Journal of neurology, neurosurgery, and psychiatry · 2019
Image-based analysis and long-term clinical outcomes of deep brain stimulation for Tourette syndrome: a multisite study.
СтатьяМногоцентровое исследованиеПоддержка NIH: внешняя программаПоддержка исследования: вне правительства СШАПоддержка правительства СШАНазвание и аннотация: Перевод пока не подготовлен
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Johnson Kara A, Fletcher P Thomas, Servello Domenico, Bona Alberto, Porta Mauro, Ostrem Jill L, Bardinet Eric, Welter Marie-Laure, Lozano Andres M, Baldermann Juan Carlos, Kuhn Jens, Huys Daniel, Foltynie Thomas, Hariz Marwan, Joyce Eileen M, Zrinzo Ludvic, Kefalopoulou Zinovia, Zhang Jian-Guo, Meng Fan-Gang, Zhang ChenCheng, Ling Zhipei, Xu Xin, Yu Xinguang, Smeets Anouk Yjm, Ackermans Linda, Visser-Vandewalle Veerle, Mogilner Alon Y, Pourfar Michael H, Almeida Leonardo, Gunduz Aysegul, Hu Wei, Foote Kelly D, Okun Michael S, Butson Christopher R
Аннотация
BACKGROUND: Deep brain stimulation (DBS) can be an effective therapy for tics and comorbidities in select cases of severe, treatment-refractory Tourette syndrome (TS). Clinical responses remain variable across patients, which may be attributed to differences in the location of the neuroanatomical regions being stimulated. We evaluated active contact locations and regions of stimulation across a large cohort of patients with TS in an effort to guide future targeting.
METHODS: We collected retrospective clinical data and imaging from 13 international sites on 123 patients. We assessed the effects of DBS over time in 110 patients who were implanted in the centromedial (CM) thalamus (n=51), globus pallidus internus (GPi) (n=47), nucleus accumbens/anterior limb of the internal capsule (n=4) or a combination of targets (n=8). Contact locations (n=70 patients) and volumes of tissue activated (n=63 patients) were coregistered to create probabilistic stimulation atlases.
RESULTS: Tics and obsessive-compulsive behaviour (OCB) significantly improved over time (p<0.01), and there were no significant differences across brain targets (p>0.05). The median time was 13 months to reach a 40% improvement in tics, and there were no significant differences across targets (p=0.84), presence of OCB (p=0.09) or age at implantation (p=0.08). Active contacts were generally clustered near the target nuclei, with some variability that may reflect differences in targeting protocols, lead models and contact configurations. There were regions within and surrounding GPi and CM thalamus that improved tics for some patients but were ineffective for others. Regions within, superior or medial to GPi were associated with a greater improvement in OCB than regions inferior to GPi.
CONCLUSION: The results collectively indicate that DBS may improve tics and OCB, the effects may develop over several months, and stimulation locations relative to structural anatomy alone may not predict response. This study was the first to visualise and evaluate the regions of stimulation across a large cohort of patients with TS to generate new hypotheses about potential targets for improving tics and comorbidities.
METHODS: We collected retrospective clinical data and imaging from 13 international sites on 123 patients. We assessed the effects of DBS over time in 110 patients who were implanted in the centromedial (CM) thalamus (n=51), globus pallidus internus (GPi) (n=47), nucleus accumbens/anterior limb of the internal capsule (n=4) or a combination of targets (n=8). Contact locations (n=70 patients) and volumes of tissue activated (n=63 patients) were coregistered to create probabilistic stimulation atlases.
RESULTS: Tics and obsessive-compulsive behaviour (OCB) significantly improved over time (p<0.01), and there were no significant differences across brain targets (p>0.05). The median time was 13 months to reach a 40% improvement in tics, and there were no significant differences across targets (p=0.84), presence of OCB (p=0.09) or age at implantation (p=0.08). Active contacts were generally clustered near the target nuclei, with some variability that may reflect differences in targeting protocols, lead models and contact configurations. There were regions within and surrounding GPi and CM thalamus that improved tics for some patients but were ineffective for others. Regions within, superior or medial to GPi were associated with a greater improvement in OCB than regions inferior to GPi.
CONCLUSION: The results collectively indicate that DBS may improve tics and OCB, the effects may develop over several months, and stimulation locations relative to structural anatomy alone may not predict response. This study was the first to visualise and evaluate the regions of stimulation across a large cohort of patients with TS to generate new hypotheses about potential targets for improving tics and comorbidities.
Предметные рубрики MeSH
AdolescentAdultAtlases as TopicCohort StudiesCompulsive BehaviorDeep Brain StimulationFemaleGlobus PallidusHumansInternal CapsuleIntralaminar Thalamic NucleiMagnetic Resonance ImagingMaleMiddle AgedNucleus AccumbensObsessive BehaviorRetrospective StudiesSeverity of Illness IndexThalamusTomography, X-Ray ComputedTourette SyndromeTreatment OutcomeYoung Adult