Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic.
Faculty of Biomedical Engineering, Czech Technical University in Prague, Prague, Czech Republic.
Sci Rep. 2018 Nov 21;8(1):17218. doi: 10.1038/s41598-018-34880-z.
Clinical benefits of pallidal deep brain stimulation (GPi DBS) in dystonia increase relatively slowly suggesting slow plastic processes in the motor network. Twenty-two patients with dystonia of various distribution and etiology treated by chronic GPi DBS and 22 healthy subjects were examined for short-latency intracortical inhibition of the motor cortex elicited by paired transcranial magnetic stimulation. The relationships between grey matter volume and intracortical inhibition considering the long-term clinical outcome and states of the GPi DBS were analysed. The acute effects of GPi DBS were associated with a shortening of the motor response whereas the grey matter of chronically treated patients with a better clinical outcome showed hypertrophy of the supplementary motor area and cerebellar vermis. In addition, the volume of the cerebellar hemispheres of patients correlated with the improvement of intracortical inhibition which was generally less effective in patients than in controls regardless of the DBS states. Importantly, good responders to GPi DBS showed a similar level of short-latency intracortical inhibition in the motor cortex as healthy controls whereas non-responders were unable to increase it. All these results support the multilevel impact of effective DBS on the motor networks in dystonia and suggest potential biomarkers of responsiveness to this treatment.
苍白球深部脑刺激（GPi DBS）在肌张力障碍中的临床益处增加相对较慢，这表明运动网络中的塑性过程较慢。对 22 名接受慢性 GPi DBS 治疗的各种分布和病因的肌张力障碍患者和 22 名健康受试者进行了检查，以评估经颅磁刺激双脉冲诱发的运动皮质短潜伏期皮质内抑制。分析了考虑长期临床结果和 GPi DBS 状态的灰质体积与皮质内抑制之间的关系。GPi DBS 的急性效应与运动反应的缩短有关，而长期接受治疗且临床效果更好的患者的辅助运动区和小脑蚓部表现出肥大。此外，患者的小脑半球体积与皮质内抑制的改善相关，无论 DBS 状态如何，患者的皮质内抑制通常比对照组效果差。重要的是，GPi DBS 的良好反应者在运动皮质中的短潜伏期皮质内抑制与健康对照组相似，而无反应者则无法增加皮质内抑制。所有这些结果都支持有效的 DBS 对肌张力障碍运动网络的多层次影响，并提示对这种治疗有反应的潜在生物标志物。
