TINNITUS MODULATION BY DEEP BRAIN STIMULATION IN LOCUS OF CAUDATE NEURONS (AREA LC)
TINNITUS MODULATION BY DEEP BRAIN STIMULATION IN LOCUS OF CAUDATE NEURONS (AREA LC)
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DOI：
10.1016/j.neuroscience.2010.06.007
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发表时间：
2010-09-15
期刊：
影响因子：
3.3
通讯作者：
Larson, P. S.
中科院分区：
文献类型：
--
作者：
Cheung, S. W.;Larson, P. S.
耳鸣是一种听觉障碍，其特征是在没有来自身体或外部环境的相应机械刺激的情况下感知内部产生的幻听觉。目前基于听觉的治疗方法，有时结合非听觉策略，如耳鸣再训练疗法和认知行为疗法，有助于减轻大多数患者的症状。然而，有超过100万耳鸣患者仍然忍受令人烦恼的慢性，持续的头部噪音，这些噪音使人衰弱并干扰日常生活活动。在这里，我们表明，应用脑深部电刺激（DBS）治疗的尾状核神经元（LC区）在体内的一个位点，纹状体的一个子网站，是不是经典的听觉通路的一部分，可以减少或增加耳鸣响度感知。DBS电极导线穿过或邻近6名帕金森病和原发性震颤伴耳鸣受试者的LC区，这些受试者接受了丘脑底核或腹侧中间核植入术。在DBS电极导线头端穿过LC区的5名受试者中，双耳耳鸣响度被抑制至0-10评定量表上的2级或更低的最低点。在DBS电极导线位于LC区外部的1例受试者中，耳鸣未得到调制。在3名受试者的术前和术后听力图，听力阈值不变的区域LC刺激。LC区的神经调节可能会中断中枢听觉系统中产生的幻肢感觉的知觉整合。这种新的，基于基底神经节的耳鸣调制方法值得进一步研究，并可能最终改善治疗难治性症状的患者。(C)2010年IBRO。由爱思唯尔有限公司出版。保留所有权利。
Tinnitus is an auditory disorder characterized by perception of internally generated phantom auditory sensations without corresponding mechanical stimuli arising from the body or external environment. Current auditory based treatment approaches, sometimes in conjunction with non-auditory based strategies, such as Tinnitus Retraining Therapy and Cognitive Behavioral Therapy, have been helpful in mitigating symptoms for the majority of patients. Yet there are over 1 million tinnitus sufferers who still endure troublesome chronic, continuous head noises that are debilitating and interfere with activities of daily living. Here we show that application of deep brain stimulation (DBS) therapy to a locus of caudate neurons (area LC) in the body of the nucleus, a subsite of the striatum that is no part of the classical auditory pathway, can decrease or increase tinnitus loudness perception. The DBS lead traversed through or was adjacent to area LC in six Parkinson's disease and essential tremor subjects with concomitant tinnitus who underwent implantation of the subthalamic or ventral intermediate nucleus. In five subjects where the DBS lead tip traversed area LC, tinnitus loudness in both ears was suppressed to a nadir of level 2 or lower on a 0-10 rating scale. In one subject where the DBS lead was outside area LC, tinnitus was not modulated. In three subjects with preoperative and postoperative audiograms, hearing thresholds were unchanged by area LC stimulation. Neuromodulation of area LC may be interrupting perceptual integration of phantom sensations generated in the central auditory system. This new, basal ganglia based approach to tinnitus modulation warrants further investigation and may be ultimately refined to treat patients with refractory symptoms. (C) 2010 IBRO. Published by Elsevier Ltd. All rights reserved.