Profiling functional networks identify activation of corticostriatal connectivity in ET patient after MRgFUS thalamotomy

Objective MR-guided focused ultrasound (MRgFUS) thalamotomy is a novel and effective treatment for medication-refractory tremor in essential tremor (ET), but how the brain responds to this deliberate lesion is not clear. The current study aimed to evaluate the immediate and longitudinal alterations of functional networks after MRgFUS thalamotomy. Methods We retrospectively obtained preoperative and postoperative 30-day, 90-day, and 180-day data of 31 ET patients subjected with MRgFUS thalamotomy from 2018 to 2020. Their archived resting-state functional MRI data were used to functional network comparison as well as graph-theory metrics analysis. Both partial least squares (PLS) regression and linear regression were conducted to associate functional features to tremor symptoms. Results MRgFUS thalamotomy dramatically abolished tremors, while global functional network only sustained immediate fluctuation within one week postoperatively. Network-based statistics have identified a long-term enhanced corticostriatal subnetwork by comparison between 180-day and preoperative data ( P = 0.019). Within this subnetwork, network degree, global efficiency and transitivity were significantly recovered in ET patients right after MRgFUS thalamotomy compared to the pre-operative timepoint ( P < 0.05), as well as hemisphere lateralization ( P < 0.001). The PLS main component significantly accounted for 33.68% and 34.16% of the total variances of hand tremor score and clinical rating scale for tremor (CRST)-total score ( P = 0.037 and 0.027). Network transitivity of this subnetwork could serve as a reliable biomarker for hand tremor score control prediction at 180-day postoperatively (β = 2.94, P = 0.03). Conclusions MRgFUS thalamotomy promoted corticostriatal connectivity activation correlated with tremor improvement in ET patient after MRgFUS thalamotomy.