在丘脑底区域进行的八次圆柱形接触导联记录将β振荡源定位到丘脑底核背侧。
Eight cylindrical contact lead recordings in the subthalamic region localize beta oscillations source to the dorsal STN.
作者信息
Tamir Idit, Wang Doris, Chen Witney, Ostrem Jill L, Starr Philip A, de Hemptinne Coralie
机构信息
Philip Starr Laboratory, Department of Neurosurgery, University of California, San Francisco, California, USA.
Philip Starr Laboratory, Department of Neurosurgery, University of California, San Francisco, California, USA.
出版信息
Neurobiol Dis. 2020 Dec;146:105090. doi: 10.1016/j.nbd.2020.105090. Epub 2020 Sep 23.
BACKGROUND
In Parkinson's disease (PD) patients, the subthalamic nucleus (STN) has prominent oscillatory activity in the beta band, which may be related to the motor symptoms severity. Local field potential (LFP) studies using standard four-contact deep brain stimulation (DBS) leads indicate that the source of beta activity in the STN region is the dorsolateral segment of the nucleus. However, these leads have few contacts outside of the STN, making the source localization of beta activity around the STN region uncertain.
OBJECTIVE
This study aimed to investigate the electrophysiological characteristics of the STN and the surrounding area in PD to better locate the source of these oscillations and their clinical relevance.
METHODS
Eight PD patients were bilaterally implanted in the STN with the eight ring-contact DBS lead (Boston Scientific Corporation). LFPs were recorded intra-operatively from each DBS contact in the off medication state at rest. Each contact location was normalized relative to the STN borders based on microelectrode recordings. For each recording, power spectral density was computed, averaged over multiple frequency bands and phase reversal analysis was used to localize the source of oscillatory activity. Beta burst, high-frequency activity (HFA), and phase-amplitude coupling (PAC) were also computed. Neurophysiological signatures were correlated with hemibody symptoms severity and clinical outcomes.
RESULTS
Beta band power and phase reversal localized the beta oscillator to the dorsal STN and correlated with pre-operative off medication hemibody bradykinesia and rigidity score. The contact along the electrode with the largest beta oscillatory power co-localized with the independently chosen optimized contact used for long-term chronic DBS. Lastly, beta bursting, HFA, and Beta-HFA PAC co-localized with the beta oscillator at the dorsal STN, and Beta-HFA PAC correlated with DBS effect.
CONCLUSIONS
Our findings support the hypothesis that the primary source of beta oscillations is located in dorsal STN, and argue against the alternative hypothesis that beta activity in the STN region arises from volume conduction from other sources. We demonstrate intrinsic STN beta-HFA PAC as an independent marker of DBS effect.
背景
在帕金森病（PD）患者中，丘脑底核（STN）在β频段具有显著的振荡活动，这可能与运动症状的严重程度有关。使用标准四触点深部脑刺激（DBS）电极的局部场电位（LFP）研究表明，STN区域β活动的来源是该核的背外侧段。然而，这些电极在STN之外的触点很少，使得STN区域周围β活动的来源定位不确定。
目的
本研究旨在调查PD患者中STN及其周围区域的电生理特征，以更好地定位这些振荡的来源及其临床相关性。
方法
8例PD患者双侧植入带有8个环形触点的DBS电极（波士顿科学公司）。在静息状态下，于术中在未用药状态下从每个DBS触点记录LFP。根据微电极记录，将每个触点位置相对于STN边界进行归一化。对于每次记录，计算功率谱密度，在多个频段上进行平均，并使用相位反转分析来定位振荡活动的来源。还计算了β爆发、高频活动（HFA）和相位-幅度耦合（PAC）。神经生理特征与半身症状严重程度和临床结果相关。
结果
β频段功率和相位反转将β振荡器定位到STN背侧，并与术前未用药时的半身运动迟缓及强直评分相关。沿电极具有最大β振荡功率的触点与用于长期慢性DBS的独立选择的优化触点共定位。最后，β爆发、HFA和β-HFA PAC在STN背侧与β振荡器共定位，且β-HFA PAC与DBS效果相关。
结论
我们的研究结果支持β振荡的主要来源位于STN背侧的假说，并反对STN区域β活动源于其他来源的容积传导这一替代假说。我们证明了STN内在的β-HFA PAC是DBS效果的独立标志物。
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