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Deep Brain Stimulation of the Globus Pallidus Internus in Patients with Intractable Tourette Syndrome： A 1-year Follow-up Study

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Chinese Medical Journal 2016年第9期129卷 1022-1027页

作者： Xiao-Hua Zhang Jian-Yu Li Yu-Qing Zhang Yong-Jie Li Department of functional neurosurgery Beijing Institute of Functional Neurosurgery Xuanwu Hospital Capital Medical University Beijing 100053 China

Background： Deep brain stimulation （DBS） has been a promising treatment for patients with refractory Tourette syndrome （TS） for more than a decade. Despite successful DBS treatment of TS in more than 100 patients worldwide, studies with a large patient sample and long-term follow-up assessments are still scarce. Accordingly, we investigated the clinical efficacy and safety of globus pallidus internus （GPi） DBS in the treatment of intractable TS in 24 patients with a 1-year follow-up assessment. Methods： Bilateral/unilateral GPi-DBS was performed in 24 patients with TS. We evaluated symptoms of tics and obsessive-compulsive disorder （OCD） through the Yale Global Tic Severity Scale （YGTSS） and Yale-Brown Obsessive-compulsive Scale （Y-BOCS）. We used the Wechsler Adult Intelligence Scale-Revised in China （WAIS-RC） to evaluate the safety of the treatment. We conducted follow-up assessments of all patients for at least 12 months （12-99 months）. Results： Symptoms of tics and OCD were significantly relieved at a 12-month follow-up assessment. The mean YGTSS score was 74.04 ± 11.52, 49.83 ± 10.91, 32.58 ± 7.97, and 31.21 ± 8.87 at baseline, 3, 6, and 12 months, respectively. The mean YGTSS scores obtained at the follow-up assessments were significantly different from the baseline （P 〈 0.05）. The improvement in motor tics was superior to that in phonic tics. The mean Y-BOCS scores were 21.61 ± 4.97, 18 ± 4.58, 14.39 ± 3.99, and 13.78 ± 4.56 at baseline, 3, 6, and 12 months, respectively （P 〈 0.05）. We observed a remarkable improvement in psychiatric comorbidities, such as OCD and attention-deficit hyperactivity disorder, after the procedure. WAIS-RC scores were comparable before and after the operation. There were no severe postoperative complications. Conclusion： GPi-DBS appears to comprehensively alleviate tic symptoms and psychiatric comorbidities in patients with TS, thus significantly improving patients＇ quality of life.

关键词： Deep Brain Stimulation Tourette Syndrome Treatment

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Sex modulates the outcome of subthalamic nucleus deep brain stimulation in patients with Parkinson's disease

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Neural Regeneration Research 2023年第4期18卷 901-907页

作者： Tian-Shuo Yuan Ying-Chuan Chen De-Feng Liu Ruo-Yu Ma Xin Zhang Ting-Ting Du Guan-Yu Zhu Jian-Guo Zhang Department of neurosurgery Beijing Tiantan HospitalCapital Medical UniversityBeijingChina Department of functional neurosurgery Beijing Neurosurgical InstituteCapital Medical UniversityBeijingChina beijing Key Laboratory of Neurostimulation BeijingChina

There are many documented sex differences in the clinical course,symptom expression profile,and treatment response of Parkinson’s disease,creating additional challenges for patient management.Although subthalamic nucleus deep brain stimulation is an established therapy for Parkinson’s disease,the effects of sex on treatment outcome are still unclear.The aim of this retrospective observational study,was to examine sex differences in motor symptoms,nonmotor symptoms,and quality of life after subthalamic nucleus deep brain stimulation.Outcome measures were evaluated at 1 and 12 months post-operation in 90 patients with Parkinson’s disease undergoing subthalamic nucleus deep brain stimulation aged 63.00±8.01 years(55 men and 35 women).Outcomes of clinical evaluations were compared between sexes via a Student’s t-test and within sex via a paired-sample t-test,and generalized linear models were established to identify factors associated with treatment efficacy and intensity for each sex.We found that subthalamic nucleus deep brain stimulation could improve motor symptoms in men but not women in the on-medication condition at 1 and 12 months post-operation.Restless legs syndrome was alleviated to a greater extent in men than in women.Women demonstrated poorer quality of life at baseline and achieved less improvement of quality of life than men after subthalamic nucleus deep brain stimulation.Furthermore,Hoehn-Yahr stage was positively correlated with the treatment response in men,while levodopa equivalent dose at 12 months post-operation was negatively correlated with motor improvement in women.In conclusion,women received less benefit from subthalamic nucleus deep brain stimulation than men in terms of motor symptoms,non-motor symptoms,and quality of life.We found sex-specific factors,i.e.,Hoehn-Yahr stage and levodopa equivalent dose,that were related to motor improvements.These findings may help to guide subthalamic nucleus deep brain stimulation patient selection,prognosis,and stimulation programming for optimal the

关键词： chronic effect deep brain stimulation generalized linear model initial effect motor symptoms non-motor symptoms Parkinson’s disease quality of life sex subthalamic nucleus

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High-frequency and brief-pulse stimulation pulses terminate cortical electrical stimulation-induced afterdischarges

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Neural Regeneration Research 2017年第6期12卷 938-944页

作者： Zhi-wei Ren Yong-jie Li Tao Yu Duan-yu Ni Guo-jun Zhang Wei Du Yuan-yuan Piao Xiao-xia Zhou Beijing Institute of Functional Neurosurgery Xuanwu Hospital of Capital Medical University

Brief-pulse stimulation at 50 Hz has been shown to terminate afterdischarges observed in epilepsy patients. However, the optimal pulse stimulation parameters for terminating cortical electrical stimulation-induced afterdischarges remain unclear. In the present study, we examined the effects of different brief-pulse stimulation frequencies（5, 50 and 100 Hz） on cortical electrical stimulation-induced afterdischarges in 10 patients with refractory epilepsy. Results demonstrated that brief-pulse stimulation could terminate cortical electrical stimulation-induced afterdischarges in refractory epilepsy patients. In conclusion,（1） a brief-pulse stimulation was more effective when the afterdischarge did not extend to the surrounding brain area.（2） A higher brief-pulse stimulation frequency（especially 100 Hz） was more likely to terminate an afterdischarge.（3） A low current intensity of brief-pulse stimulation was more likely to terminate an afterdischarge.

关键词： stimulation cortical epilepsy brief seizure likely unclear refractory epileptic cortex

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Deep brain stimulation of the nucleus basalis of Meynert modulates hippocampal-frontoparietal networks in patients with advanced Alzheimer’s disease

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Translational Neurodegeneration 2022年第1期11卷 148-160页

作者： Yin Jiang Tian-Shuo Yuan Ying-Chuan Chen Peng Guo Teng-Hong Lian Yu-Ye Liu Wei Liu Yu-Tong Bai Quan Zhang Wei Zhang Jian-Guo Zhang Department of functional neurosurgery Beijing Neurosurgical InstituteCapital Medical UniversityBeijing 100070China Department of functional neurosurgery Beijing Tiantan HospitalCapital Medical UniversityBeijing 100070China Center for Cognitive Neurology Department of NeurologyBeijing Tiantan HospitalCapital Medical UniversityBeijing 100070China beijing Key Laboratory of Neurostimulation Beijing 100070China.

Background:Deep brain stimulation(DBS)of the nucleus basalis of Meynert(NBM)has shown potential for the treatment of mild-to-moderate Alzheimer’s disease(AD).However,there is little evidence of whether NBM-DBS can improve cognitive functioning in patients with advanced AD.In addition,the mechanisms underlying the modulation of brain networks remain unclear.This study was aimed to assess the cognitive function and the resting-state connectivity following NBM-DBS in patients with advanced AD.Methods:Eight patients with advanced AD underwent bilateral NBM-DBS and were followed up for 12 months.Clinical outcomes were assessed by neuropsychological examinations using the Mini-Mental State Examination(MMSE)and Alzheimer’s Disease Assessment Scale.Resting-state functional magnetic resonance imaging and positron emis-sion tomography data were also collected.Results:The cognitive functioning of AD patients did not change from baseline to the 12-month follow-up.Interestingly,the MMSE score indicated clinical efficacy at 1 month of follow-up.At this time point,the connectivity between the hippocampal network and frontoparietal network tended to increase in the DBS-on state compared to the DBS-off state.Additionally,the increased functional connectivity between the parahippocampal gyrus(PHG)and the parietal cortex was associated with cognitive improvement.Further dynamic functional network analysis showed that NBM-DBS increased the proportion of the PHG-related connections,which was related to improved cognitive performance.Conclusion:The results indicated that NBM-DBS improves short-term cognitive performance in patients with advanced AD,which may be related to the modulation of multi-network connectivity patterns,and the hippocampus plays an important role within these networks.

关键词： Alzheimer’s disease Deep brain stimulation Nucleus basalis of Meynert Hippocampal Frontoparietal functional connectivity

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Advances in brain imaging of neuropathic pain

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Chinese Medical Journal 2008年第7期121卷 653-657页

作者： CHEN Fu-yong TAO Wei LI Yong-jie Department of functional neurosurgery Beijing Institute of Functional Neurosurgery Xuanwu Hospital Capital MedicalUniversity Beijing 100053 China

To review the literature on the use of brain imaging, including functional magnetic resonance imaging （fMRI）, positron emission tomography （PET）, magnetic resonance spectroscopy （MRS） and voxel-based morphometry （VBM） in investigation of the activity in diverse brain regions that creates and modulates chronic neuropathic pain. Data sources English literatures from January 1, 2000 to July 31, 2007 that examined human brain activity in chronic neuropathic pain were accessed through MEDLINE/CD ROM, using PET, fMRI, VBM, MRS and receptor binding. Study selection Published articles about the application of fMRI, PET, VBM, MRS and chronic neuropathic pain were selected. Data extraction Data were mainly extracted from 40 representative articles as the research basis. Results The PET studies suggested that spontaneous neuropathic pain is associated with changes in thalamic activity. Both PET and fMRI have been used to investigate the substrate of allodynia. The VBM demonstrated that brain structural changes are involved in chronic neuropathic pain, which is not seen in a matched control group. However, the results obtained had a large variety, which may be due to different pain etiology, pain distribution, lesion tomography, symptoms and stimulation procedures. Conclusions Application of the techniques of brain imaging plays a very important role in the study of structural and functional reorganization in patients with neuropathic pain. However, a unique “pain matrix” has not been defined. Future studies should be conducted using a prospective longitudinal research design, which would guarantee the control for many confounding factors.

关键词： magnetic resonance imaging function positron emission tomography neuropathic pain review

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Anterior thalamic nuclei deep brain stimulation inhibits mossy fiber sprouting via 3′,5′-cyclic adenosine monophosphate/protein kinase A signaling pathway in a chronic epileptic monkey model

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Chinese Medical Journal 2021年第3期134卷 326-333页

作者： Ting-Ting Du Ying-Chuan Chen Guan-Yu Zhu De-Feng Liu Yu-Ye Liu Tian-Shuo Yuan Xin Zhang Jian-Guo Zhang Department of functional neurosurgery Beijing Neurosurgical InstituteCapital Medical UniversityBeijing 100070China Department of neurosurgery Beijing Tiantan HospitalCapital Medical UniversityBeijing 100070China beijing Key Laboratory of Neurostimulation Beijing 100070China

Background:Anterior thalamic nuclei(ATN)deep brain stimulation(DBS)is an effective method of controlling epilepsy,especially temporal lobe epilepsy.Mossy fiber sprouting(MFS)plays an indispensable role in the pathogenesis and progression of epilepsy,but the effect of ATN-DBS on MFS in the chronic stage of epilepsy and the potential underlying mechanisms are unknown.This study aimed to investigate the effect of ATN-DBS on MFS,as well as potential signaling pathways by a kainic acid(KA)-induced epileptic model.Methods:Twenty-four rhesus monkeys were randomly assigned to control,epilepsy(EP),EP-sham-DBS,and EP-DBS groups.KA was injected to establish the chronic epileptic model.The left ATN was implanted with a DBS lead and stimulated for 8 weeks.Enzyme-linked immunosorbent assay,Western blotting,and immunofluorescence staining were used to evaluate MFS and levels of potential molecular mediators in the hippocampus.One-way analysis of variance,followed by the Tukeypost hoc correction,was used to analyze the statistical significance of differences among multiple groups.Results:ATN-DBS is found to significantly reduce seizure frequency in the chronic stage of epilepsy.The number of ectopic granule cells was reduced in monkeys that received ATN stimulation(P<0.0001).Levels of 3′,5′-cyclic adenosine monophosphate(cAMP)and protein kinase A(PKA)in the hippocampus,together with Akt phosphorylation,were noticeably reduced in monkeys that received ATN stimulation(P=0.0030 andP=0.0001,respectively).ATN-DBS also significantly reduced MFS scores in the hippocampal dentate gyrus and CA3 sub-regions(allP<0.0001).Conclusion:ATN-DBS is shown to down-regulate the cAMP/PKA signaling pathway and Akt phosphorylation and to reduce the number of ectopic granule cells,which may be associated with the reduced MFS in chronic epilepsy.The study provides further insights into the mechanism by which ATN-DBS reduces epileptic seizures.

关键词： Anterior thalamic nuclei Deep brain stimulation Epilepsy Hippocampus Mossy fiber sprouting

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A study of medial and lateral temporal lobe epilepsy based on stereoelectroencephalography

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Chinese Medical Journal 2021年第1期134卷 68-72页

作者： Xiao-Ming Yan Cui-Ping Xu Yu-Ping Wang Kai Ma Tao Yu Xiao-Hua Zhang Xi Zhang Run-Shi Gao Guo-Jun Zhang Yong-Jie Li Beijing Institute of Functional Neurosurgery Xuanwu HospitalCapital Medical UniversityBeijing 100053China Department of Neurology Xuanwu HospitalCapital Medical UniversityBeijing 100053China

Background:Patients with temporal lobe epilepsy(TLE)originating from different seizure onset zones had distinct electrophysiological characteristics and surgical outcomes.In this study,we aimed to investigate the relationship between the origin and prognosis of TLE,and the stereoelectroencephalography(SEEG)features.Methods:Thirty patients with TLE,who underwent surgical treatment in our functional neurosurgery department from January 2016 to December 2017,were enrolled in this study.All patients underwent anterior temporal lobectomy after an invasive preoperative evaluation with SEEG.Depending on the epileptic focus location,patients were divided into those with medial temporal lobe seizures(MTLS)and those with lateral temporal lobe seizures(LTLS).The Engel classification was used to evaluate operation effectiveness,and the Kaplan-Meier analysis was used to detect seizure-free duration.Results:The mean follow-up time was 25.7±4.8 months.Effectiveness was 63.3%for Engel I(n=19),13.3%for Engel II,3.3%for Engel III,and 20.0%for Engel IV.According to the SEEG,60.0%(n=18)had MTLS,and 40.0%(n=12)had LTLS.Compared with the MTLS group,the operation age of those with LTLS was significantly greater(26.9±6.9 vs.29.9±12.5 years,t=-0.840,P=0.009)with longer epilepsy duration(11.9±6.0 vs.17.9±12.1 years,t=-1.801,P=0.038).Patients with MTLS had a longer time interval between ictal onset to seizure(67.3±59.1 s vs.29.3±24.4 s,t=2.017,P=0.008).The most common SEEG ictal pattern was a sharp/spike-wave rhythm in the MTLS group(55.6%)and low-voltage fast activity in the LTLS group(58.3%).Compared with the LTLS group,patients with MTLS had a more favorable prognosis(41.7%vs.77.8%,P=0.049).Post-operative recurrence was more likely to occur within three months after the operation for both groups,and there appeared to be a stable longterm outcome.Conclusion:Patients with MTLS,who accounted for three-fifths of patients with TLE,showed a more favorable surgical outcome.

关键词： Epilepsy Stereoelectroencephalography Surgical outcome Temporal lobe

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Stimulation of Anterior Thalamic Nuclei Protects Against Seizures and Neuronal Apoptosis in Hippocampal CA3 Region of Kainic Acid-induced Epileptic Rats

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Chinese Medical Journal 2016年第8期129卷 960-966页

作者： Da-Wei Meng Huan-Guang Liu An-Chao Yang KaiZhang Jian-Guo Zhang Department of neurosurgery Beijing Tiantan Hospital Capital Medical University Beijing 100050 China beijing Key Laboratory of Neuromodulation Beijing 100050 China Department of functional neurosurgery Beijing Neurosurgical Institute Capital Medical University Beijing 100050 China

Background：The antiepileptic effect of the anterior thalamic nuclei （ANT） stimulation has been demonstrated;however,its underlying mechanism remains unclear.The aim of this study was to investigate the effect of chronic ANT stimulation on hippocampal neuron loss and apoptosis.Methods：Sixty-four rats were divided into four groups：The control group,the kainic acid （KA） group,the sham-deep brain stimulation （DBS） group,and the DBS group.KA was used to induce epilepsy.Seizure count and latency to the first spontaneous seizures were calculated.Nissl staining was used to analyze hippocampal neuronal loss.Polymerase chain reaction and Western blotting were conducted to assess the expression of caspase-3 （Casp3）,B-cell lymphoma-2 （Bcl2）,and Bcl2-associated X protein （Box） in the hippocampal CA3 region.One-way analysis of variance was used to determine the differences between the four groups.Results：The latency to the first spontaneous seizures in the DBS group was significantly longer than that in the KA group （27.50 ± 8.05 vs.16.38 ± 7.25 days,P =0.0005）.The total seizure number in the DBS group was also significantly reduced （DBS vs.KA group：11.75 ± 6.80 vs.23.25 ± 7.72,P =0.0002）.Chronic ANT-DBS reduced neuronal loss in the hippocampal CA3 region （DBS vs.KA group：23.58 ± 6.34 vs.13.13 ± 4.00,P =0.0012）.After chronic DBS,the relative mRNA expression level of Casp3 was decreased （DBS vs.KA group：1.18 ± 0.37 vs.2.09 ± 0.46,P =0.0003）,and the relative mRNA expression level of Bcl2 was increased （DBS vs.KA group：0.92 ± 0.21 vs.0.48 ± 0.16,P =0.0004）.The protein expression levels of CASP3 （DBS vs.KA group：1.25 ± 0.26 vs.2.49 ± 0.38,P 〈 0.0001） and BAX （DBS vs.KA group：1.57 ± 0.49 vs.2.80 ± 0.63,P =0.0012） both declined in the DBS group whereas the protein expression level of BCL2 （DBS vs.KA group：0.78 ± 0.32 vs.0.36 ± 0.17,P =0.0086） increased in the DBS group.Conclusions：This study demonstrated that chronic ANT stimulation could exert a neuroprotective effect on hippocampal neurons.This neuroprotective effect is likely to

关键词： Anterior Thalamic Nuclei Apoptosis Deep Brain Stimulation Epilepsy Hippocampus

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Techniquesof frameless robot-assisted deep brain stimulation and accuracy compared with the frame-based technique

Techniquesof frameless robot-assisted deep brain stimulation...

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第十六届中国医师协会神经外科医师年会

作者： Kaijia Yu Zhiwei Ren Yongsheng Hu Song Guo Yongjie Li Jianyu Li Beijing Institute of Functional Neurosurgery Xuanwu Hospital of Capital Medical University

Background:The frameless robot-assisted deep brain stimulation(DBS) is an innovative technique for leads implantation.This study aimedto evaluate the accuracy and precision of this technique using the Sinovation SR1 robot.Methods:35 patients with Parkinson’s disease who accepted conventional frame-based DBS surgery(n=18) and frameless robot-assisted DBS surgery(n=17) bya same group of neurosurgeons were analyzed.The coordinate of the tip of the intended trajectory was recorded asxi,yi,and zi.The actual position of lead implantation was recorded as xa,ya,and za.The vector error was calculated bythe formula of √(xi-xa)2+(yi-ya)2+(zi-za)2to evaluate the accuracy.Results:The vector error was 1.52 ± 0.53 mm(range:0.20-2.39 mm) in the robot-assisted group and was 1.77 ± 0.67 mm(0.59-2.98 mm) in the frame-based group with no significant difference between two groups(p=0.3357).In 10.7%(n=3) frameless robot-assisted implanted leads,vector error was greater than 2.00 mm with a maximum offset of 2.39 mm,and in 35.5%(n=11) frame-based implanted leads,vector error was larger than 2.00 mm with a maximum offset of 2.98 mm.Leads were more posterior than planned trajectories in the robot-assisted group and more medial and posterior in the conventional frame-based group.Conclusions:The awake frameless robot-assisted DBS surgery was comparable to the conventional frame-based technique in the accuracy and precision for leads implantation.

关键词： frameless robot-assisted surgery frame deep brain stimulation accuracy Parkinson’s disease

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Dorsal root entry zone coagulation for treatment of deafferentation pain syndromes

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Chinese Medical Journal 2008年第12期121卷 1089-1092页

作者： ZHANG Xiao-hua LI Yong-jie HU Yong-sheng TAO Wei ZHENG Zhe Beijing Institute of Functional Neurosurgery Xuanwu Hospital Capital Medical University Beijing 100053 China

Background Deafferentation pain is a kind of chronic pain syndrome and hard to manipulate. To evaluate the effectiveness and safety of junctional dorsal root entry zone （DREZ） coagulation, 23 consecutive patients with intractable deafferentation pain syndrome were studied.Methods Twenty-three patients underwent junctional DREZ coagulation （C5-T1 for upper extremities and L2-S1 for lower extremities） under general anesthesia. The pain severity was evaluated by the short McGill pain questionnaire （MPQ） and the visual analog scale （VAS）, and the depression and anxiety of patients were assessed by Hamilton rating scale for depression （HRSD）, Hamilton anxiety scale （HAMA）, self-rating anxiety scale （SAS） and self-rating depression scale （SDS）.Results All the patients experienced significant pain reduction immediately after surgery. The scales of short MPQ and VAS at pre-operation, 6-month and 12-month follow-up were 31.5±3.4 and 8.8±1.5, 6.5±1.9 and 2.5±2.2, 7.1±2.1 and 2.9±1.9, respectively. The postoperative scores comparing to pre-operative scores showed a statistically significant difference （P 〈0.01）. The depression and anxiety state was also significantly relieved. At 12-month follow-up 6 patients had complete pain relief, 11 had excellent results with more than 75% pain relief, 17 had good results with more than 50% pain relief （73.9%）. The main postoperative complications were transient slight hemiplegia （8）, hypesthesia and paresthesia （15）, a bearing down feeling of affected extremity （6）, and deep sensory disability in the lower limbs （4） on the operated side. Because of the long time and prone position of the operation, 13 cases had a transient hyperalgesia in the upper chest. Conclusion DREZ coagulation is a safe and effective procedure in the treatment of deafferentation pain syndromes.

关键词： deafferentation pain dorsal roat entry zone coagulation

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