帕金森病患者的双阈值神经闭环深部脑刺激。

Dual threshold neural closed loop deep brain stimulation in Parkinson disease patients.

机构信息

Department of Neurology and Neurological Sciences, School of Medicine, Stanford University, Stanford, CA, USA.

Department of Neurology and Neurological Sciences, School of Medicine, Stanford University, Stanford, CA, USA; Department of Neurosurgery, School of Medicine, Stanford University, Stanford, CA, USA.

出版信息

Brain Stimul. 2019 Jul-Aug;12(4):868-876. doi: 10.1016/j.brs.2019.02.020. Epub 2019 Feb 25.

DOI:10.1016/j.brs.2019.02.020

PMID:30833216

Abstract

BACKGROUND

Closed loop deep brain stimulation (clDBS) in Parkinson's disease (PD) using subthalamic (STN) neural feedback has been shown to be efficacious only in the acute post-operative setting, using externalized leads and stimulators.

OBJECTIVE

To determine feasibility of neural (N)clDBS using the clinical implanted neurostimulator (Activa™ PC + S, FDA IDE approved) and a novel beta dual threshold algorithm in tremor and bradykinesia dominant PD patients on chronic DBS.

METHODS

13 PD subjects (20 STNs), on open loop (ol)DBS for 22 ± 7.8 months, consented to NclDBS driven by beta (13-30 Hz) power using a dual threshold algorithm, based on patient specific therapeutic voltage windows. Tremor was assessed continuously, and bradykinesia was evaluated after 20 min of NclDBS using a repetitive wrist flexion-extension task (rWFE). Total electrical energy delivered (TEED) on NclDBS was compared to olDBS using the same active electrode.

RESULTS

NclDBS was tolerated for 21.67 [21.10-26.15] minutes; no subject stopped early. Resting beta band power was measurable and similar between tremor and bradykinesia dominant patients. NclDBS improved bradykinesia and tremor while delivering only 56.86% of the TEED of olDBS; rWFE velocity (p = 0.003) and frequency (p < 0.001) increased; tremor was below 0.15 rad/sec for 95.4% of the trial and averaged 0.26 rad/sec when present.

CONCLUSION

This is the first study to demonstrate that STN NclDBS is feasible, efficacious and more efficient than olDBS in tremor and bradykinesia dominant PD patients, on long-term DBS, using an implanted clinical neurostimulator and driven by beta power with a novel dual threshold algorithm, based on customized therapeutic voltage windows.

摘要

背景

使用外部化导联和刺激器，在亚丘脑（STN）神经反馈的闭环深部脑刺激（clDBS）在帕金森病（PD）中的应用仅在急性术后环境中显示出有效。

目的

使用临床植入神经刺激器（Activa™ PC+S，FDA IDE 批准）和新型β双阈值算法，确定在慢性 DBS 中震颤和运动迟缓为主的 PD 患者中进行神经（N）clDBS 的可行性。

方法

13 名 PD 患者（20 个 STN），使用开环（ol）DBS 治疗 22±7.8 个月，同意使用基于患者特定治疗电压窗的β（13-30 Hz）功率双阈值算法进行 NclDBS。连续评估震颤，使用重复腕部屈伸任务（rWFE）在 NclDBS 后 20 分钟评估运动迟缓。使用相同的有源电极比较 NclDBS 和 olDBS 的总电能输送（TEED）。

结果

NclDBS 耐受时间为 21.67 [21.10-26.15] 分钟；没有患者提前停止。震颤和运动迟缓为主的患者之间可测量到静息β频带功率且相似。NclDBS 在仅输送 olDBS 的 TEED 的 56.86%时改善了运动迟缓并减轻了震颤；rWFE 速度（p=0.003）和频率（p<0.001）增加；震颤在试验的 95.4%时间内低于 0.15 弧度/秒，当存在时平均为 0.26 弧度/秒。