Phibbs Fenna T, Pallavaram Srivatsan, Tolleson Christopher, D'Haese Pierre-François, Dawant Benoit M
Dept. of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA.
Dept. of Electrical Eng. & Computer Science, Vanderbilt University, Nashville, TN, USA.
Parkinsonism Relat Disord. 2014 Dec;20(12):1341-4. doi: 10.1016/j.parkreldis.2014.09.004. Epub 2014 Sep 16.
Post-operative programming of deep brain stimulation for movement disorders can be both time consuming and difficult, which can delay the optimal symptom control for the patient. Probabilistic maps of stimulation response could improve programming efficiency and optimization.
The clinically selected contacts of patients who had undergone ventral intermediate nucleus deep brain stimulation for the treatment of essential tremor at our institution were compared against contacts selected based on a probability map of symptom reduction built by populating data from a number of patients using non-rigid image registration. A subgroup of patients whose clinical contacts did not match the map-based selections prospectively underwent a tremor rating scale evaluation to compare the symptom relief achieved by the two options. Both the patient and video reviewer were blinded to the selection.
54% of the map-based and clinical contacts were an exact match retrospectively and were within one contact 83% of the time. In 5 of the 8 mismatched leads that were evaluated prospectively in a double blind fashion, the map-based contact showed equivalent or better tremor improvement than the clinically active contact.
This study suggests that probability maps of stimulation responses can assist in selecting the clinically optimal contact and increase the efficiency of programming.
用于运动障碍的脑深部电刺激术后程控既耗时又困难，这可能会延迟患者获得最佳症状控制。刺激反应概率图可提高程控效率和优化程度。
将我院因治疗特发性震颤而接受腹中间核脑深部电刺激患者的临床选定触点，与基于通过使用非刚性图像配准填充多名患者数据构建的症状减轻概率图所选定的触点进行比较。临床触点与基于图谱选择不匹配的患者亚组前瞻性地接受震颤评分量表评估，以比较两种选择所实现的症状缓解情况。患者和视频评估者均对选择情况不知情。
回顾性分析显示，基于图谱和临床选定的触点有54%完全匹配，83%的情况下相差不超过一个触点。在以双盲方式前瞻性评估的8个不匹配导联中的5个中，基于图谱的触点显示出与临床激活触点相当或更好的震颤改善效果。
本研究表明，刺激反应概率图有助于选择临床最佳触点并提高程控效率。
