Can I ask a question? So, really interesting, you know, I wasn't aware of this work that you had done with this occipital area that seems to be very involved. Now, is there any parallel literature in the DBS literature, you know, for tremor? Meaning like, if I'm not mistaken, did you say that there's also, once you do the lesion, over time do you see a difference in the cortical thickness in this area with the VBM, or was it a predictor? You speak about the VBM. So, VBM, we have both. So, the cluster is different in the responders and the non-responders at baseline, and the change in the VBM at one year is different in the responders and non-responders. So, with the DBS literature, you know, as you say, the advantage of the lesion, of course, is you're free to do all kinds of different imaging afterwards, but even with DBS you can do some imaging, and is there any evidence that with, you know, a similar VBM analysis after DBS that this happens at all? I'm not aware about something similar in the literature, but we have just started to do it in our DBS. We don't do resting state, but what we do is VBM and PET, and we will see, but I don't have the experience. That would be interesting, because, I mean, presumably these patients could be candidates for either, and so, you know, if they're going to get better with a lesion, is that the only situation where you see this change, or would you see it with DBS also, and is there, you know, something that we can learn about the network? Yeah, that's great. So, the main question we have is about when we see a difference in response between responders and non-responders on the VBM, the PET, is it because our targeting was less accurate? So, we induce a change, a distant change, which is different because we are injuring different connections, but what is against this idea is the fact that this is predictable based on the images before. So, I'll ask the obvious question. Can you speculate as to what the functional significance is of this area in tremor? No, no. I think there is a number of hypotheses. I think that's very obvious, that in patients with a sensor tremor, there is something in the occipital lobe which is related to the fact that when you are checking, you are trying to control in space your movements, you are affecting dramatically what is happening in your occipital lobe. That's what I can say. Then, is it a consequence? Is it part of the pathology of the tremor? I don't know. Beautiful talk. I've seen you had some activation in the anterior insula, and my question is, we are looking for gustatory disturbances, so taste disturbances in patients with bilateral stimulation, and the gustatory pathway goes typically to the anterior insula on the left side. Have you observed some changes in patients also in that direction, like disturbance of taste, of tasting after your thalamotomies? Gustative changes, you mean? Yeah. We are not checking this. That's a very interesting comment. We will. Yeah, because the anterior insula, especially on the left side, is especially where that basically is recepted, so that probably could have a... Interesting. I think you are aware there is an area called MT in the temporal lobe, obviously involved in motion processing that has very strong connections with the visual cortex. Is this that area or something different? V5. That's V5. I think MT and V5 are synonymous. Yes. Yes, V5 is part of it. Absolutely. So you can start to think of some really interesting stuff. V5 was clearly part of it. Oh, that's great. We'll talk about it after. Okay, thank you. So I would like to thank all of the speakers for this morning's session. We really appreciate the excellent work that you are doing across the globe, and tell the audience that there is a break now. There is a 20-minute break, and then we will reconvene for those of you interested in the International Pediatric Neurosurgery Session that follows. Thank you.

neurological research

tremors

imaging techniques

DBS

thalamotomies