Brain connectivity abnormalities and treatment-induced restorations in patients with cervical dystonia

Liang Feng; Dazhi Yin; Xiangbin Wang; Yifei Xu; Yongsheng Xiang; Fei Teng; Yougui Pan; Xiaolong Zhang; Junhui Su; Zheng Wang; Lingjing Jin

doi:10.1111/ene.14695

Brain connectivity abnormalities and treatment-induced restorations in patients with cervical dystonia

Eur J Neurol. 2021 May;28(5):1537-1547. doi: 10.1111/ene.14695. Epub 2021 Jan 9.

Authors

Liang Feng¹, Dazhi Yin^{2

3}, Xiangbin Wang⁴, Yifei Xu¹, Yongsheng Xiang⁴, Fei Teng¹, Yougui Pan¹, Xiaolong Zhang¹, Junhui Su¹, Zheng Wang^{3

5}, Lingjing Jin¹

Affiliations

¹ Neurotoxin Research Center of Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of Ministry of Education, Department of Neurology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China.
² Key Laboratory of Brain Functional Genomics (MOE and STCSM), Institute of Cognitive Neuroscience, School of Psychology and Cognitive Science, East China Normal University, Shanghai, China.
³ Institute of Neuroscience, CAS Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences, Shanghai, China.
⁴ Department of Radiology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China.
⁵ University of Chinese Academy of Sciences, Beijing, China.

PMID: 33350546
DOI: 10.1111/ene.14695

Abstract

Background: The relationship between brain abnormalities and phenotypic characteristics in cervical dystonia (CD) patients has not been fully established, and little is known about the neuroplastic changes induced by botulinum toxin type A (BoNT-A) treatment.

Methods: Ninety-two CD patients presenting with rotational torticollis and 45 healthy controls from our database were retrospectively screened. After clinical assessment, the 92 patients underwent baseline magnetic resonance imaging (MRI) followed by a single-dose injection of BoNT-A. Four weeks later, 76 out of the 92 patients were re-evaluated with the Tsui scale for dystonia severity, and 33 out of 76 patients completed post-treatment MRI scanning. Data-driven global brain connectivity and regional homogeneity in tandem with seed-based connectivity analyses were used to examine the functional abnormalities in CD and longitudinal circuit alterations that scaled with clinical response to BoNT-A. Multiple regression models were employed for the prediction analysis of treatment efficacy.

Results: Cervical dystonia patients exhibited elevated baseline connectivity of the right postcentral gyrus with the left dorsomedial prefrontal cortex and right caudate nucleus, which was associated with their symptom severity. BoNT-A reduced excessive functional connectivity between the sensorimotor cortex and right superior frontal gyrus, which was significantly correlated with changes in Tsui score. Moreover, pre-treatment regional homogeneity of the left middle frontal gyrus was linearly related to varied response to treatment.

Conclusions: Our findings unravel dissociable connectivity of the sensorimotor cortex underlying the pathology of CD and central effects of BoNT-A therapy. Furthermore, baseline regional homogeneity with the left middle frontal gyrus may represent a potential evidence-based marker of patient stratification for BoNT-A therapy in CD.

Keywords: botulinum toxin; brain connectivity; cervical dystonia; regional homogeneity; resting-state fMRI.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Botulinum Toxins, Type A*
Brain / diagnostic imaging
Humans
Magnetic Resonance Imaging
Retrospective Studies
Sensorimotor Cortex*
Torticollis* / diagnostic imaging
Torticollis* / drug therapy

Substances

Botulinum Toxins, Type A