Department of Neurosurgery, University Medical Centre Groningen, the Netherlands; Medical Research Council Brain Network Dynamics Unit at the University of Oxford, United Kingdom; Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom; Department of Neurology, Amsterdam Neuroscience Institute, Amsterdam University Medical Center, Amsterdam, The Netherlans.
Department of Neurosurgery, University Medical Centre Groningen, the Netherlands.
Brain Stimul. 2020 Nov-Dec;13(6):1507-1516. doi: 10.1016/j.brs.2020.07.016. Epub 2020 Jul 29.
Beta-based adaptive Deep Brain Stimulation (aDBS) is effective in Parkinson's disease (PD), when assessed in the immediate post-implantation phase. However, the potential benefits of aDBS in patients with electrodes chronically implanted, in whom changes due to the microlesion effect have disappeared, are yet to be assessed.
To determine the acute effectiveness and side-effect profile of aDBS in PD compared to conventional continuous DBS (cDBS) and no stimulation (NoStim), years after DBS implantation, 13 PD patients undergoing battery replacement were pseudo-randomised in a crossover fashion, into three conditions (NoStim, aDBS or cDBS), with a 2-min interval between them. Patient videos were blindly evaluated using a short version of the Unified Parkinson's Disease Rating Scale (subUPDRS), and the Speech Intelligibility Test (SIT).
Mean disease duration was 16 years, and the mean time since DBS-implantation was 6.9 years. subUPDRS scores (11 patients tested) were significantly lower both in aDBS (p=<.001), and cDBS (p = .001), when compared to NoStim. Bradykinesia subscores were significantly lower in aDBS (p = .002), and did not achieve significance during cDBS (p = .08), when compared to NoStim. Two patients demonstrated re-emerging tremor during aDBS. SIT scores of patients who presented stimulation-induced dysarthria significantly worsened in cDBS (p = .009), but not in aDBS (p = .407), when compared to NoStim. Overall, stimulation was applied 48.8% of the time during aDBS.
Beta-based aDBS is effective in PD patients with bradykinetic phenotypes, delivers less stimulation than cDBS, and potentially has a more favourable speech side-effect profile. Patients with prominent tremor may require a modified adaptive strategy.
基于贝塔的适应性脑深部刺激（aDBS）在帕金森病（PD）患者中具有即时植入后评估的有效性。然而，在电极长期植入的患者中，由于微损伤效应的变化已经消失，aDBS 的潜在益处尚未得到评估。
为了确定在 DBS 植入多年后，与传统的连续 DBS（cDBS）和无刺激（NoStim）相比，aDBS 在 PD 患者中的急性有效性和副作用特征，13 名接受电池更换的 PD 患者以交叉方式进行了伪随机分组，分为三组（NoStim、aDBS 或 cDBS），每组之间有 2 分钟的间隔。患者视频使用简短版的统一帕金森病评定量表（subUPDRS）和语音清晰度测试（SIT）进行盲法评估。
平均疾病持续时间为 16 年，DBS 植入后平均时间为 6.9 年。11 名患者测试的 subUPDRS 评分在 aDBS（p<0.001）和 cDBS（p=0.001）时均显著低于 NoStim。在 aDBS（p=0.002）时，运动迟缓亚评分显著降低，在 cDBS 时未达到显著水平（p=0.08），与 NoStim 相比。两名患者在 aDBS 时出现震颤再出现。刺激诱导的构音障碍患者的 SIT 评分在 cDBS 时显著恶化（p=0.009），但在 aDBS 时无显著变化（p=0.407），与 NoStim 相比。总体而言，在 aDBS 期间，刺激应用时间为 48.8%。
基于贝塔的 aDBS 对具有运动迟缓表型的 PD 患者有效，刺激量低于 cDBS，并且可能具有更有利的言语副作用特征。具有明显震颤的患者可能需要修改适应性策略。
