Tinkhauser Gerd, Pogosyan Alek, Little Simon, Beudel Martijn, Herz Damian M, Tan Huiling, Brown Peter
Medical Research Council Brain Network Dynamics Unit at the University of Oxford, Oxford, UK.
Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK.
Brain. 2017 Apr 1;140(4):1053-1067. doi: 10.1093/brain/awx010.
Adaptive deep brain stimulation uses feedback about the state of neural circuits to control stimulation rather than delivering fixed stimulation all the time, as currently performed. In patients with Parkinson's disease, elevations in beta activity (13-35 Hz) in the subthalamic nucleus have been demonstrated to correlate with clinical impairment and have provided the basis for feedback control in trials of adaptive deep brain stimulation. These pilot studies have suggested that adaptive deep brain stimulation may potentially be more effective, efficient and selective than conventional deep brain stimulation, implying mechanistic differences between the two approaches. Here we test the hypothesis that such differences arise through differential effects on the temporal dynamics of beta activity. The latter is not constantly increased in Parkinson's disease, but comes in bursts of different durations and amplitudes. We demonstrate that the amplitude of beta activity in the subthalamic nucleus increases in proportion to burst duration, consistent with progressively increasing synchronization. Effective adaptive deep brain stimulation truncated long beta bursts shifting the distribution of burst duration away from long duration with large amplitude towards short duration, lower amplitude bursts. Critically, bursts with shorter duration are negatively and bursts with longer duration positively correlated with the motor impairment off stimulation. Conventional deep brain stimulation did not change the distribution of burst durations. Although both adaptive and conventional deep brain stimulation suppressed mean beta activity amplitude compared to the unstimulated state, this was achieved by a selective effect on burst duration during adaptive deep brain stimulation, whereas conventional deep brain stimulation globally suppressed beta activity. We posit that the relatively selective effect of adaptive deep brain stimulation provides a rationale for why this approach could be more efficacious than conventional continuous deep brain stimulation in the treatment of Parkinson's disease, and helps inform how adaptive deep brain stimulation might best be delivered.
适应性深部脑刺激利用关于神经回路状态的反馈来控制刺激，而不是像目前这样一直进行固定刺激。在帕金森病患者中，已证明丘脑底核中β活动（13 - 35赫兹）的升高与临床损伤相关，并为适应性深部脑刺激试验中的反馈控制提供了基础。这些初步研究表明，适应性深部脑刺激可能比传统深部脑刺激更有效、更高效且更具选择性，这意味着两种方法在机制上存在差异。在这里，我们检验这样一种假设，即这种差异是通过对β活动的时间动态产生不同影响而出现的。在帕金森病中，β活动并非持续增加，而是以不同持续时间和幅度的爆发形式出现。我们证明，丘脑底核中β活动的幅度与爆发持续时间成正比增加，这与同步性逐渐增加一致。有效的适应性深部脑刺激截断了长时间的β爆发，使爆发持续时间的分布从长时间、大幅度向短时间、低幅度爆发转变。至关重要的是，持续时间较短的爆发与刺激关闭时的运动损伤呈负相关，而持续时间较长的爆发与运动损伤呈正相关。传统深部脑刺激并未改变爆发持续时间的分布。尽管与未刺激状态相比，适应性和传统深部脑刺激都抑制了平均β活动幅度，但这在适应性深部脑刺激中是通过对爆发持续时间的选择性作用实现的，而传统深部脑刺激则是全局抑制β活动。我们认为，适应性深部脑刺激的相对选择性作用为这种方法在治疗帕金森病方面比传统持续深部脑刺激更有效的原因提供了理论依据，并有助于说明如何最好地实施适应性深部脑刺激。
Zotero 插件
