MRI EVALUATION OF DBS IN PARKINSON'S DISEASE

帕金森病 DBS 的 MRI 评估

• 批准号: 7608223
• 负责人: Michael Sean Phillips
• 金额: $ 0.12万
• 依托单位: CLEVELAND CLINIC LERNER COM-CWRU
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-04-01 至 2007-09-16
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7608223
• 关键词: Admission activity; Adverse effects; Animal Model; Bilateral; Clinical; Computer Retrieval of Information on Scientific Projects Database; Deep Brain Stimulation; Disease; EEF1A2 gene; Environment; Evaluation; Functional Magnetic Resonance Imaging; Funding; Globus Pallidus; Goals; Grant; Hospitals; Hour; Human; Image Analysis; Inpatients; Institution; Left; Magnetic Resonance Imaging; Medical; Motor; Motor Pathways; Operative Surgical Procedures; Parkinson Disease; Parkinsonian Disorders; Patients; Pattern; Physiologic pulse; Placement; Postoperative Period; Procedures; Pulse taking; Rate; Research; Research Personnel; Resources; Source; Staging; Structure of subthalamic nucleus; Symptoms; Thalamic structure; United States National Institutes of Health; Week; clinical efficacy; day; deep brain stimulator

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. The overall goal of this study is to characterize the changes in motor pathway activity produced by deep brain stimulation in the subthalamic nucleus (STN DBS) in patients with Parkinson¿s disease (PD) using functional magnetic resonance imaging (fMRI). STN DBS provides excellent symptom relief for PD patients in the late stages of the disease when medical therapies are no longer effective or produce too many unwanted side effects. Present understanding of the mechanisms of STN DBS for PD is derived primarily from animal models and inferences drawn from lesional therapies in humans. The aims of the study are 1) to determine the pattern of fMRI activation associated with optimal relief in Parkinsonian motor signs during STN DBS, 2) to determine the relationship between functional MRI activation and clinical efficacy in DBS of the STN in PD and 3) to determine the pattern of activation associated with unilateral stimulation which results in bilateral symptom relief. It is hypothesized that DBS of the STN in PD will 1) produce a consistent pattern of activation in the globus pallidus and thalamus with optimal symptom relief such that activation in these regions will be a sensitive and specific marker of symptomatic benefit, 2) produce activation that will positively correlate in degree with the amount of Parkinsonian motor symptom relief, and 3) in subjects with strong bilateral symptom relief from unilateral stimulation will produce a bilateral pattern of activation in during unilateral stimulation. The GCRC will be used for a 72 hour inpatient stay. Subjects will receive a placement of a DBS for treatment of Parkinson's disease on Tuesday of a given week. The placement procedure will be performed as a 23 hour observational admission. Subject will then be discharged from the hospital and admitted to the GCRC. On postoperative day 2 (Thursday) the subject will receive a clinical examination evaluating the United Parkinson's Disease Rating Scale Motor Subscore (UPDRSSS) for each of the DBS settings to be used during the fMRI evaluation. The subject will then go from the GCRC to the MRI scanner for functional MRI examination. Following the functional MRI examination the subject will return to the GCRC. The subject will be then discharged from the GCRC on Friday morning and have a final surgery for internalization of the deep brain stimulator only turns and placement of the internal pulse generator. The GCRC will be utilized in or to defer the expense of hospital admission as the subjects cannot leave the hospital environment with an externalized DBS in place.

这个子项目是许多研究子项目中的一个 由NIH/NCRR资助的中心赠款提供的资源。子项目和 研究者（PI）可能从另一个NIH来源获得了主要资金， 因此可以在其他CRISP条目中表示。所列机构为 研究中心，而研究中心不一定是研究者所在的机构。 本研究的总体目标是使用功能性磁共振成像（fMRI）表征帕金森病（PD）患者丘脑底核（DBS）脑深部刺激产生的运动通路活动的变化。当药物治疗不再有效或产生太多不必要的副作用时，DBS为PD患者在疾病晚期提供了极好的症状缓解。目前对PDDBS治疗PD机制的理解主要来自动物模型和人类病变治疗的推断。 本研究的目的是：1）确定在DBS期间与帕金森病运动体征最佳缓解相关的fMRI激活模式，2）确定功能性MRI激活与PD患者DBS中帕金森病的临床疗效之间的关系，3）确定与导致双侧症状缓解的单侧刺激相关的激活模式。假设帕金森病患者的DBS将1）在苍白球和丘脑中产生一致的激活模式，具有最佳的症状缓解，使得这些区域中的激活将是症状益处的敏感和特异性标志物，2）产生在程度上与帕金森病运动症状缓解量正相关的激活，以及3）在具有强的双侧症状的受试者中，单侧刺激的缓解将在单侧刺激期间产生双侧激活模式。 GCRC将用于72小时住院治疗。 受试者将在给定周的星期二接受DBS的放置以治疗帕金森病。 放置程序将作为23小时观察入院进行。 然后受试者将出院并入住GCRC。 在术后第2天（星期四），受试者将接受临床检查，评价在fMRI评价期间使用的每种DBS设置的联合帕金森病评定量表运动分项评分（United Parkinson's Disease Rating Scale Motor Subscore，简称MRSSS）。 然后，受试者将从GCRC转到MRI扫描仪进行功能性MRI检查。功能性MRI检查后，受试者将返回GCRC。 然后受试者将于周五上午从GCRC出院，并接受最终手术，以将深部脑刺激器内化，并放置内部脉冲发生器。 GCRC将用于住院或推迟住院费用，因为受试者无法在外部DBS就位的情况下离开医院环境。