Functional connectomic profile correlates with effective anterior thalamic stimulation for refractory epilepsy

Cuiping Xu; Lei Qi; Xueyuan Wang; Frédéric L.W.V.J. Schaper; Di Wu; Tao Yu; Xiaoming Yan; Guangyuan Jin; Qiao Wang; Xiaopeng Wang; Xinqi Huang; Yuke Wang; Yuanhong Chen; Jinghui Liu; Yuping Wang; Andreas Horn; Robert S. Fisher; Liankun Ren

Brain Stimulation (Sep 2023)

Functional connectomic profile correlates with effective anterior thalamic stimulation for refractory epilepsy

Cuiping Xu,
Lei Qi,
Xueyuan Wang,
Frédéric L.W.V.J. Schaper,
Di Wu,
Tao Yu,
Xiaoming Yan,
Guangyuan Jin,
Qiao Wang,
Xiaopeng Wang,
Xinqi Huang,
Yuke Wang,
Yuanhong Chen,
Jinghui Liu,
Yuping Wang,
Andreas Horn,
Robert S. Fisher,
Liankun Ren

Affiliations

Cuiping Xu: National Center for Neurological Disorders, Beijing, China; Department of Functional Neurosurgery, Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Clinical Center for Epilepsy, Capital Medical University, Beijing, China
Lei Qi: National Center for Neurological Disorders, Beijing, China; Department of Neurology, Xuanwu Hospital, Clinical Center for Epilepsy, Capital Medical University, Beijing, China
Xueyuan Wang: National Center for Neurological Disorders, Beijing, China; Department of Functional Neurosurgery, Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Clinical Center for Epilepsy, Capital Medical University, Beijing, China
Frédéric L.W.V.J. Schaper: Center for Brain Circuit Therapeutics, Departments of Neurology, Psychiatry, and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, United States
Di Wu: National Center for Neurological Disorders, Beijing, China; Department of Neurology, Xuanwu Hospital, Clinical Center for Epilepsy, Capital Medical University, Beijing, China
Tao Yu: National Center for Neurological Disorders, Beijing, China; Department of Functional Neurosurgery, Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Clinical Center for Epilepsy, Capital Medical University, Beijing, China
Xiaoming Yan: National Center for Neurological Disorders, Beijing, China; Department of Functional Neurosurgery, Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Clinical Center for Epilepsy, Capital Medical University, Beijing, China
Guangyuan Jin: National Center for Neurological Disorders, Beijing, China; Department of Neurology, Xuanwu Hospital, Clinical Center for Epilepsy, Capital Medical University, Beijing, China
Qiao Wang: National Center for Neurological Disorders, Beijing, China; Department of Neurology, Xuanwu Hospital, Clinical Center for Epilepsy, Capital Medical University, Beijing, China
Xiaopeng Wang: National Center for Neurological Disorders, Beijing, China; Department of Neurology, Xuanwu Hospital, Clinical Center for Epilepsy, Capital Medical University, Beijing, China
Xinqi Huang: National Center for Neurological Disorders, Beijing, China; Department of Neurology, Xuanwu Hospital, Clinical Center for Epilepsy, Capital Medical University, Beijing, China
Yuke Wang: National Center for Neurological Disorders, Beijing, China; Department of Neurology, Xuanwu Hospital, Clinical Center for Epilepsy, Capital Medical University, Beijing, China
Yuanhong Chen: National Center for Neurological Disorders, Beijing, China; Department of Neurology, Xuanwu Hospital, Clinical Center for Epilepsy, Capital Medical University, Beijing, China
Jinghui Liu: National Center for Neurological Disorders, Beijing, China; Department of Neurology, Xuanwu Hospital, Clinical Center for Epilepsy, Capital Medical University, Beijing, China
Yuping Wang: National Center for Neurological Disorders, Beijing, China; Department of Neurology, Xuanwu Hospital, Clinical Center for Epilepsy, Capital Medical University, Beijing, China
Andreas Horn: Center for Brain Circuit Therapeutics, Departments of Neurology, Psychiatry, and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, United States; Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany; MGH Neurosurgery & Center for Neurotechnology and Neurorecovery (CNTR) at MGH Neurology, Massachusetts General Hospital, Harvard Medical School, United States
Robert S. Fisher: Department of Neurology and Neurological Sciences and Neurosurgery by Courtesy, Stanford University School of Medicine, Palo Alto, CA, USA
Liankun Ren: National Center for Neurological Disorders, Beijing, China; Department of Neurology, Xuanwu Hospital, Clinical Center for Epilepsy, Capital Medical University, Beijing, China; Chinese Institute for Brain Research, Beijing, China; Corresponding author. Department of Neurology, Xuanwu Hospital, Clinical Center for Epilepsy, Capital Medical University, National Center for Neurological Disorders, NO.45 Changchun Street, Xicheng District, Beijing, 100053, China.

Journal volume & issue: Vol. 16, no. 5
pp. 1302 – 1309

Abstract

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Background: Deep brain stimulation of the anterior nucleus of the thalamus (ANT-DBS) is an effective treatment for refractory epilepsy; however, seizure outcome varies among individuals. Identifying a reliable noninvasive biomarker to predict good responders would be helpful. Objectives: To test whether the functional connectivity between the ANT-DBS sites and the seizure foci correlates with effective seizure control in refractory epilepsy. Methods: We performed a proof-of-concept pilot study of patients with focal refractory epilepsy receiving ANT-DBS. Using normative human connectome data derived from 1000 healthy participants, we investigated whether intrinsic functional connectivity between the seizure foci and the DBS site was associated with seizure outcome. We repeated this analysis controlling for the extent of seizure foci, distance between the seizure foci and DBS site, and using functional connectivity of the ANT instead of the DBS site to test the contribution of variance in DBS sites. Results: Eighteen patients with two or more seizure foci were included. Greater functional connectivity between the seizure foci and the DBS site correlated with more favorable outcome. The degree of functional connectivity accounted for significant variance in clinical outcomes (DBS site: |r| = 0.773, p < 0.001 vs ANT-atlas: |r| = 0.715, p = 0.001), which remained significant when controlling for the extent of the seizure foci (|r| = 0.773, p < 0.001) and the distance between the seizure foci and DBS site (|r| = 0.777, p < 0.001). Significant correlations were independent of variance in the DBS sites (|r| = 0.148, p = 0.57). Conclusion: These findings suggest that functional connectomic profile is a potential reliable non-invasive biomarker to predict ANT-DBS outcomes. Accordingly, the identification of ANT responders could decrease the surgical risk for patients who may not benefit and optimize the cost-effective allocation of health care resources.

Published in Brain Stimulation

ISSN: 1935-861X (Print); 1876-4754 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Neurosciences. Biological psychiatry. Neuropsychiatry
Website: https://www.journals.elsevier.com/brain-stimulation

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