Atrophy is a Real Phenomenon that Can Result in Changes in Deep Brain Stimulation Outcome
Notice bibliographique
Résumé
To the Editor We read the case report by Choi et. al. with great interest and would like to add to their observations and to lend strong support to the notion that atrophy impacts DBS outcome. Our experience was previously published in PLOSONE in 2014 but not cited in their report, and we think important for the readership to be aware of this phenomenon.1 Choi reported a 57-year old man who underwent bilateral thalamic DBS surgery for refractory epilepsy and had worsening of seizures following 8 years of reasonable seizure control. This exacerbation of symptoms was attributed to a lead migration into the third ventricle caused by significant ventricular enlargement and atrophy. Re-implantation of a new DBS lead revealed a clinically significant improvement. We agree with the authors that brain atrophy as a potential cause of lead migration leading to a loss of benefit from DBS is possible and should be a worrisome issue. DBS-induced side effects can also result from this phenomenon. We previously reported two Parkinson’s disease and one Essential Tremor patient with an unexpected loss of benefit and/or appearance of new side effects from DBS following several years of clinical benefit.2 Our patients underwent a DBS troubleshooting protocol and careful examination of the implantable pulse generator as well as a careful examination of the electrical system integrity (e.g. impedance and current drain). There were further studies of the DBS system with plain x-rays and no relevant issues were uncovered. We reviewed serial brain imaging studies inclusive of lead locations. We observed a substantial increase in brain atrophy indices (3rd ventricular width, Evans index, ventricular index, and cella media index) and also observed a relative lateral migration of the leads when compared to previous imaging examinations. The likely cause was atrophy which changed the relationship of the DBS leads over time to the surrounding neuroanatomical structures (i.e. a lead may be closer to the internal capsule and may more easily evoke side effects). There is pathological and imaging evidence that the brain changes with age, and that the most prominent changes have been in the frontal cortex, the temporal cortex, the putamen, the thalamus, and the nucleus accumbens though other regions are also at risk.3 We have now encountered another interesting case of shifting DBS leads due to atrophy. This case included serial brain scans and a post-mortenm pathological analysis in a Huntington’s disease patient with bilateral globus pallidus internus DBS. In this case, a change in lead position was observed over time (case has been accepted for publication and publication is pending). Atrophy is a real phenomenon that DBS clinicians should pay attention to as it could affect the long-term DBS outcome.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,024 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,002 | 0,001 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,001 | 0,002 |
| Communication savante | 0,002 | 0,004 |
| Science ouverte | 0,003 | 0,001 |
| Intégrité de la recherche | 0,010 | 0,009 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,002 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».