Department of Neurology and Clinical Neurophysiology, Amsterdam University Medical, Centers, Amsterdam Neuroscience, University of Amsterdam, PO Box 22660, Amsterdam 1100DD, the Netherland.
Department of Neurology and Clinical Neurophysiology, Amsterdam University Medical, Centers, Amsterdam Neuroscience, University of Amsterdam, PO Box 22660, Amsterdam 1100DD, the Netherland.
Neuroimage. 2022 Jul 1;254:119147. doi: 10.1016/j.neuroimage.2022.119147. Epub 2022 Mar 27.
Subcortical structures are a relative neurophysiological 'terra incognita' owing to their location within the skull. While perioperative subcortical sensing has been performed for more than 20 years, the neurophysiology of the basal ganglia in the home setting has remained almost unexplored. However, with the recent advent of implantable pulse generators (IPG) that are able to record neural activity, the opportunity to chronically record local field potentials (LFPs) directly from electrodes implanted for deep brain stimulation opens up. This allows for a breakthrough of chronic subcortical sensing into fundamental research and clinical practice. In this review an extensive overview of the current state of subcortical sensing is provided. The widespread potential of chronic subcortical sensing for investigational and clinical use is discussed. Finally, status and future perspectives of the most promising application of chronic subcortical sensing -i.e., adaptive deep brain stimulation (aDBS)- are discussed in the context of movement disorders. The development of aDBS based on both chronic subcortical and cortical sensing has the potential to dramatically change clinical practice and the life of patients with movement disorders. However, several barriers still stand in the way of clinical implementation. Advancements regarding IPG and lead technology, physiomarkers, and aDBS algorithms as well as harnessing artificial intelligence, multimodality and sensing in the naturalistic setting are needed to bring aDBS to clinical practice.
皮质下结构由于位于颅骨内，因此是相对的神经生理学“未知领域”。虽然皮质下感觉已在围手术期进行了 20 多年，但基底神经节的家庭环境神经生理学仍几乎未被探索。然而，随着能够记录神经活动的可植入脉冲发生器（IPG）的出现，为深部脑刺激而植入的电极直接记录局部场电位（LFP）的机会出现了。这为慢性皮质下感觉进入基础研究和临床实践开辟了一条途径。在这篇综述中，提供了对皮质下感觉的当前状态的广泛概述。讨论了慢性皮质下感觉在研究和临床应用中的广泛潜力。最后，在运动障碍的背景下，讨论了慢性皮质下感觉的最有前途的应用——即适应性深部脑刺激（aDBS）——的现状和未来前景。基于慢性皮质下和皮质感觉的 aDBS 的发展有可能极大地改变运动障碍患者的临床实践和生活。然而，临床实施仍然存在一些障碍。需要在 IPG 和导联技术、生理标记物和 aDBS 算法方面取得进展，以及利用人工智能、多模态和自然环境中的感觉，才能将 aDBS 应用于临床实践。
