Bilateral Cortical Encephalomalacia in a Patient Implanted With Bilateral Deep Brain Stimulation for Alzheimer's Disease: A Case Report.
Bilateral Cortical Encephalomalacia in a Patient Implanted With Bilateral Deep Brain Stimulation for Alzheimer's Disease: A Case Report.
复制标题
接受双侧深部脑刺激治疗阿尔茨海默病的患者出现双侧皮质脑软化症：病例报告。
DOI：
10.1097/wad.0000000000000095
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发表时间：
2016
影响因子：
2.1
通讯作者：
Anderson,WilliamS
中科院分区：
文献类型：
--
作者：
McMullen,DavidP;Rosenberg,Paul;Cheng,Jennifer;Smith,GwennS;Lyketsos,Constantine;Anderson,WilliamS
DISCUSSION Deep brain stimulation of the fornix may provide a new avenue for improving the symptoms of AD, a goal that has so far eluded the scientific community. The impetus for DBS-f came from a case report demonstrating induced enhancement of memory in a patient implanted in the hypothalamus near the fornix for treatment of his obesity. 1 An open-label pilot study of DBS in AD demonstrated possible slowing of cognitive decline and improvement in glucose utilization. 2, 3 In addition, there is evidence that the structural integrity of the fornix predicts cognitive and functional decline in prodromal AD. 4 These efforts led to a larger randomized clinical trial, the ADvance Study, to assess the efficacy of DBS-f for the treatment of AD. This report details an adverse event wherein 1 patient demonstrated bilateral encephalomalacia at the cortical entry site of the DBS leads on delayed postoperative imaging while, to date, remaining clinically asymptomatic.Encephalomalacia is a known, but relatively rare, postsurgical complication of DBS lead implantation. 5, 6 Retrospective studies have estimated the incidence of encephalomalacia at around 4.2%. 6 Instances of encephalomalacia are usually unilateral as opposed to the bilateral nature of the event here. In these cases, encephalomalacia was not evident immediately postoperatively but on scans an average of 19 months postoperatively. In most of these cases, immediate MRI had shown intraparenchymal hemorrhage or edema. 6 The ADvance trial includes 42 participants implanted bilaterally yielding 84 DBS-f implantation sites. To date, no other patient implanted with DBS-f for AD has demonstrated encephalomalacia on postoperative imaging, including 6 patients implanted for a phase I clinical trial focused on safety. Including our patient, the incidence of encephalomalacia in DBS-f is 2.1% per side (2/96). Although this rate is lower than that reported with DBS for Parkinson’s disease, it is too early in the implementation of DBS-f, with too few patients implanted, to provide conclusive rates.
