深部脑刺激治疗原发性肌张力障碍共识会议决策的相关因素。
Correlates of deep brain stimulation consensus conference decision to treat primary dystonia.
作者信息
Niccolai Lindsay, Aita Stephen L, Walker Harrison C, Del Bene Victor A, Gerstenecker Adam, Marotta Dario, Gammon Meredith, Martin Roy C, Clay Olivio J, Crowe Michael, Triebel Kristen L
机构信息
Department of Neuro-Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Department of Neurology, University of Alabama at Birmingham (UAB), Birmingham, AL, USA; Department of Psychiatry & Behavioral Neurobiology, University of Alabama at Birmingham (UAB), Birmingham, AL, USA; Department of Psychology, University of South Alabama, Mobile, AL, USA.
出版信息
Clin Neurol Neurosurg. 2021 Aug;207:106747. doi: 10.1016/j.clineuro.2021.106747. Epub 2021 Jun 8.
BACKGROUND
Deep brain stimulation (DBS) is an effective treatment for motor disturbance in people with primary dystonia (PWD). Numerous factors are considered by an interdisciplinary consensus conference before deciding candidacy for DBS surgery (e.g., demographic, medical, cognitive, and behavioral factors). However, little is known about which of these factors are associated with PWD DBS surgery consensus conference decisions.
OBJECTIVE
Our goal was to examine whether pre-operative demographic, medical, and cognitive/behavioral variables are associated DBS consensus conference decisions in patients with dystonia.
METHODS
Thirty-two PWD completed comprehensive presurgery workup included neurological and neuropsychological exams, and neuroimaging in consideration for DBS surgery. An interdisciplinary conference committee either recommended or did not recommend DBS surgery based upon these data. Demographic and medical data (e.g., dystonia disease characteristics, medical comorbidities, medications) were also collected. We also examined impact from cardiovascular disease factors, using a Revised Cardiac Risk Index. PWD were grouped based on DBS conference decision (eligible: n = 21, ineligible: n = 11) and compared across demographic, medical, and cognitive/behavioral variables.
RESULTS
Across clinical variables, PWD who were deemed ineligible for DBS surgery had a higher Revised Cardiac Risk Index. PWD who were classified as ineligible displayed lower global cognitive functioning, working memory, phonemic fluency, memory retrieval, and cognitive flexibility.
CONCLUSIONS
Consensus decision making regarding DBS surgery eligibility involves a multifactorial process. We found that deficits in executive functioning were associated with the DBS consensus committee decision. We also observed elevated cardiac risk among these individuals, likely reflecting the relation between vascular health and cognition. Implications, and clinical and scientific applications of these findings are discussed.
背景
深部脑刺激（DBS）是治疗原发性肌张力障碍（PWD）患者运动障碍的有效方法。在决定是否适合进行DBS手术之前，跨学科共识会议会考虑许多因素（例如人口统计学、医学、认知和行为因素）。然而，对于这些因素中哪些与PWD的DBS手术共识会议决策相关，我们知之甚少。
目的
我们的目标是研究术前人口统计学、医学和认知/行为变量是否与肌张力障碍患者的DBS共识会议决策相关。
方法
32名PWD患者完成了全面的术前检查，包括神经学和神经心理学检查以及神经影像学检查，以考虑是否适合进行DBS手术。一个跨学科会议委员会根据这些数据推荐或不推荐DBS手术。还收集了人口统计学和医学数据（例如肌张力障碍疾病特征、医学合并症、药物治疗）。我们还使用修订的心脏风险指数检查了心血管疾病因素的影响。PWD患者根据DBS会议决策进行分组（符合条件：n = 21，不符合条件：n = 11），并在人口统计学、医学和认知/行为变量方面进行比较。
结果
在所有临床变量中，被认为不适合进行DBS手术的PWD患者的修订心脏风险指数更高。被归类为不符合条件的PWD患者表现出较低的整体认知功能、工作记忆、音素流畅性、记忆检索和认知灵活性。
结论
关于DBS手术资格的共识决策涉及一个多因素过程。我们发现执行功能缺陷与DBS共识委员会的决策相关。我们还观察到这些个体的心脏风险升高，这可能反映了血管健康与认知之间的关系。讨论了这些发现的意义以及临床和科学应用。
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