Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Brainlab AG, Munich, Germany.
J Neurol. 2020 Jun;267(6):1663-1671. doi: 10.1007/s00415-020-09753-z. Epub 2020 Feb 17.
Deep brain stimulation (DBS) within the pallidum represents an effective and well-established treatment for isolated dystonia. However, clinical outcome after surgery may be variable with limited response in 10-25% of patients. The effect of lead location on clinical improvement is still under debate.
To identify stimulated brain regions associated with the most beneficial clinical outcome in dystonia patients.
18 patients with cervical and generalized dystonia with chronic DBS of the internal pallidum were investigated. Patients were grouped according to their clinical improvement into responders, intermediate responders and non-responders. Magnetic resonance and computed tomography images were co-registered, and the volume of tissue activated (VTA) with respect to the pallidum of individual patients was analysed.
VTAs in responders (n = 11), intermediate responders (n = 3) and non-responders (n = 4) intersected with the posterior internal (GPi) and external (GPe) pallidum and the subpallidal area. VTA heat maps showed an almost complete overlap of VTAs of responders, intermediate and non-responders. VTA coverage of the GPi was not higher in responders. In contrast, VTAs of intermediate and non-responders covered the GPi to a significantly larger extent in the left hemisphere (p < 0.01).
DBS of ventral parts of the posterior GPi, GPe and the adjacent subpallidal area containing pallidothalamic output projections resulted in favourable clinical effects. Of note, non-responders were also stimulated within the same area. This suggests that factors other than mere lead location (e.g., clinical phenotype, genetic background) have determined clinical outcome in the present cohort.
苍白球内的深部脑刺激（DBS）是治疗孤立性肌张力障碍的一种有效且成熟的方法。然而，手术后的临床效果可能存在差异，10-25%的患者反应有限。电极位置对临床改善的影响仍存在争议。
确定与肌张力障碍患者最佳临床效果相关的刺激脑区。
对 18 例慢性苍白球内 DBS 的颈性和全身性肌张力障碍患者进行研究。根据临床改善情况，将患者分为反应良好组、中间反应组和无反应组。将磁共振和计算机断层扫描图像配准，并分析个体患者的苍白球激活体积（VTA）。
反应良好组（n=11）、中间反应组（n=3）和无反应组（n=4）的 VTA 与苍白球内（GPi）和外（GPe）部及亚苍白球区相交。VTA 热图显示反应良好组、中间反应组和无反应组的 VTA 几乎完全重叠。反应良好组的 GPi 覆盖范围没有更高。相比之下，中间反应组和无反应组的 VTA 在左侧大脑半球对 GPi 的覆盖范围明显更大（p<0.01）。
DBS 刺激后 GPi、GPe 腹侧和相邻包含苍白球丘脑输出投射的亚苍白球区，可产生良好的临床效果。值得注意的是，无反应者也在相同区域被刺激。这表明，除了电极位置等因素外（例如，临床表型、遗传背景），在本队列中，其他因素也决定了临床结果。
