Cedars Sinai Medical Center, Department of Neurology, Los Angeles, CA.
Ann Neurol. 2014 Jul;76(1):22-30. doi: 10.1002/ana.24187. Epub 2014 Jun 18.
To create a data-driven computational model that identifies brain regions most frequently influenced by successful deep brain stimulation (DBS) of the globus pallidus (GP) for advanced, medication-resistant, generalized dystonia.
We studied a retrospective cohort of 21 DYT1 primary dystonia patients treated for at least 1 year with bilateral pallidal DBS. We first created individual volume of tissue activation (VTA) models utilizing neuroimaging and postoperative stimulation and clinical data. These models were then combined into a standardized probabilistic dystonia stimulation atlas (DSA). Finally, we constructed a candidate target volume from electrodes demonstrating at least 75% improvement in contralateral symptoms, utilizing voxels stimulated by least 75% of these electrodes.
Pallidal DBS resulted in a median contralateral hemibody improvement of 90% (mean = 83%, standard deviation [SD] = 20) after 1 year of treatment. Individual VTA models of the 42 active electrodes included in the study demonstrated a mean stimulation volume of 501mm ([SD] = 284). The resulting DSA showed that areas most frequently stimulated were located squarely in the middle of the posterior GP, with a common target volume measuring 153mm(3) .
Our results provide a map of the region of influence of therapeutic DBS for dystonia and represent a potential target to refine current methods of surgical planning and stimulation parameters selection. Based on their role in alleviating symptoms, these regions may also provide anatomical and physiological information relevant to disease models of dystonia. Further experimental and clinical studies will be needed to validate their importance.
创建一个数据驱动的计算模型，识别出在治疗药物难治性全身性肌张力障碍时，成功进行苍白球深部脑刺激（DBS）最常影响的大脑区域。
我们研究了 21 例 DYT1 原发性肌张力障碍患者的回顾性队列，这些患者至少接受了 1 年的双侧苍白球 DBS 治疗。我们首先利用神经影像学和术后刺激以及临床数据创建了个体的组织激活体积（VTA）模型。然后，将这些模型组合到标准化的概率性肌张力障碍刺激图谱（DSA）中。最后，我们利用至少有 75%电极刺激的体素，从显示至少有 75%对侧症状改善的电极中构建候选目标体积。
苍白球 DBS 在 1 年的治疗后，平均（均值=83%，标准差[SD]=20）使对侧肢体的改善中位数达到 90%。研究中包含的 42 个活跃电极的个体 VTA 模型平均刺激体积为 501mm（[SD]=284）。所得 DSA 显示，最常刺激的区域位于后苍白球的正中间，共有一个 153mm（3）的共同目标体积。
我们的结果提供了治疗性 DBS 治疗肌张力障碍的影响区域图谱，代表了一种潜在的目标，可用于改进当前的手术计划和刺激参数选择方法。基于它们在缓解症状方面的作用，这些区域也可能为肌张力障碍的疾病模型提供与解剖和生理相关的信息。需要进一步的实验和临床研究来验证其重要性。
