Gülke Eileen, Juárez Paz León, Scholtes Heleen, Gerloff Christian, Kühn Andrea A, Pötter-Nerger Monika
Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Boston Scientific, Valencia, CA, Spain.
NPJ Parkinsons Dis. 2022 Oct 29;8(1):144. doi: 10.1038/s41531-022-00396-7.
Technological advances of Deep Brain Stimulation (DBS) within the subthalamic nucleus (STN) for Parkinson's disease (PD) provide increased programming options with higher programming burden. Reducing the effort of DBS optimization requires novel programming strategies. The objective of this study was to evaluate the feasibility of a semi-automatic algorithm-guided-programming (AgP) approach to obtain beneficial stimulation settings for PD patients with directional DBS systems. The AgP evaluates iteratively the weighted combination of sensor and clinician assessed responses of multiple PD symptoms to suggested DBS settings until it converges to a final solution. Acute clinical effectiveness of AgP DBS settings and DBS settings that were found following a standard of care (SoC) procedure were compared in a randomized, crossover and double-blind fashion in 10 PD subjects from a single center. Compared to therapy absence, AgP and SoC DBS settings significantly improved (p = 0.002) total Unified Parkinson's Disease Rating Scale III scores (median 69.8 interquartile range (IQR) 64.6|71.9% and 66.2 IQR 58.1|68.2%, respectively). Despite their similar clinical results, AgP and SoC DBS settings differed substantially. Per subject, AgP tested 37.0 IQR 34.0|37 settings before convergence, resulting in 1.7 IQR 1.6|2.0 h, which is comparable to previous reports. Although AgP long-term clinical results still need to be investigated, this approach constitutes an alternative for DBS programming and represents an important step for future closed-loop DBS optimization systems.
用于帕金森病（PD）的丘脑底核（STN）深部脑刺激（DBS）技术的进步提供了更多的程控选项，但同时也带来了更高的程控负担。减少DBS优化的工作量需要新颖的程控策略。本研究的目的是评估一种半自动算法引导程控（AgP）方法的可行性，以获得适用于使用定向DBS系统的PD患者的有益刺激设置。AgP会迭代评估传感器和临床医生评估的多种PD症状对建议的DBS设置的反应的加权组合，直到收敛到最终解决方案。在来自单一中心的10名PD受试者中，以随机、交叉和双盲方式比较了AgP DBS设置和遵循标准治疗（SoC）程序找到的DBS设置的急性临床疗效。与未进行治疗相比，AgP和SoC DBS设置均显著改善（p = 0.002）帕金森病统一评分量表III总分（中位数分别为69.8，四分位间距（IQR）为64.6|71.9%和66.2，IQR为58.1|68.2%）。尽管临床结果相似，但AgP和SoC DBS设置有很大差异。每位受试者在收敛前AgP测试了37.0（IQR 34.0|37）个设置，耗时1.7（IQR 1.6|2.0）小时，这与之前的报告相当。虽然AgP的长期临床结果仍有待研究，但这种方法构成了DBS程控的一种替代方案，并且是未来闭环DBS优化系统的重要一步。
