Heiden Petra, Weigel Daniel Tim, Loução Ricardo, Hamisch Christina, Gündüz Enes M, Ruge Maximilian I, Kuhn Jens, Visser-Vandewalle Veerle, Andrade Pablo
Department of Stereotactic and Functional Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
Department of Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
Front Hum Neurosci. 2022 Aug 24;16:958247. doi: 10.3389/fnhum.2022.958247. eCollection 2022.
Self-injurious behavior (SIB) is associated with diverse psychiatric conditions. Sometimes (e.g., in patients with autism spectrum disorder or acquired brain injuries), SIB is the most dominant symptom, severely restricting the psychosocial functioning and quality of life of the patients and inhibiting appropriate patient care. In severe cases, it can lead to permanent physical injuries or even death. Primary therapy consists of medical treatment and if implementable, behavioral therapy. For patients with severe SIB refractory to conventional therapy, neuromodulation can be considered as a last recourse. In scientific literature, several successful lesioning and deep brain stimulation targets have been described that can indicate a common underlying neuronal pathway. The objectives of this study were to evaluate the short- and long-term clinical outcome of patients with severe, therapy refractory SIB who underwent DBS with diverse underlying psychiatric disorders and to correlate these outcomes with the activated connectivity networks. We retrospectively analyzed 10 patients with SIB who underwent DBS surgery with diverse psychiatric conditions including autism spectrum disorder, organic personality disorder after hypoxic or traumatic brain injury or Tourette syndrome. DBS targets were chosen according to the underlying disorder, patients were either stimulated in the nucleus accumbens, amygdala, posterior hypothalamus, medial thalamus or ventrolateral thalamus. Clinical outcome was measured 6 months after surgery and at long-term follow-up after 10 or more years using the Early Rehabilitation Barthel index (ERBI) and time of restraint. Connectivity patterns were analyzed using normative connectome. Based on previous literature the orbitofrontal cortex, superior frontal gyrus, the anterior cingulate cortex, the amygdala and the hippocampus were chosen as regions of interest. This analysis showed a significant improvement in the functionality of the patients with DBS in the short- and long-term follow-up. Good clinical outcome correlated with higher connectivity to the amygdala and hippocampus. These findings may suggest a common pathway, which can be relevant when planning a surgical procedure in patients with SIB.
自伤行为(SIB)与多种精神疾病相关。有时(例如,在患有自闭症谱系障碍或获得性脑损伤的患者中),SIB是最主要的症状,严重限制了患者的心理社会功能和生活质量,并阻碍了适当的患者护理。在严重情况下,它可导致永久性身体损伤甚至死亡。主要治疗方法包括药物治疗,若可行,还包括行为治疗。对于常规治疗难治的严重SIB患者,神经调节可作为最后的手段。在科学文献中,已经描述了几种成功的毁损术和脑深部刺激靶点,这些靶点可能表明存在共同的潜在神经通路。本研究的目的是评估患有严重、治疗难治性SIB且患有多种潜在精神疾病的患者接受脑深部刺激(DBS)后的短期和长期临床结果,并将这些结果与激活的连接网络相关联。我们回顾性分析了10例患有SIB且接受DBS手术的患者,这些患者患有多种精神疾病,包括自闭症谱系障碍、缺氧或创伤性脑损伤后的器质性人格障碍或抽动秽语综合征。根据潜在疾病选择DBS靶点,患者分别在伏隔核、杏仁核、下丘脑后部、丘脑内侧或丘脑腹外侧接受刺激。使用早期康复Barthel指数(ERBI)和约束时间在术后6个月以及10年或更长时间的长期随访中测量临床结果。使用标准连接组分析连接模式。基于先前的文献,选择眶额皮质、额上回、前扣带回皮质、杏仁核和海马体作为感兴趣区域。该分析表明,在短期和长期随访中,接受DBS治疗的患者功能有显著改善。良好的临床结果与与杏仁核和海马体的更高连接性相关。这些发现可能提示一条共同通路,这在为SIB患者规划手术程序时可能具有相关性。