OBJECTIVE: To correlate pretherapeutic resting-state functional MRI (rs-fMRI) measures with pretherapeutic head tremor presence and/or further improvement 1 year after stereotactic radiosurgical thalamotomy (SRS-T) for essential tremor (ET).

METHODS: We prospectively collected head tremor scores (range 0-3) and rs-fMRI data for a cohort of 17 consecutive ET patients in pretherapeutic and 1 year after SRS-T states. We additionally acquired rs-fMRI data for a healthy control (HC) group (n=12). Group-level independent component analysis (ICA, n=17 for pretherapeutic rs-fMRI) was applied to decompose neuroimaging data into 20 large-scale brain networks using a standard approach. Through spatial regression, we projected 1-year after SRS-T and HC rs-fMRI time-points, on the same 20 brain networks.

RESULTS: Pretherapeutic interconnectivity (IC) strength between the network including bilateral thalamus and limbic system with left supplementary motor area predicted head tremor improvement at 1 year after SRS-T (p family-wise corrected <0.001, cluster size kc 146). For the statistically significant cluster, IC strength was strongest in HC (mean 4.6, median 3.8), as compared with pretherapeutic (mean 0.1, median 0.2) or post-therapeutic (mean -0.2, median 0.09) states.

CONCLUSIONS: Baseline measures of IC between bilateral thalamus and limbic system with left supplementary motor area may predict head tremor arrest after thalamotomy. However, procedures such as SRS-T, for this particular clinical feature, do not align patients to healthy controls in terms of functional brain connectivity. We postulate that supplementary motor area is modulating head tremor appearance, by abnormal connectivity with the thalamolimbic system.

01/2018