Probabilistic tractography in Tourette syndrome (TS) patients have shown an alteration in the connectivity of the primary motor cortex and supplementary motor area with the striatum and thalamus, suggesting an abnormal connectivity of the cortico-striatum-thalamocortical-pathways in TS. Deep brain stimulation (DBS) of the centromedian nucleus-nucleus ventrooralis internus (CM-Voi complex) in the thalamus is an effective treatment for refractory TS patients. We investigated the connectivity of activated fibers from CM-Voi to the motor cortex and its correlation between these projections and their clinical outcome. Seven patients with TS underwent CM-Voi-DBS surgery and were clinically evaluated preoperatively and six months postoperatively. We performed diffusion tensor imaging to display the activated fibers projecting from the CM-Voi to the different motor cortex regions of interest. These analyses showed that the extent of tic reduction during DBS is associated with the degree of stimulation-dependent connectivity between CM-Voi and the motor cortex, and in particular, an increased density of projections to the presupplementary motor area (preSMA). Non-responder patients displayed the largest amount of active fibers projecting into cortical areas other than motor cortex compared to responder patients. These findings support the notion that an abnormal connectivity of thalamocortical pathways underlies TS, and that modulation of these circuits through DBS could restore the function and reduce symptoms.

中文翻译：

---

抽动秽语患者丘脑DBS期间纤维对运动皮质的调节与Tic降低相关。

抽动秽语综合征（TS）患者的概率束线图显示，原发性运动皮层和辅助运动区域与纹状体和丘脑的连通性发生了变化，表明TS中皮质-纹状体-丘脑-皮质途径的连通性异常。丘脑中的着丝粒体核-腹室内核（CM-Voi复合体）的深部脑刺激（DBS）是难治性TS患者的有效治疗方法。我们研究了从CM-Voi到运动皮层的活化纤维的连通性，以及这些预测与临床结果之间的相关性。7例TS患者接受了CM-Voi-DBS手术，并在术前和术后六个月接受了临床评估。我们进行了扩散张量成像，以显示从CM-Voi投射到感兴趣的不同运动皮层区域的活化纤维。这些分析表明，DBS期间抽动的减少程度与CM-Voi和运动皮层之间的刺激依赖性连接程度有关，特别是与辅助运动区（preSMA）的投影密度增加有关。与有反应的患者相比，无反应的患者表现出最多的活性纤维投射到运动皮层以外的皮质区域。这些发现支持以下观点：丘脑皮质通路的异常连通性是TS的基础，而通过DBS调节这些回路可以恢复功能并减轻症状。这些分析表明，DBS期间抽动的减少程度与CM-Voi和运动皮层之间依赖刺激的连通程度有关，特别是与辅助运动区（preSMA）的投影密度增加有关。与有反应的患者相比，无反应的患者表现出最多的活性纤维投射到运动皮层以外的皮质区域。这些发现支持以下观点：丘脑皮质通路的异常连通性是TS的基础，而通过DBS调节这些回路可以恢复功能并减轻症状。这些分析表明，DBS期间抽动的减少程度与CM-Voi和运动皮层之间依赖刺激的连通程度有关，特别是与辅助运动区（preSMA）的投影密度增加有关。与有反应的患者相比，无反应的患者表现出最多的活性纤维投射到运动皮层以外的皮质区域。这些发现支持以下观点：丘脑皮质通路的异常连通性是TS的基础，而通过DBS调节这些回路可以恢复功能并减轻症状。与有反应的患者相比，无反应的患者表现出最多的活性纤维投射到运动皮层以外的皮质区域。这些发现支持以下观点：丘脑皮质通路的异常连通性是TS的基础，而通过DBS调节这些回路可以恢复功能并减轻症状。与有反应的患者相比，无反应的患者表现出最多的活性纤维投射到运动皮层以外的皮质区域。这些发现支持以下观点：丘脑皮质通路的异常连通性是TS的基础，而通过DBS调节这些回路可以恢复功能并减轻症状。