Montreal Neurological Institute, Department of Neurology & Neurosurgery, McGill University, 3801 University Street, Montreal, QC, Canada H3A 2B4.
Exp Neurol. 2013 Mar;241:179-83. doi: 10.1016/j.expneurol.2013.01.002. Epub 2013 Jan 9.
Deep brain stimulation (DBS) is a promising tool for treating drug-resistant epileptic patients. Currently, the most common approach is fixed-frequency stimulation (periodic pacing) by means of stimulating devices that operate under open-loop control. However, a drawback of this DBS strategy is the impossibility of tailoring a personalized treatment, which also limits the optimization of the stimulating apparatus. Here, we propose a novel DBS methodology based on a closed-loop control strategy, developed by exploiting statistical machine learning techniques, in which stimulation parameters are adapted to the current neural activity thus allowing for seizure suppression that is fine-tuned on the individual scale (adaptive stimulation). By means of field potential recording from adult rat hippocampus-entorhinal cortex (EC) slices treated with the convulsant drug 4-aminopyridine we determined the effectiveness of this approach compared to low-frequency periodic pacing, and found that the closed-loop stimulation strategy: (i) has similar efficacy as low-frequency periodic pacing in suppressing ictal-like events but (ii) is more efficient than periodic pacing in that it requires less electrical pulses. We also provide evidence that the closed-loop stimulation strategy can alternatively be employed to tune the frequency of a periodic pacing strategy. Our findings indicate that the adaptive stimulation strategy may represent a novel, promising approach to DBS for individually-tailored epilepsy treatment.
深部脑刺激（DBS）是治疗耐药性癫痫患者的一种很有前途的工具。目前，最常见的方法是通过使用开环控制的刺激设备进行固定频率刺激（周期性起搏）。然而，这种 DBS 策略的一个缺点是不可能进行个性化治疗，这也限制了刺激设备的优化。在这里，我们提出了一种基于闭环控制策略的新型 DBS 方法，该方法利用统计机器学习技术开发，其中刺激参数适应当前的神经活动，从而允许在个体尺度上进行精细调整的癫痫抑制（自适应刺激）。通过记录用致惊厥药物 4-氨基吡啶处理的成年大鼠海马-内嗅皮层（EC）切片中的场电位，我们确定了与低频周期性起搏相比，这种方法的有效性，并发现闭环刺激策略：（i）在抑制癫痫样事件方面与低频周期性起搏具有相似的疗效，但（ii）比周期性起搏更有效，因为它需要的电脉冲更少。我们还提供了证据表明，闭环刺激策略可以替代周期性起搏策略来调整其频率。我们的研究结果表明，自适应刺激策略可能代表一种新的、有前途的 DBS 方法，用于针对个体的癫痫治疗。
