Swan Brandon D, Brocker David T, Hilliard Justin D, Tatter Stephen B, Gross Robert E, Turner Dennis A, Grill Warren M
Department of Biomedical Engineering, Duke University, Durham, NC, USA.
Department of Neurosurgery, Wake Forest University Baptist Medical Center, Winston-Salem, NC, USA.
Clin Neurophysiol. 2016 Feb;127(2):1551-1559. doi: 10.1016/j.clinph.2015.07.034. Epub 2015 Aug 20.
We conducted intraoperative measurements of tremor during DBS containing short pauses (⩽50 ms) to determine if there is a minimum pause duration that preserves tremor suppression.
Nine subjects with ET and thalamic DBS participated during IPG replacement surgery. Patterns of DBS included regular 130 Hz stimulation interrupted by 0, 15, 25 or 50 ms pauses. The same patterns were applied to a model of the thalamic network to quantify effects of pauses on activity of model neurons.
All patterns of DBS decreased tremor relative to 'off'. Patterns with pauses generated less tremor reduction than regular high frequency DBS. The model revealed that rhythmic burst-driver inputs to thalamus were masked during DBS, but pauses in stimulation allowed propagation of bursting activity. The mean firing rate of bursting-type model neurons as well as the firing pattern entropy of model neurons were both strongly correlated with tremor power across stimulation conditions.
The temporal pattern of stimulation influences the efficacy of thalamic DBS. Pauses in stimulation resulted in decreased tremor suppression indicating that masking of pathological bursting is a mechanism of thalamic DBS for tremor.
Pauses in stimulation decreased the efficacy of open-loop DBS for suppression of tremor.
我们在包含短暂停顿(≤50毫秒)的脑深部电刺激(DBS)过程中进行了震颤的术中测量,以确定是否存在能保持震颤抑制的最短停顿持续时间。
9名患有特发性震颤(ET)且接受丘脑DBS治疗的受试者在植入式脉冲发生器(IPG)更换手术期间参与研究。DBS模式包括以0、15、25或50毫秒的停顿打断的130赫兹常规刺激。将相同模式应用于丘脑网络模型,以量化停顿对模型神经元活动的影响。
所有DBS模式相对于“关闭”状态均降低了震颤。有停顿的模式产生的震颤减轻程度低于常规高频DBS。该模型显示,在DBS期间,丘脑的节律性爆发驱动输入被掩盖,但刺激停顿允许爆发活动传播。在不同刺激条件下,爆发型模型神经元的平均放电率以及模型神经元的放电模式熵均与震颤功率密切相关。
刺激的时间模式会影响丘脑DBS的疗效。刺激停顿导致震颤抑制作用减弱,表明病理性爆发的掩盖是丘脑DBS治疗震颤的一种机制。
刺激停顿降低了开环DBS抑制震颤的疗效。