio-visual oddball task. We provide evidences that both cross-modal responses (visual responses in auditory cortex or the reverse) and multisensory processing (alteration of the unimodal responses during bimodal stimulation) can be observed in intracranial event-related potentials (iERPs) and in power modulations of oscillatory activity at different temporal scales within the first 150 msec after stimulus onset. The temporal profiles of the iERPs are compatible with the hypothesis that MSI occurs by means of direct pathways linking early visual and auditory regions. Our data indicate, moreover, that MSI mainly relies on modulations of the low-frequency bands (foremost the theta band in the auditory cortex and the alpha band in the visual cortex), suggesting the involvement of feedback pathways between the two sensory regions. Remarkably, we also observed high-gamma power modulations by sounds in the early visual cortex, thus suggesting the presence of neuronal populations involved in auditory processing in the calcarine and pericalcarine region in humans.

The neural correlates of lexical processing in disorders of consciousness.

There is a growing interest in the use of functional imaging to assess brain activity in the absence of behavioural responses in patients with disorders of consciousness (DOC). In the present study, we applied a hierarchical auditory stimulation paradigm to functional magnetic resonance (fMRI) in a group of long-term DOC adult patients. Brain response to pairs of pseudowords, of unrelated words and of semantically related words, i.e. stimuli differing in lexical status (words vs. pseudowords) and semantic relatedness (related vs. unrelated) was assessed. The former contrast was considered to reflect the automatic brain response to the passive presentation of meaningful real words, while the latter aimed to assess the response to meaning relationships. The results of the study indicate that automatic lexical processing can be observed in minimally conscious state (MCS), but also in vegetative state/unresponsive wakefulness syndrome (VS/UWS) patients, as indicated by increase in blood oxygenation level dependent (BOLD) activity in the linguistic networks. DOC patients, for some task conditions, recruited additional areas in comparison to healthy participants. Furthermore this study provides additional evidence of the potential role of fMRI in the assessment of residual cognitive processing in some of these patients, which may not be evident at the clinical level.

Effect of diffusion-sensitizing gradient timings on the exponential, biexponential and diffusional kurtosis model parameters: in-vivo measurements in the rat thalamus.

OBJECT: To investigate whether spacing (Delta) and duration (delta) of the diffusion-sensitizing gradient pulses differentially affect exponential (D'), biexponential (D (slow), D (fast) and f (slow)) and diffusional kurtosis (D and K) model parameters. METHODS: Measurements were performed in the rat thalamus for b = 200-3,200 s mm(-2), sweeping Delta between 20 and 100 ms at delta = 15 ms, and delta between 15 and 50 ms at Delta = 60 ms. Linear regressions were performed for each model parameter vs. Delta or delta. RESULTS: Increasing Delta from 20 to 100 ms increases D' (from 0.64 to 0.70 x 10(-3) mm(2)s(-1)) and D (slow) (from 0.26 to 0.33 x 10(-3) mm(2)s(-1)), reduces K (from 0.57 to 0.53), and has no effects on D (fast), f (slow) or D. Increasing delta from 15 to 50 ms increases D (from 0.80 to 0.88 x 10(-3) mm(2)s(-1)), and has no effects on the other parameters. CONCLUSION: The parameters of the biexponential and diffusional kurtosis models are more sensitive than the exponential model to Delta and delta; however, observed effects are too small to account for the discrepancies found in literature.

Functional MRI/event-related potential study of sensory consonance and dissonance in musicians and nonmusicians.

Pleasurability of individual chords, known as sensory consonance, is widely regarded as physiologically determined and has been shown to be associated with differential activity in the auditory cortex and in several other regions. Here, we present results obtained contrasting isolated four-note chords classified as consonant or dissonant in tonal music. Using event-related functional MRI, consonant chords were found to elicit a larger haemodynamic response in the inferior and middle frontal gyri, premotor cortex and inferior parietal lobule. The effect was right lateralized for nonmusicians and less asymmetric for musicians. Using event-related potentials, the degree of sensory consonance was found to modulate the amplitude of the P1 in both groups and of the N2 in musicians only.

Spatial correspondence between functional MRI (fMRI) activations and cortical current density maps of event-related potentials (ERP): a study with four tasks.

We investigated the spatial correspondence between functional MRI (fMRI) activations and cortical current density maps of event-related potentials (ERPs) reconstructed without fMRI priors. The presence of a significant spatial correspondence is a prerequisite for direct integration of the two modalities, enabling to combine the high spatial resolution of fMRI with the high temporal resolution of ERPs. Four separate tasks were employed: visual stimulation with a pattern-reversal chequerboard, recognition of images of nameable objects, recognition of written words, and auditory stimulation with a piano note. ERPs were acquired with 19 recording channels, and source localisation was performed using a realistic head model, a standard cortical mesh and the multiple sparse priors method. Spatial correspondence was evaluated at group level over 10 subjects, by means of a voxel-by-voxel test and a test on the distribution of local maxima. Although not complete, it was significant for the visual stimulation task, image and word recognition tasks (P < 0.001 for both types of test), but not for the auditory stimulation task. These findings indicate that partial but significant spatial correspondence between the two modalities can be found even with a small number of channels, for three of the four tasks employed. Absence of correspondence for the auditory stimulation task was caused by the unfavourable situation of the activated cortex being perpendicular to the overlying scalp, whose consequences were exacerbated by the small number of channels. The present study corroborates existing literature in this field, and may be of particular relevance to those interested in combining fMRI with ERPs acquired with the standard 10-20 system.