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Image-based analysis and long-term clinical outcomes of deep brain stimulation for Tourette syndrome: a multisite study.

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收录情况： ◇ SCIE

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机构： [1]Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, Utah, USA [2]Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah, USA [3]School of Computing, University of Utah, Salt Lake City, Utah, USA [4]Neurosurgical Department, IRCCS Istituto Ortopedico Galeazzi, Milan, , Italy [5]Tourette’s Syndrome and Movement Disorders Center, IRCCS Istituto Ortopedico Galeazzi, Milan, , Italy [6]Department of Neurology, University of California San Francisco, San Francisco, California, USA [7]Institut du Cerveau et de la Moelle Epiniere, Paris, , France [8]Sorbonne Universités, University of Pierre and Marie Curie University of Paris, the French National Institute of Health and Medical Research U 1127, the National Center for Scientific Research 7225, Paris, France [9]Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada [10]Department of Psychiatry and Psychotherapy, University of Cologne, Koln, , Germany [11]Queen Square, Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience, University College London Institute of Neurology, London, UK [12]Beijing Neurosurgical Institute, Capital Medical University, Beijing, China [13]Department of Functional Neurosurgery, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China [14]Department of Neurosurgery, PLA Army General Hospital, Beijing, China [15]Department of Neurosurgery, Maastricht University Medical Centre+, Maastricht, , The Netherlands [16]Department of Stereotaxy and Functional Neurosurgery, University Hospital Cologne, Koln, , Germany [17]Center for Neuromodulation, Departments of Neurology and Neurosurgery, New York University Medical Center, New York, New York, USA [18]Fixel Institute for Neurological Diseases, Program for Movement Disorders and Neurorestoration, Departments of Neurology and Neurosurgery, University of Florida, Gainesville, Florida, USA [19]J Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, Florida, USA [20]Departments of Neurology, Neurosurgery, and Psychiatry, University of Utah, Salt Lake City, Utah, USA

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Deep brain stimulation (DBS) can be an effective therapy for tics and comorbidities in select cases of severe, treatment-refractory Tourette syndrome (TS). Clinical responses remain variable across patients, which may be attributed to differences in the location of the neuroanatomical regions being stimulated. We evaluated active contact locations and regions of stimulation across a large cohort of patients with TS in an effort to guide future targeting. We collected retrospective clinical data and imaging from 13 international sites on 123 patients. We assessed the effects of DBS over time in 110 patients who were implanted in the centromedial (CM) thalamus (n=51), globus pallidus internus (GPi) (n=47), nucleus accumbens/anterior limb of the internal capsule (n=4) or a combination of targets (n=8). Contact locations (n=70 patients) and volumes of tissue activated (n=63 patients) were coregistered to create probabilistic stimulation atlases. Tics and obsessive-compulsive behaviour (OCB) significantly improved over time (p<0.01), and there were no significant differences across brain targets (p>0.05). The median time was 13 months to reach a 40% improvement in tics, and there were no significant differences across targets (p=0.84), presence of OCB (p=0.09) or age at implantation (p=0.08). Active contacts were generally clustered near the target nuclei, with some variability that may reflect differences in targeting protocols, lead models and contact configurations. There were regions within and surrounding GPi and CM thalamus that improved tics for some patients but were ineffective for others. Regions within, superior or medial to GPi were associated with a greater improvement in OCB than regions inferior to GPi. The results collectively indicate that DBS may improve tics and OCB, the effects may develop over several months, and stimulation locations relative to structural anatomy alone may not predict response. This study was the first to visualise and evaluate the regions of stimulation across a large cohort of patients with TS to generate new hypotheses about potential targets for improving tics and comorbidities. © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

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中科院(CAS)分区：

出版当年[2018]版：

大类 | 1 区

医学

小类 | 1 区临床神经病学 1 区外科 2 区精神病学

最新[2023]版：

大类 | 1 区

医学

小类 | 1 区临床神经病学 1 区精神病学 1 区外科

JCR分区：

出版当年[2017]版：

Q1 CLINICAL NEUROLOGY Q1 SURGERY Q1 PSYCHIATRY

最新[2023]版：

Q1 CLINICAL NEUROLOGY Q1 PSYCHIATRY Q1 SURGERY

影响因子： 8.8 最新[2023版] 9.6 最新五年平均 7.144 出版当年[2017版] 6.923 出版当年五年平均 7.349 出版前一年[2016版] 8.327 出版后一年[2018版]

第一作者：

第一作者机构： [1]Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, Utah, USA [2]Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah, USA

通讯作者：

通讯机构： [1]Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, Utah, USA [2]Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah, USA [20]Departments of Neurology, Neurosurgery, and Psychiatry, University of Utah, Salt Lake City, Utah, USA [*1]Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT 84112, USA

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