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利用多单位活动定位帕金森病的丘脑底核。

Localization of the subthalamic nucleus in Parkinson disease using multiunit activity.

机构信息

Dept. of Neurology, University of Massachusetts Medical School, MA 01655, USA.

出版信息

J Neurol Sci. 2011 Nov 15;310(1-2):44-9. doi: 10.1016/j.jns.2011.07.027.

DOI:10.1016/j.jns.2011.07.027
PMID:21855895
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3195940/
Abstract

BACKGROUND

Refinement of the subthalamic nucleus (STN) coordinates using intraoperative microelectrode recordings (MER) is routinely performed during deep brain stimulation (DBS) surgeries in Parkinson disease (PD). The commonly used criteria for electrophysiological localization of the STN are qualitative. The goal of this study was to validate quantitative STN detection algorithm (QD) derived from the multi-unit activity in a prospective setting.

METHODS

Ten PD patients underwent STN DBS surgery. The MUA was obtained by removing large spikes close to microelectrode using wavelet method and integrating the 500-2000Hz band in the power spectral density. The qualitative intraoperative mapping of the STN using MER (IOM) versus QD was compared using Bland-Altman and Pearson's correlation analysis.

RESULTS

The clinical efficacy was confirmed in all subjects. The mean difference between IOM and QD of the dorsal/ventral border was 0.31±0.84/0.44±0.47mm. Using Bland-Altman statistic, only 2/36 (5.6%) differences (one for the dorsal border and one for the ventral border) were out of ±2 sd line of measurement differences. Correlation between dorsal border/ventral border positions obtained by IOM and QD was 0.79, p<0.0001/0.91, p<0.0001.

CONCLUSION

Both methods are in reasonable agreement and are strongly correlated. The QD gives objective coordinates of the STN borders at high precision and may be more accurate than IOM. Prospective blinded comparative studies where the DBS leads will be placed using either QD or IOM are warranted.

摘要

背景

在帕金森病（PD）的深部脑刺激（DBS）手术中，通常使用术中微电极记录（MER）对丘脑底核（STN）坐标进行精细化处理。STN 电生理定位的常用标准是定性的。本研究的目的是在前瞻性设置中验证源自多单位活动的定量 STN 检测算法（QD）。

方法

10 例 PD 患者接受 STN-DBS 手术。使用小波方法去除靠近微电极的大尖峰，并在功率谱密度中整合 500-2000Hz 频段，获得多单位活动。使用 Bland-Altman 和 Pearson 相关分析比较 MER （IOM）与 QD 对 STN 的术中定性定位。

结果

所有患者的临床疗效均得到确认。IOM 与 QD 的背/腹边界平均差值为 0.31±0.84/0.44±0.47mm。使用 Bland-Altman 统计，只有 2/36（5.6%）的差异（一个是背边界，一个是腹边界）超出了±2sd 测量差异线。IOM 和 QD 获得的背侧边界/腹侧边界位置之间的相关性分别为 0.79，p<0.0001/0.91，p<0.0001。

结论

两种方法具有较好的一致性且相关性较强。QD 以高精度给出 STN 边界的客观坐标，可能比 IOM 更准确。需要进行前瞻性、盲法比较研究，使用 QD 或 IOM 放置 DBS 导联。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/65d0/3195940/58640e26cd32/nihms315602f8.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/65d0/3195940/58640e26cd32/nihms315602f8.jpg
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