管理基本震深度大脑刺激诱导的副作用
Alfonso Enrique Martinez-Nunez1,2, Filipe P Sarmento1, Vyshak Chandra3
1Norman Fixel Institute for Neurological Diseases, Gainesville, FL, United States.
Frontiers in human neuroscience
|March 8, 2024
概括
深度大脑刺激 (DBS) 有效地治疗基本震 (ET). 本综述探讨了DBS对ET的副作用,并提供了在保持震控制的同时管理它们的策略.
科学领域:
- 神经外科 神经外科
- 神经学 神经学
- 运动障碍 运动障碍
背景情况:
- 深度大脑刺激 (DBS) 是治疗药物耐药性基本震 (ET) 的外科选择.
- 对于ET的常见DBS目标包括腹腔中间核 (VIM),尾部不确定区域 (cZI) 和后部亚thalamic区域 (PSA).
- 尽管有效抑制震,但刺激诱导的副作用如肌痛性关节炎,消化不良,动力衰竭和步行障碍可能会发生.
研究的目的:
- 审查有关ET DBS中刺激诱导副作用的原因的证据.
- 提出基于证据的解决故障和重新编程DBS的策略,以管理副作用.
- 引导临床医生保持震抑制,同时最大限度地减少不良影响.
主要方法:
- 对DBS对基本震的当前证据的文献综述.
- 对刺激诱导的副作用的病因学的分析.
- 对DBS编程和管理的策略的综合.
主要成果:
- 刺激诱导的副作用通常来自于调节与预期的DBS目标相邻的大脑区域.
- 重编程和有针对性的故障排除可以有效地管理或解决这些副作用.
- 现有策略可以平衡震抑制与尽量减少不良事件.
结论:
- 了解副作用的解剖基础对于ET中有效的DBS管理至关重要.
- 基于证据的重编程策略可以通过减少刺激诱导的副作用来改善患者的治疗结果.
- 优化DBS治疗可以持续控制震,并改善耐受性.
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