低频震荡抑制在肌张力障碍中的作用：对自适应脑深部刺激的启示。
Low-frequency oscillation suppression in dystonia: Implications for adaptive deep brain stimulation.
机构信息
University of Groningen, University Medical Center Groningen, Department of Neurosurgery, Groningen, the Netherlands; Expertise Center Movement Disorders Groningen, University of Groningen, University Medical Center Groningen, Department of Neurology, Groningen, the Netherlands; Amsterdam UMC, University of Amsterdam, Department of Neurology, Amsterdam Neuroscience, Meibergdreef 9, Amsterdam, the Netherlands.
Expertise Center Movement Disorders Groningen, University of Groningen, University Medical Center Groningen, Department of Neurology, Groningen, the Netherlands; Amsterdam UMC, University of Amsterdam, Department of Neurology, Amsterdam Neuroscience, Meibergdreef 9, Amsterdam, the Netherlands.
出版信息
Parkinsonism Relat Disord. 2020 Oct;79:105-109. doi: 10.1016/j.parkreldis.2020.08.030. Epub 2020 Aug 23.
BACKGROUND
Low-frequency oscillations (LFO) detected in the internal globus pallidus of dystonia patients have been identified as a physiomarker for adaptive Deep Brain Stimulation (aDBS), since LFO correlate with dystonic symptoms and are rapidly suppressed by continuous DBS (cDBS). However, it is as yet unclear how LFO should be incorporated as feedback for aDBS.
OBJECTIVES
to test the acute effects of aDBS, using the amplitude of short-lived LFO-bursts to titrate stimulation, to explore the immediate effects of cDBS on LFO-modulation and dystonic symptoms, and to investigate whether a difference in the resting-state LFO is present between DBS-naïve patients and patients with chronic DBS.
METHODS
seven patients were assessed during either DBS-implantation (n = 2) or battery replacement surgery (n = 5), and pseudorandomized in three conditions: no stimulation, cDBS, and aDBS. Additionally, resting-state LFP-recordings from patients undergoing battery replacement were compared to those obtained during DBS-implantation; LFP-recordings from a previous cohort of six dystonia patients undergoing DBS-implantation were incorporated into this analysis (total n = 8 newly implanted patients).
RESULTS
we corroborated that a mild LFO-suppression rapidly occurs during cDBS. However, no acute changes in clinical symptoms were observed after cDBS or aDBS. Remarkably, we observed that resting-state LFO were significantly lower in patients who had been effectively treated with chronic cDBS compared to those of newly implanted patients, even when stimulation was suspended.
CONCLUSIONS
our results indicate that LFO-suppression in dystonia, similar to symptom response to cDBS, might be gradual, and remain after stimulation is suspended. Therefore, tracking gradual changes in LFO may be required for aDBS implementation.
背景
在肌张力障碍患者的内苍白球中检测到的低频振荡（LFO）已被确定为适应性脑深部刺激（aDBS）的生理标志物，因为 LFO 与肌张力障碍症状相关，并可被连续脑深部刺激（cDBS）快速抑制。然而，目前尚不清楚如何将 LFO 作为 aDBS 的反馈纳入。
目的
使用短暂 LFO 爆发的幅度来滴定刺激，测试 aDBS 的急性效应，探索 cDBS 对 LFO 调制和肌张力障碍症状的即时影响，并研究 DBS 初治患者和慢性 DBS 患者之间是否存在静息状态 LFO 的差异。
方法
在 DBS 植入术（n=2）或电池更换手术期间（n=5），对 7 名患者进行评估，并随机分为三种情况：无刺激、cDBS 和 aDBS。此外，还比较了接受电池更换手术的患者的静息状态 LFP 记录与 DBS 植入术期间获得的记录；将之前接受 DBS 植入术的 6 名肌张力障碍患者的 LFP 记录纳入本分析（总共 8 名新植入患者）。
结果
我们证实，cDBS 期间会迅速出现轻微的 LFO 抑制。然而，cDBS 或 aDBS 后没有观察到临床症状的急性变化。值得注意的是，我们观察到与新植入患者相比，那些接受慢性 cDBS 有效治疗的患者的静息状态 LFO 明显较低，即使在刺激暂停时也是如此。
结论
我们的结果表明，与 cDBS 对症状的反应相似，肌张力障碍患者的 LFO 抑制可能是逐渐的，并在刺激停止后仍然存在。因此，对于 aDBS 的实施，可能需要跟踪 LFO 的逐渐变化。
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