Buijink A W G, Piña-Fuentes D A, Stam M J, Bot M, Schuurman P R, van den Munckhof P, van Rootselaar A F, de Bie R M A, Beudel M
Department of Neurology, Amsterdam University Medical Centers, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, The Netherlands.
Department of Neurosurgery, Amsterdam University Medical Centers, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, The Netherlands.
Clin Neurophysiol Pract. 2022 Mar 10;7:103-106. doi: 10.1016/j.cnp.2022.03.002. eCollection 2022.
Essential tremor (ET) is one of the most common movement disorders, and continuous deep brain stimulation (DBS) is an established treatment for medication-refractory cases. However, the need for increasing stimulation intensities, with unpleasant side effects, and DBS tolerance over time can be problematic. The advent of novel DBS devices now provides the opportunity to longitudinally record LFPs using the implanted pulse generator, which opens up possibilities to implement adaptive DBS algorithms in a real-life setting.
Here we report a case of thalamic LFP activity recorded using a commercially available sensing-enabled DBS pulse generator (Medtronic Percept PC).
In the OFF-stimulation condition, a peak tremor frequency of 3.8 Hz was identified during tremor evoking movements as assessed by video and accelerometers. Activity at the same and supraharmonic frequency was seen in the frequency spectrum of the LFP data from the left vim nucleus during motor tasks. Coherence analysis showed that peripherally recorded tremor was coherent with the LFP signal at the tremor frequency and supraharmonic frequency.
This is the first report of recorded tremor-related thalamic activity using the electrodes and pulse generator of an implanted DBS system. Larger studies are needed to evaluate the clinical potential of these fully implantable systems, and ultimately pulse generators with sensing-coupled algorithms driving stimulation, to really close the loop.
特发性震颤（ET）是最常见的运动障碍之一，持续深部脑刺激（DBS）是治疗药物难治性病例的既定方法。然而，随着时间的推移，刺激强度不断增加、出现令人不适的副作用以及DBS耐受性可能会成为问题。新型DBS设备的出现现在提供了使用植入式脉冲发生器纵向记录局部场电位（LFP）的机会，这为在实际环境中实施自适应DBS算法开辟了可能性。
在此，我们报告一例使用市售具备传感功能的DBS脉冲发生器（美敦力Percept PC）记录丘脑LFP活动的病例。
在刺激关闭状态下，通过视频和加速度计评估，在诱发震颤的运动过程中确定峰值震颤频率为3.8赫兹。在运动任务期间，从左侧腹中间核的LFP数据频谱中观察到相同频率及超谐波频率的活动。相干分析表明，外周记录的震颤与震颤频率及超谐波频率下的LFP信号相干。
这是首次使用植入式DBS系统的电极和脉冲发生器记录与震颤相关的丘脑活动的报告。需要开展更大规模的研究来评估这些完全可植入系统的临床潜力，以及最终评估具有传感耦合算法驱动刺激功能的脉冲发生器，以真正实现闭环。
