Wagle Shukla Aparna, Zeilman Pam, Fernandez Hubert, Bajwa Jawad A, Mehanna Raja
Center for Movement Disorders and Neurorestoration, Department of Neurology, University of Florida, Gainesville, FL, USA.
Center for Neurological Restoration, Cleveland Clinic, Cleveland, OH, USA.
Parkinsons Dis. 2017;2017:8492619. doi: 10.1155/2017/8492619. Epub 2017 Sep 24.
Deep brain stimulation (DBS) surgery is a well-established therapy for control of motor symptoms in Parkinson's disease. Despite an appropriate targeting and an accurate placement of DBS lead, a thorough and efficient programming is critical for a successful clinical outcome. DBS programming is a time consuming and laborious manual process. The current approach involves use of general guidelines involving determination of the lead type, electrode configuration, impedance check, and battery check. However there are no validated and well-established programming protocols. In this review, we will discuss the current practice and the recent advances in DBS programming including the use of interleaving, fractionated current, directional steering of current, and the use of novel DBS pulses. These technological improvements are focused on achieving a more efficient control of clinical symptoms with the least possible side effects. Other promising advances include the introduction of computer guided programming which will likely impact the efficiency of programming for the clinicians and the possibility of remote Internet based programming which will improve access to DBS care for the patients.
脑深部电刺激（DBS）手术是控制帕金森病运动症状的一种成熟疗法。尽管DBS电极的靶向定位恰当且放置准确，但全面且有效的程控对于取得成功的临床效果至关重要。DBS程控是一个耗时费力的手工过程。目前的方法包括遵循一般指南，涉及确定电极类型、电极配置、阻抗检查和电池检查。然而，尚无经过验证且成熟的程控方案。在本综述中，我们将讨论DBS程控的当前实践和最新进展，包括交错刺激、分段电流、电流方向控制以及新型DBS脉冲的应用。这些技术改进旨在以尽可能少的副作用更有效地控制临床症状。其他有前景的进展包括引入计算机引导的程控，这可能会提高临床医生的程控效率，以及基于互联网的远程程控的可能性，这将改善患者获得DBS治疗的机会。
