Lead Repositioning Guided by Both Physiology and Atlas Based Targeting in Tourette Deep Brain Stimulation

Tremor and Other Hyperkinetic Movements

article

Jackson N. Cagle¹  Wissam Deeb²  Robert S. Eisinger³  Rene Molina⁴  Enrico Opri¹  Marshall T. Holland⁵  Kelly D. Foote⁶  Michael S. Okun²  Aysegul Gunduz¹ 

[1] J. Crayton Pruitt Department of Biomedical Engineering, University of Florida;Department of Neurology, University of Florida Fixel Institute for Neurological Diseases;Department of Neuroscience, University of Florida;Department of Electrical and Computer Engineering, University of Florida;Department of Neurosurgery, University of Iowa;Department of Neurosurgery, University of Florida Fixel Institute for Neurological Diseases

关键词: Tourette syndrome;    Deep brain stimulation;    Electrophysiology;    Centromedian thalamus;    Brain mapping;   

DOI  :  10.5334/tohm.140

学科分类：社会科学、人文和艺术（综合）

来源: Ubiquity Press

【 摘 要 】

Background: The centromedian (CM) region of the thalamus is a common target for deep brain stimulation (DBS) treatment for Tourette Syndrome (TS). However, there are currently no standard microelectrode recording or macrostimulation methods to differentiate CM thalamus from other nearby structures and nuclei. Case Report: Here we present a case of failed conventional stereotactic targeting in TS DBS. Postoperative local field potential recordings (LFPs) showed features including beta power desynchronization during voluntary movement and thalamo-cortical phase amplitude coupling at rest. These findings suggested that the DBS lead was suboptimally placed in the ventral intermediate (VIM) nucleus of the thalamus rather than the intended CM region. Due to a lack of clinical improvement in tic severity scales three months following the initial surgery, the patient underwent lead revision surgery. Slight repositioning of the DBS leads resulted in a remarkably different clinical outcome. Afterwards, LFPs revealed less beta desynchronization and disappearance of the thalamo-cortical phase amplitude coupling. Follow-up clinical visits documented improvement of the patient’s global tic scores. Discussion: This case provides preliminary evidence that combining physiology with atlas based targeting may possibly enhance outcomes in some cases of Tourette DBS. A larger prospective study will be required to confirm these findings. Highlight: This report demonstrates a case of failed centromedian nucleus region deep brain stimulation (DBS). We observed suboptimal tic improvement several months following DBS surgery and subsequent lead revision improved the outcome. The neurophysiology provided an important clue suggesting the possibility of suboptimally placed DBS leads. Repeat LFPs during lead revision revealed less beta desynchronization and disappearance of the thalamo-cortical phase amplitude coupling. There was improvement in tic outcome following slight repositioning during bilateral DBS lead revision. This case provides preliminary evidence supporting the use of physiology to augment the atlas based targeting of Tourette DBS cases.

【 授权许可】

CC BY