Refining the Deep Brain Stimulation Target within the Limbic Globus Pallidus Internus for Tourette Syndrome
Refining the Deep Brain Stimulation Target within the Limbic Globus Pallidus Internus for Tourette Syndrome
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DOI：
10.1159/000478273
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发表时间：
2017-01-01
影响因子：
1.7
通讯作者：
Foltynie, Tom
中科院分区：
文献类型：
--
作者：
Akbarian-Tefaghi, Ladan;Akram, Harith;Foltynie, Tom
背景资料：脑深部电刺激（DBS）治疗严重难治性抽动秽语综合征（TS）患者迄今已显示出有希望但结果不一。丘脑和前内侧苍白球内（amGPi）一直是皮质-纹状体丘脑回路中最常见的刺激部位，但最佳靶点尚未阐明。目的：本研究纳入了15例长期amGPi DBS治疗重度TS的患者，研究了amGPi内的特定解剖部位是否与抽搐、强迫行为（OCB）和情绪指标的最佳临床结局相关。研究方法：在DBS之前和最近的随访（1782个月）时，使用经验证的临床评估来测量抽搐、OCB、生活质量、焦虑和抑郁。使用电极位置和个体刺激参数信息为每例患者创建电场模拟。随后的回归分析将这些患者特异性模拟与结果测量的百分比变化相关联，以识别与临床改善相关的任何显著体素。结果如下：腹侧边缘GPi内的区域，特别是在ACPC水平的苍白球内侧髓板上，与改善抽搐显著相关，但与情绪或OCB结果无关。结论：这项研究进一步支持DBS在抽动相关网络中的应用，尽管患者样本量和临床异质性等因素仍然是限制因素，需要重复。(C)2017 S. Karger AG，巴塞尔
Background: Deep brain stimulation (DBS) in patients with severe, refractory Tourette syndrome (TS) has demonstrated promising but variable results thus far. The thalamus and anteromedial globus pallidus internus (amGPi) have been the most commonly stimulated sites within the cortico-striato thalamic circuit, but an optimal target is yet to be elucidated. Objectives: This study of 15 patients with long-term amGPi DBS for severe TS investigated whether a specific anatomical site within the amGPi correlated with optimal clinical outcome for the measures of tics, obsessive compulsive behaviour (OCB), and mood. Methods: Validated clinical assessments were used to measure tics, OCB, quality of life, anxiety, and depression before DBS and at the latest follow-up (1782 months). Electric field simulations were created for each patient using information on electrode location and individual stimulation parameters. A subsequent regression analysis correlated these patient-specific simulations to percentage changes in outcome measures in order to identify any significant voxels related to clinical improvement. Results: A region within the ventral limbic GPi, specifically on the me-dial medullary lamina in the pallidum at the level of the ACPC, was significantly associated with improved tics but not mood or OCB outcome. Conclusions: This study adds further support to the application of DBS in a tic-related network, though factors such as patient sample size and clinical heterogeneity remain as limitations and replication is required. (C) 2017 S. Karger AG, Basel