RESUMO
OBJECTIVE: Refractory Tourette syndrome (TS) disturbs the social life of patients. Deep brain stimulation (DBS) has recently been applied to relieve severe tics. We report a prospective open-labeled case series of DBS for TS as a pilot study. CASES AND METHODS: Three patients (19-21 years old, one male) with refractory TS were treated with DBS. They were targeted at the centromedian-parafascicular complex-ventral oral thalamic nuclei of the bilateral thalami. RESULTS: The scores for the Yale Global Tic Severity Scale decreased from 42.7 ± 2.7 (before DBS) to 26.0 ± 1.7 (one year after DBS) (means ± standard error of means). Intelligence levels of the patients showed no change after surgery. There was no morbidity or mortality. All patients presented an increase in satisfaction with activities of daily living. CONCLUSIONS: These results support the safety and efficacy of thalamic DBS for TS.
Assuntos
Estimulação Encefálica Profunda/métodos , Tálamo/fisiologia , Tiques/terapia , Síndrome de Tourette/terapia , Atividades Cotidianas , Feminino , Humanos , Japão , Imageamento por Ressonância Magnética , Masculino , Testes Neuropsicológicos , Projetos Piloto , Estudos Prospectivos , Tálamo/anatomia & histologia , Resultado do Tratamento , Adulto JovemRESUMO
A mismatch between auditory sensation and expectant imagery of syllables elicited a possible equivalent of mismatch negativity in a previous study. The purpose of this study was to verify whether auditory imagery from musical notation could also mediate such imagery-based mismatch negativity. Neuromagnetic recording was obtained from eight musicians, who were instructed to identify unpredictably occurring pitch mismatches between a random tone sequence and a visually presented musical score. The difference between incongruent and congruent responses showed a magnetic distribution consistent with two frontal-negative current dipoles bilaterally located in the vicinity of Heschl's gyrus, peaking at approximately 150 ms in latency. This imagery-based mismatch negativity may represent an early neural process of deviance detection between the sensory input and expectant imagery.
Assuntos
Córtex Auditivo/fisiologia , Percepção Auditiva/fisiologia , Mapeamento Encefálico , Potenciais Evocados Auditivos/fisiologia , Imaginação/fisiologia , Música , Estimulação Acústica/métodos , Adulto , Córtex Auditivo/efeitos da radiação , Percepção Auditiva/efeitos da radiação , Variação Contingente Negativa , Eletroculografia , Potenciais Evocados Auditivos/efeitos da radiação , Feminino , Humanos , Magnetoencefalografia/métodos , Masculino , Pessoa de Meia-Idade , Estimulação Luminosa/métodos , Tempo de Reação/fisiologia , Tempo de Reação/efeitos da radiaçãoRESUMO
During silent reading, visual information provided by letters is converted to auditory information in the mind. The purpose of this study was to identify the primary locus for auditory verbal imagery in the brain. Neuromagnetic recording was obtained from 10 right-handed study participants, who were instructed to identify infrequently occurring phonological mismatches between a random-ordered sequence of syllable sounds and a visually presented syllabogram sequence. The activity difference in early latency, calculated by subtracting the averaged responses to matched syllables from the averaged responses to mismatched syllables, showed a spatiotemporal profile strikingly similar to that of mismatch negativity. Auditory imagery of forthcoming verbal sounds may establish a memory trace as a template for imagery-based mismatch negativity generation in the auditory cortex.