Optimal deep brain stimulation sites and networks for cervical vs. generalized dystonia.
Optimal deep brain stimulation sites and networks for cervical vs. generalized dystonia.
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DOI：
10.1073/pnas.2114985119
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发表时间：
2022-04-05
影响因子：
11.1
通讯作者：
Kuhn, Andrea A.
中科院分区：
文献类型：
--
作者：
Horn, Andreas;Reich, Martin M.;Ewert, Siobhan;Li, Ningfei;Al-Fatly, Bassam;Lange, Florian;Roothans, Jonas;Oxenford, Simon;Horn, Isabel;Paschen, Steffen;Runge, Joachim;Wodarg, Fritz;Witt, Karsten;Nickl, Robert C.;Wittstock, Matthias;Schneider, Gerd-Helge;Mahlknecht, Philipp;Poewe, Werner;Eisner, Wilhelm;Helmers, Ann-Kristin;Matthies, Cordula;Krauss, Joachim K.;Deuschl, Gunther;Volkmann, Jens;Kuhn, Andrea A.
我们研究了深部脑刺激对两种类型肌张力障碍的影响，并得出结论，苍白球和丘脑之间的不同特异性连接是最佳治疗效果的原因。由于除了脑深部电刺激之外，肌张力障碍的替代治疗方案很少，因此我们的研究结果对于最大限度地提高这一患者人群的治疗效果至关重要。肌张力障碍是一种使人衰弱的疾病，几乎没有治疗选择。一个有效的选择是深部脑刺激（DBS）的内部苍白球。虽然颈部和全身形式的孤立性肌张力障碍已经有针对性的一个共同的方法后三分之一的核，大规模的调查，最佳的刺激部位和潜在的网络效应尚未进行。在这里，我们回顾性研究了80例患者的多中心队列中DBS治疗颈部和全身性肌张力障碍的临床结果。我们根据术前和术后成像对DBS电极放置进行建模，并介绍了一种将最佳刺激部位映射到解剖空间的方法。其次，我们调查哪些道占最佳的临床改善，调制时。第三，我们研究了全脑功能连接体水平上的分布式刺激效应。我们的研究结果显示，映射到内部苍白球的躯体位置结构的最佳刺激位点的显着差异。虽然基底神经节的纹状体离体轴的调制占颈部肌张力障碍的最佳治疗，苍白球丘脑束的调制在全身性肌张力障碍。最后，我们显示了一个共同的多突触网络基板的形式连接到小脑和somatomotor皮层的两种表型。我们的研究结果表明，最佳刺激网络的短暂分歧颈部与全身性肌张力障碍内的苍白球丘脑回路，再次合并在丘脑-皮质水平，并共享一个共同的全脑网络。
We studied deep brain stimulation effects in two types of dystonia and conclude that different specific connections between the pallidum and thalamus are responsible for optimal treatment effects. Since alternative treatment options for dystonia beyond deep brain stimulation are scarce, our results will be crucial to maximize treatment outcome in this population of patients. Dystonia is a debilitating disease with few treatment options. One effective option is deep brain stimulation (DBS) to the internal pallidum. While cervical and generalized forms of isolated dystonia have been targeted with a common approach to the posterior third of the nucleus, large-scale investigations regarding optimal stimulation sites and potential network effects have not been carried out. Here, we retrospectively studied clinical results following DBS for cervical and generalized dystonia in a multicenter cohort of 80 patients. We model DBS electrode placement based on pre- and postoperative imaging and introduce an approach to map optimal stimulation sites to anatomical space. Second, we investigate which tracts account for optimal clinical improvements, when modulated. Third, we investigate distributed stimulation effects on a whole-brain functional connectome level. Our results show marked differences of optimal stimulation sites that map to the somatotopic structure of the internal pallidum. While modulation of the striatopallidofugal axis of the basal ganglia accounted for optimal treatment of cervical dystonia, modulation of pallidothalamic bundles did so in generalized dystonia. Finally, we show a common multisynaptic network substrate for both phenotypes in the form of connectivity to the cerebellum and somatomotor cortex. Our results suggest a brief divergence of optimal stimulation networks for cervical vs. generalized dystonia within the pallidothalamic loop that merge again on a thalamo-cortical level and share a common whole-brain network.
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影响因子：
9.8
作者：
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通讯作者：
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