Neidhart Stephan, Kohnen Oona, Stieglitz Lennart, Imbach Lukas
Swiss Epilepsy Center, Klinik Lengg, Zurich, Switzerland.
University Hospital Zurich, Department of Neurosurgery, Zurich, Switzerland.
Clin Neurophysiol Pract. 2024 Aug 12;9:233-235. doi: 10.1016/j.cnp.2024.08.001. eCollection 2024.
We present a case of a 46-year-old man with Lennox-Gastaut syndrome and drug-resistant epilepsy. An adjunctive neurostimulation therapy strategy was implemented involving bilateral deep brain stimulation (DBS) of the centromedian thalamic nucleus (CMT).
Robotically assisted implantation of bilateral DBS directional lead system with 8 contacts in the CMT was performed. The clinical course was assessed in repeated in-patient follow-ups.
Initial DBS stimulation resulted in progressive ataxia and dysarthria significantly beyond the level seen before surgery. Deactivation of DBS coincided with improvement of dysarthria. A DBS stimulation paradigm with reduction of lateral and superior stimulation resulted in improvement and eventually complete resolution of the stimulation side effect.
This case suggests that stimulation-induced dysarthria in DBS can be improved by targeted reduction of lateral and/or superior thalamic stimulation. When dysarthria and ataxia occur during DBS, directed stimulation to medial thalamic structures and more inferior electrode contacts offers a promising strategy to reduce side effects while maintaining positive effects.
我们报告一例46岁患有Lennox-Gastaut综合征和耐药性癫痫的男性病例。实施了一种辅助神经刺激治疗策略，包括对丘脑中央中核（CMT）进行双侧深部脑刺激（DBS）。
采用机器人辅助在CMT植入具有8个触点的双侧DBS定向导联系统。在多次住院随访中评估临床病程。
最初的DBS刺激导致进行性共济失调和构音障碍，程度明显超过手术前所见。DBS停用与构音障碍改善同时出现。采用减少外侧和上方刺激的DBS刺激模式后，刺激副作用得到改善并最终完全消除。
该病例表明，通过有针对性地减少丘脑外侧和/或上方刺激，可改善DBS中由刺激引起的构音障碍。当DBS过程中出现构音障碍和共济失调时，向内丘脑结构和更靠下的电极触点进行定向刺激，为减少副作用同时维持积极效果提供了一种有前景的策略。
