O135 Sensory evoked potentials and central motor conduction times in children with dystonia help predict outcomes from Deep Brain Stimulation (DBS)
O135 Sensory evoked potentials and central motor conduction times in children with dystonia help predict outcomes from Deep Brain Stimulation (DBS)
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O135 肌张力障碍儿童的感觉诱发电位和中枢运动传导时间有助于预测深部脑刺激 (DBS) 的结果
DOI：
10.1016/j.clinph.2017.07.146
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发表时间：
2017
影响因子：
4.7
通讯作者：
McClelland V
中科院分区：
文献类型：
--
作者：
McClelland V
目的 苍白球内肌深部脑刺激 (DBS) 对原发性肌张力障碍有显着疗效。继发性肌张力障碍患者的改善较小，并且个体之间存在显着差异。缺乏预测标记。本研究检验了体感诱发电位 (SEP) 和中枢运动传导时间 (CMCT) 可以预测儿童肌张力障碍 DBS 结果的假设。方法数据来自连续 180 名接受 DBS 多学科评估的肌张力障碍儿童（平均年龄 10 岁；范围 2.5-19）。使用经颅磁刺激和 F 波方法获得每个肢体的 CMCT。记录对侧和中线顶叶中央头皮的正中和胫后神经 SEP。技术上不令人满意的数据被排除在外。通过颅脑 MRI 评估结构异常。 DBS 在 1 年时的结果以 Burke-Fahn-Marsden 肌张力障碍评定量表 (BFMDRS-m) 的改善百分比进行评估。结果从 146 名儿童中获得了令人满意的 CMCT 数据，其中 28 名 (19%) 至少一侧肢体有异常 CMCT。从 100 名儿童中获得了令人满意的皮质 SEP 数据，其中 47 名儿童至少有一项异常皮质电位。继发性/原发性肌张力障碍患者中 CMCT 和 SEP 异常的发生率高于原发性/原发性肌张力障碍患者（继发性患者中 CMCT 异常为 22%，原发性患者为 9%；原发性患者中 SEP 异常为 53%，原发性患者为 24%）。在接受 DBS 治疗的儿童中，正常 CMCT 儿童 (n= 78) 的 BFMDRS-m 改善程度高于 CMCT 异常儿童 (n= 11)（Mann Whitney 检验 p= 0.002），并且 SEP 正常儿童 (n= 35) 与异常 SEP 儿童 (n= 16) 相比，BFMDRS-m 改善也更大（Mann Whitney 检验 p= 0.001）。在亚组分析中，CMCT/SEP 和 BFMDRS-m 评分之间的关系独立于病因（原发性与继发性）和 MRI 结果（正常与异常）。 讨论/结论 CMCT 和 SEP 提供了肌张力障碍儿童运动和感觉通路功能障碍的客观证据，并与 DBS 结果相关。因此，这些标志物可能有助于患者选择和向家属提供有关神经调节潜在益处的咨询。意义我们确定了可以指导 DBS 患者选择的神经生理学标志物。
ObjectivesDeep Brain Stimulation (DBS) of the Globus Pallidus Internus produces dramatic benefits in primary dystonia. Improvements in patients with secondary dystonia are smaller and vary markedly between individuals. Predictive markers are lacking. This study tests the hypothesis that Somatosensory Evoked Potentials (SEPs) and Central Motor Conduction Times (CMCT) may predict outcome from DBS in childhood dystonia.MethodsData were obtained from 180 consecutive children with dystonia undergoing multidisciplinary assessment for DBS (mean age 10 years; range 2.5–19). CMCT to each limb was obtained using Transcranial Magnetic Stimulation and theF-wave method. Median and posterior tibial nerve SEPs were recorded over contralateral and midline centro-parietal scalp. Technically unsatisfactory data were excluded. Structural abnormalities were assessed with cranial MRI. Outcome from DBS at 1 year was assessed as percentage improvement in Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS-m).ResultsSatisfactory CMCT data were obtained from 146 children, of whom 28 (19%) had an abnormal CMCT to at least one limb. Satisfactory cortical SEP data were obtained from 100 children, of whom 47 had at least one abnormal cortical potential. Abnormal CMCTs and SEPs were both observed more frequently in secondary than primary/primary plus dystonia (CMCT abnormal in 22% secondary versus 9% primary patients; SEP abnormal in 53% secondary vs 24% primary patients). Of children proceeding to DBS, improvement in BFMDRS-m was greater in those with normal (n= 78) than abnormal CMCT (n= 11) (Mann Whitney testp= 0.002) and was also greater in those with normal (n= 35) versus abnormal SEPs (n= 16) (Mann Whitney testp= 0.001). On sub-group analysis, the relationships between CMCT/SEPs and BFMDRS-m scores were independent of aetiology (primary versus secondary) and MRI findings (normal versus abnormal).Discussion/ConclusionCMCTs and SEPs provide objective evidence of motor and sensory pathway dysfunction in children with dystonia and relate to DBS outcome. These markers may therefore contribute to patient selection and counselling of families about potential benefit from neuromodulation.SignificanceWe identify neurophysiological markers that can guide the selection of patients for DBS.