دورية أكاديمية
Cerebellar deep brain stimulation for the treatment of movement disorders in cerebral palsy.
| العنوان: | Cerebellar deep brain stimulation for the treatment of movement disorders in cerebral palsy. |
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| المؤلفون: | Cajigas I; Departments of1Neurological Surgery., Morrison MA; 2Radiology & Biomedical Imaging, and., Luciano MS; 3Neurology, University of California, San Francisco, California., Starr PA; Departments of1Neurological Surgery. |
| المصدر: | Journal of neurosurgery [J Neurosurg] 2023 Feb 10; Vol. 139 (3), pp. 605-614. Date of Electronic Publication: 2023 Feb 10 (Print Publication: 2023). |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: American Association of Neurological Surgeons Country of Publication: United States NLM ID: 0253357 Publication Model: Electronic-Print Cited Medium: Internet ISSN: 1933-0693 (Electronic) Linking ISSN: 00223085 NLM ISO Abbreviation: J Neurosurg Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: Charlottesville, VA : American Association of Neurological Surgeons Original Publication: Chicago [etc.] |
| مواضيع طبية MeSH: | Cerebral Palsy*/complications , Cerebral Palsy*/therapy , Dystonia*/etiology , Deep Brain Stimulation*/methods , Movement Disorders*/etiology , Movement Disorders*/therapy , Dystonic Disorders*, Child ; Humans ; Adolescent ; Young Adult ; Adult ; Globus Pallidus/surgery ; Cerebellum/diagnostic imaging ; Treatment Outcome |
| مستخلص: | Objective: Cerebral palsy (CP) represents the most common childhood physical disability that encompasses disorders of movement and posture attributed to nonprogressive disturbances that occurred in the developmental fetal or infant brain. Dyskinetic CP (DCP), the second most common type of CP after spastic forms, refers to a subset of patients in whom dystonia and choreoathetosis are the predominant motor manifestations. Most children with CP have abnormal brain MRI studies indicative of cortical and deep gray matter damage consistent with hypoxic ischemic encephalopathy, which may preclude or suggest decreased efficacy of standard deep brain stimulation (DBS) targets. The cerebellum has been posited as an attractive target for treatment of DCP because it is frequently spared from hypoxic ischemic damage and has shown promise in alleviating patient symptoms both in early work in the 1970s and in more recent case series with DBS. Methods: The authors performed bilateral cerebellar DBS implantation, targeting the dentate nucleus (DN) and cerebellar outflow pathway, in 3 patients with DCP. Leads were connected to a pulse generator that senses local field potentials during chronic continuous DBS. The authors report their surgical methods, examples of chronic cerebellar local field potential recordings, and preliminary clinical outcomes. Motor outcomes were assessed using the Burke-Fahn-Marsden Dystonia Rating Scale. Results: Three patients 14-22 years old with DCP and MRI evidence of structural damage to the basal ganglia were offered cerebellar stimulation targeting the DN. All patients tolerated the procedure well and demonstrated improvement in subjective motor function as well as objective improvement in the Burke-Fahn-Marsden Dystonia Rating Scale movement subscale, although the range of responses was variable (19%-40%). Patients experienced subjective improvement in motor function including ease of hand movements and coordination, gait, head control, speech, decreased overflow, and diminished muscle tightness. Conclusions: DBS of the dentate nuclei in patients with DCP appears to be safe and shows preliminary evidence of clinical benefit. New chronic sensing technology may allow for determination of in vivo mechanisms of network disruption in DCP and allow for further understanding of the effects of neuromodulation on brain physiology. Larger studies with long-term follow up will be required to further elucidate the clinical benefits of this therapy. This report addresses a gap in the literature regarding the technical approach to image-based stereotactic targeting and chronic neural recording in the DN. |
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| معلومات مُعتمدة: | K23 NS099441 United States NS NINDS NIH HHS |
| فهرسة مساهمة: | Keywords: cerebellum; deep brain stimulation; dyskinetic cerebral palsy; functional neurosurgery |
| تواريخ الأحداث: | Date Created: 20230215 Date Completed: 20230904 Latest Revision: 20231219 |
| رمز التحديث: | 20231219 |
| مُعرف محوري في PubMed: | PMC10726727 |
| DOI: | 10.3171/2023.1.JNS222289 |
| PMID: | 36789999 |
| قاعدة البيانات: | MEDLINE |
| تدمد: | 1933-0693 |
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| DOI: | 10.3171/2023.1.JNS222289 |