Weichart Emily R, Sederberg Per B, Sammartino Francesco, Krishna Vibhor, Corrigan John D, Rezai Ali R
Department of Psychology, Ohio State University, Columbus, OH, United States.
Department of Neurosurgery, Ohio State University Wexner Medical Center, Columbus, OH, United States.
Front Psychiatry. 2020 Feb 19;11:30. doi: 10.3389/fpsyt.2020.00030. eCollection 2020.
Device titration is a major challenge when using deep brain stimulation (DBS) to treat behavioral disorders. Unlike in movement disorders, there is no reliable real-time clinical feedback for changes in complex behaviors resulting from DBS. Here, a female patient receiving DBS of the nucleus accumbens for the treatment of morbid obesity underwent cognitive testing the flanker task alongside traditional methods of device titration. One set of stimulation parameters administered during titration resulted in acute cognitive improvement (p = 0.033) and increased frontal engagement as measured by electroencephalography (left anterior: p = 0.007, right anterior: p = 0.005) relative to DBS-OFF. The same parameters resulted in the most weight-loss during long-term continuous stimulation (47.8 lbs lost in 129 days) compared to the results of other stimulation settings. Diffusion tensor imaging analyses showed increased connectivity to dorsal attention networks and decreased connectivity to the default mode network for optimal parameters (p < 0.01). Our results provide evidence that targeted cognitive testing is a potentially useful tool for capturing acute effects of DBS stimulation during titration and predicting long-term treatment outcomes.
www.ClinicalTrials.gov, identifier: NCT01512134.
在使用脑深部电刺激（DBS）治疗行为障碍时，设备滴定是一项重大挑战。与运动障碍不同，对于DBS引起的复杂行为变化，没有可靠的实时临床反馈。在此，一名接受伏隔核DBS治疗病态肥胖的女性患者，除了传统的设备滴定方法外，还接受了认知测试——侧翼任务。滴定过程中给予的一组刺激参数导致急性认知改善（p = 0.033），并且与关闭DBS相比，通过脑电图测量显示额叶参与增加（左前：p = 0.007，右前：p = 0.005）。与其他刺激设置的结果相比，相同参数在长期持续刺激期间导致了最多的体重减轻（129天内减轻了47.8磅）。扩散张量成像分析显示，对于最佳参数，与背侧注意力网络的连接增加，与默认模式网络的连接减少（p < 0.01）。我们的结果提供了证据，表明有针对性的认知测试是一种潜在有用的工具，可用于在滴定期间捕捉DBS刺激的急性效应并预测长期治疗结果。
