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  • Structural and functional alterations in the gustatory network underlie taste disturbances after lesional tremor therapy with MRgFUS

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Structural and functional alterations in the gustatory network underlie taste disturbances after lesional tremor therapy with MRgFUS
  1. Veronika Purrer1,2,
  2. Neeraj Upadhyay2,3,
  3. Valeri Borger4,
  4. Carsten Schmeel5,
  5. Henning Boecker3,6,
  6. Ullrich Wüllner1
  1. 1Department of Neurology, University Hospital Bonn, Bonn, Germany
  2. 2German Center of Neurodegenerative Diseases, Bonn, Germany
  3. 3Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn, Germany
  4. 4Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
  5. 5Department of Neuroradiology, University Hospital Bonn, Bonn, Germany
  6. 6Department of Diagnostic and Interventional Radiology, German Centre of Neurodegenerative Diseases, Bonn, Germany
  1. Correspondence to Dr Veronika Purrer; Veronika.Purrer{at}ukbonn.de

https://doi.org/10.1136/jnnp-2023-331324

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    Introduction

    MR-guided focused ultrasound (MRgFUS) is an emerging technique for treatment of severe, medication-refractory essential tremor (ET). Typical side effects include paraesthesias, gait disorders and less frequently taste disturbances.1 2 The gustatory tract is assumed to pass within the cranial nerves VII, IX and X to the ipsilateral solitary nucleus in the medulla to project via the parvocellular division of the ventral posterior medial nucleus (VPMpc) to the gustatory cortex in the insula, the frontal operculum and the orbitofrontal cortex (OFC).3 Thalamic nuclei adjacent to the targeted posteroventral part of the ventrolateral thalamic nucleus (VLpv) may be affected by MRgFUS and interfere with gustatory projections. Our objective was to identify microstructural alterations and changes in functional connectivity (FC) within the gustatory network (GN) in patients with ET with taste disturbances post-MRgFUS.

    Methods

    Clinical and imaging findings of 26 ET patients, 13 with taste disturbances (‘GUST’) and 13 without taste disturbances (‘NO-GUST’), were analysed during pre-MRgFUS baseline (T0) and at 1 (T2) and 6 months (T3) post-MRgFUS.

    Treatment efficacy was measured using a hand-specific subscore combining part A and B of the Clinical Rating Scale for Tremor. Side effects were recorded at each visit and depending on the report of taste disturbances, patients were categorised as ‘GUST’ or ‘NO-GUST’.

    The MR protocol contained T1-weighted, diffusion-weighted imaging and resting state functional MRI (rs-fMRI). Lesion volumes were determined manually and microstructural alterations within the gustatory white matter pathway were assessed using fractional anisotropy (FA). rs-fMRI data were analysed for changes in FC within the GN.

    Separate linear mixed-effects models (LME) with Bonferroni correction for multiple testing and pairwise comparison post hoc t-tests were applied to assess within-subject and between-group changes in tremor scores, lesion volumes, overlap volumes of lesions and VPM, as well as longitudinal FA and FC changes for all three time points. …

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    Footnotes

    • VP and NU are joint first authors.

    • Correction notice Since this letter first published, VP and NU have been listed as joint first authors and HB and UW have been listed as joint last authors.

    • Contributors VP contributed to conception and design, data acquisition, data analysis and interpretation, drafted the manuscript and critically revised the manuscript. NU contributed to conception and design, data analysis and interpretation, drafted the manuscript and critically revised the manuscript. VB contributed to data acquisition and critically revised the manuscript. CS contributed to data acquisition and critically revised the manuscript. HB contributed to conception and design, data analysis and interpretation and critically revised the manuscript. UW contributed to conception and design, data acquisition, data analysis and interpretation and critically revised the manuscript. HB and UW are joint last authors.

    • Funding The MRgFUS system was in part funded by the German Research Foundation (INST 1172/64-1).

    • Competing interests UW served as consultant and lecturer and on advisory boards for Bayer AG, STADA Pharm and Zambon; he received grant from the Federal Ministry of Education and Research (BMBF), the German Research Foundation (DFG) and the Deutsche Parkinson Vereinigung e.V. HB received grants from the Federal Ministry of Education and Research (BMBF), the German Research Foundation (DFG) and royalties from Springer.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.