阳极和对称双相脉冲可扩大用于特发性震颤的深部脑刺激的治疗窗口。
Anodic and symmetric biphasic pulses enlarge the therapeutic window in deep brain stimulation for essential tremor.
作者信息
Boogers Alexandra, Peeters Jana, Van Bogaert Tine, Asamoah Boateng, De Vloo Philippe, Vandenberghe Wim, Nuttin Bart, Mc Laughlin Myles
机构信息
Experimental ORL, Department of Neurosciences, The Leuven Brain Institute, KU Leuven, Herestraat 49, 3000, Leuven, Belgium; Department of Neurology, UZ Leuven, Herestraat 49, 3000, Leuven, Belgium.
Experimental ORL, Department of Neurosciences, The Leuven Brain Institute, KU Leuven, Herestraat 49, 3000, Leuven, Belgium.
出版信息
Brain Stimul. 2022 Mar-Apr;15(2):286-290. doi: 10.1016/j.brs.2022.01.012. Epub 2022 Jan 29.
BACKGROUND
Since the inception of DBS, cathodic pulses have been used.
OBJECTIVE
To investigate the effect of anodic and symmetric biphasic pulses on the therapeutic window (TW) in essential tremor (ET) patients.
METHODS
A randomized, doubled-blinded, cross-over design was used to test the effect of cathodic, anodic and symmetric biphasic pulses (cathode-first and anode-first) on the TW in an acute clinical setting. TW was defined as the difference between the minimal stimulation amplitude provoking side effects and minimal stimulation amplitude inducing tremor arrest.
RESULTS
9 ET patients (10 hemispheres) were included. Anodic stimulation induced a significantly larger TW compared to cathodic stimulation (p = 0.008). Symmetric biphasic stimulation also widened the TW compared to cathodic stimulation for both cathode- (p = 0.047) and anode-first (p = 0.008) biphasic pulses. For both anodic and biphasic pulses, the effect on TW was mainly driven by the change in side effect threshold. The order of the phases in the biphasic pulse had a significant effect on the side effect threshold (p = 0.039), with biphasic-anode first having the highest value. All pulse shapes were safe in the acute setting.
CONCLUSION
Anodic and symmetric biphasic pulses increase TW in ET patients.
背景
自深部脑刺激（DBS）开始应用以来，一直使用阴极脉冲。
目的
研究阳极和对称双相脉冲对特发性震颤（ET）患者治疗窗（TW）的影响。
方法
采用随机、双盲、交叉设计，在急性临床环境中测试阴极、阳极和对称双相脉冲（阴极先于阳极和阳极先于阴极）对TW的影响。TW定义为引发副作用的最小刺激幅度与诱发震颤停止的最小刺激幅度之间的差值。
结果
纳入9例ET患者（10个半球）。与阴极刺激相比，阳极刺激诱导出显著更大的TW（p = 0.008）。对于阴极先于阳极（p = 0.047）和阳极先于阴极（p = 0.008）的双相脉冲，对称双相刺激与阴极刺激相比也拓宽了TW。对于阳极和双相脉冲，对TW的影响主要由副作用阈值的变化驱动。双相脉冲中的相位顺序对副作用阈值有显著影响（p = 0.039），阳极先于阴极的双相脉冲副作用阈值最高。在急性环境中，所有脉冲形状都是安全的。
结论
阳极和对称双相脉冲可增加ET患者的TW。
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