Tremor and other hyperkinetic movements (New York, N.Y.) · 2020
Brain Atrophy Following Deep Brain Stimulation: Management of a Moving Target.
Клинический случайПоддержка NIH: внешняя программаПоддержка исследования: вне правительства СШАСтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Chiu Shannon Y, Deeb Wissam, Zeilman Pamela, Ramirez-Zamora Adolfo, Patterson Addie, Patel Bhavana, Foote Kelly D, Okun Michael S, Patel Amar, Almeida Leonardo
Аннотация
CLINICAL VIGNETTE: A 51-year-old man with essential tremor (ET) had bilateral ventralis intermedius nucleus deep brain stimulation (VIM-DBS) placed to address refractory tremor. Despite well-placed DBS leads and adequate tremor response, he subsequently experienced worsening. Re-programming of the device and reconfirming the electrical thresholds for benefits and side effects were both performed. Six years following DBS implantation, repeat imaging revealed brain atrophy and a measured lead position change with a coincident change in clinical response.
CLINICAL DILEMMA: What do we know about brain atrophy affecting lead placement and long-term DBS effectiveness? What are the potential strategies to combat narrowed therapeutic thresholds and to maximize DBS therapeutic benefit?
CLINICAL SOLUTION: Decreasing the electrical field of stimulation and programming in a bipolar configuration are strategies to provide symptomatic tremor control and to minimize stimulation-induced side effects.
GAPS IN KNOWLEDGE: Currently, effects of brain atrophy, and factors underpinning emergence of side effects and/or loss of benefit in chronic VIM-DBS remain largely unexplored.
CLINICAL DILEMMA: What do we know about brain atrophy affecting lead placement and long-term DBS effectiveness? What are the potential strategies to combat narrowed therapeutic thresholds and to maximize DBS therapeutic benefit?
CLINICAL SOLUTION: Decreasing the electrical field of stimulation and programming in a bipolar configuration are strategies to provide symptomatic tremor control and to minimize stimulation-induced side effects.
GAPS IN KNOWLEDGE: Currently, effects of brain atrophy, and factors underpinning emergence of side effects and/or loss of benefit in chronic VIM-DBS remain largely unexplored.