Spooner Rachel K, Bahners Bahne H, Schnitzler Alfons, Florin Esther
Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany.
Department of Neurology, Center for Movement Disorders and Neuromodulation, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany.
NPJ Parkinsons Dis. 2023 Mar 11;9(1):37. doi: 10.1038/s41531-023-00474-4.
Although subthalamic deep brain stimulation (DBS) is a highly-effective treatment for alleviating motor dysfunction in patients with Parkinson's disease (PD), clinicians currently lack reliable neurophysiological correlates of clinical outcomes for optimizing DBS parameter settings, which may contribute to treatment inefficacies. One parameter that could aid DBS efficacy is the orientation of current administered, albeit the precise mechanisms underlying optimal contact orientations and associated clinical benefits are not well understood. Herein, 24 PD patients received monopolar stimulation of the left STN during magnetoencephalography and standardized movement protocols to interrogate the directional specificity of STN-DBS current administration on accelerometer metrics of fine hand movements. Our findings demonstrate that optimal contact orientations elicit larger DBS-evoked cortical responses in the ipsilateral sensorimotor cortex, and importantly, are differentially predictive of smoother movement profiles in a contact-dependent manner. Moreover, we summarize traditional evaluations of clinical efficacy (e.g., therapeutic windows, side effects) for a comprehensive review of optimal/non-optimal STN-DBS contact settings. Together, these data suggest that DBS-evoked cortical responses and quantitative movement outcomes may provide clinical insight for characterizing the optimal DBS parameters necessary for alleviating motor symptoms in patients with PD in the future.
尽管丘脑底核深部脑刺激（DBS）是缓解帕金森病（PD）患者运动功能障碍的一种高效治疗方法，但临床医生目前缺乏用于优化DBS参数设置的可靠神经生理学与临床结果的相关性，这可能导致治疗无效。一个有助于提高DBS疗效的参数是所施加电流的方向，尽管最佳接触方向及相关临床益处背后的确切机制尚不完全清楚。在此，24名PD患者在脑磁图检查期间接受了左侧丘脑底核的单极刺激，并采用标准化运动方案，以探究丘脑底核-DBS电流施加对精细手部运动加速度计指标的方向特异性。我们的研究结果表明，最佳接触方向会在同侧感觉运动皮层引发更大的DBS诱发皮层反应，重要的是，以接触依赖的方式对更平滑的运动轨迹具有不同的预测性。此外，我们总结了临床疗效的传统评估（如治疗窗口、副作用），以全面回顾最佳/非最佳丘脑底核-DBS接触设置。总之，这些数据表明，DBS诱发的皮层反应和定量运动结果可能为未来确定缓解PD患者运动症状所需的最佳DBS参数提供临床见解。
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