A localized pallidal physiomarker in cervical dystonia
A localized pallidal physiomarker in cervical dystonia
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DOI：
10.1002/ana.25095
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发表时间：
2017-12-01
影响因子：
11.2
通讯作者：
Kuehn, Andrea A.
中科院分区：
文献类型：
--
作者：
Neumann, Wolf-Julian;Horn, Andreas;Kuehn, Andrea A.
脑深部电刺激（DBS）允许直接记录人类基底神经节的神经元活动。在帕金森氏病中，确定了一种疾病特异性生理标志物，目前在第一项研究中用于研究自适应闭环刺激。在肌张力障碍，这样一个physiomarker是missing.Methodspallidal振荡记录从153接触对27例。我们调查了θ和β波段的功率幅度是否与患者的肌张力障碍症状严重程度相关。然后，我们将每个触点对的θ功率投射到标准皮质下解剖结构上。在这种方式中，我们定义了一个组水平上的θ热点，并调查是否接近的活动DBS接触到它与临床improvement.ResultsDystonic症状的严重程度显着相关θ，但不β振荡幅度（=0.4，p=0.009）和半球间的连贯性（=0.5，p=0.002）。θ活动的最佳点位于内部苍白球的后三分之一，θ功率与接近该位置相关（=0.23，p=0.002），这与3个先前发表的描述最佳刺激靶点的坐标相吻合。最后，通过苍白球长期DBS的运动改善与θ峰振幅相关（=0.38，p=0.018）。InterpretationOur研究结果表明，在内部苍白球θ振荡与颈部肌张力障碍的肌张力障碍症状密切相关，可能是一个有用的生物标志物，自适应闭环刺激。此外，θ振荡活动可能对长期DBS后的临床受益具有预测价值，可用于改善电极植入期间的术中神经生理学靶点标测。神经学年鉴2017;82：912-924
ObjectiveDeep brain stimulation (DBS) allows for direct recordings of neuronal activity from the human basal ganglia. In Parkinson's disease, a disease-specific physiomarker was identified that is now used to investigate adaptive closed-loop stimulation in first studies. In dystonia, such a physiomarker is missing.MethodsPallidal oscillations were recorded from 153 contact pairs in 27 patients. We investigated whether power amplitudes in theta and beta bands correlate with dystonic symptom severity across patients. We then projected theta power from each contact pair onto standard subcortical anatomy. In this way, we defined a theta hot spot on a group level and investigated whether proximity of the active DBS contacts to it correlated with clinical improvement.ResultsDystonic symptom severity significantly correlated with theta but not beta oscillatory amplitudes (=0.4, p=0.009) and interhemispheric coherence (=0.5, p=0.002). The sweet spot of theta activity localized to the posterior third of the internal pallidum and theta power correlated with proximity to this location (=0.23, p=0.002), which coincided with 3 previously published coordinates describing optimal stimulation targets. Finally, motor improvement through pallidal long-term DBS correlated with theta peak amplitude (=0.38, p=0.018).InterpretationOur findings suggest that theta oscillations in the internal pallidum are robustly associated with dystonic symptoms in cervical dystonia and may be a useful biomarker for adaptive closed-loop stimulation. Furthermore, theta oscillatory activity may have a predictive value for the clinical benefit after chronic DBS that could be used to improve intraoperative neurophysiological target mapping during electrode implantation. Ann Neurol 2017;82:912-924