Metabolic Positron Emission Tomography Response to Gamma Knife of the Ventral Intermediate Nucleus in Essential Tremor
Résumé
Background: To understand the substrate of response and non-response, and identify potential biomarkers for selection and follow-up of patients with essential tremor (ET) treated by Gamma-Knife of the Ventrointermedius nucleus (GKVIM).
Objective: This observational study aims to characterize PET changes in metabolism of glucose and metabolic connectivity in patients with ET treated by GKVIM. Methods: Forty-two patients with right ET were referred to 18F-FDG PET imaging before, and after left GKVIM. Statistical Parametric Mapping-T score maps comparisons were performed
between pre- and post-GKVIM groups, and between clinical responders and non-responders. Metabolic connectivity was evaluated by interregional correlation analysis method.
Results: After GKVIM, patients with ET exhibited a decrease of the left thalamic metabolism, associated with remote metabolic decreases in the right cerebellum, left temporal gyri, and bilateral frontal gyri (p<0.05 with family-wise error correction). Non-responders (n=7) additionally showed after GKVIM a metabolic decrease in the right temporo-occipital area (p<0.005 corrected for cluster volume). The metabolism of this area was already reduced before treatment in comparison to responders, and was predictive of the future response (sensitivity: 89 %; specificity: 71 %). In non-responder patients, a strong connectivity between the left thalamus and right temporo-occipital area was found before GKVIM and lost after treatment, while it remained weak and stable in responders.
Conclusions: These findings could lead to a better knowledge of the variability of metabolic PET profiles among patients with ET, especially the integration of 18F-FDG PET imaging in the pretherapeutic evaluation of patients with refractory ET candidate to GKVIM.
Domaines
Médecine humaine et pathologie
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METABOLIC PET RESPONSE TO GAMMA KNIFE OF THE VENTRAL INTERMEDIATE NUCLEUS IN ESSENTIAL TREMOR.pdf (851.06 Ko)
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