Dong Wenwen, Qiu Chang, Chang Lei, Sun Jian, Yan Jiuqi, Luo Bei, Lu Yue, Liu Weiguo, Zhang Li, Zhang Wenbin
Department of Functional Neurosurgery, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China.
Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China.
CNS Neurosci Ther. 2024 Apr;30(4):e14501. doi: 10.1111/cns.14501. Epub 2023 Oct 13.
Parkinson's disease (PD) patients undergoing deep brain stimulation (DBS) surgery require subsequent programming, which is complex and cumbersome. The local field potential (LFP) in the deep brain is associated with motor symptom improvement. The current study aimed to identify LFP biomarkers correlated with improved motor symptoms in PD patients after DBS and verify their guiding role in postoperative programming.
Initially, the study included 36 PD patients undergoing DBS surgery. Temporary external electrical stimulation was performed during electrode implantation, and LFP signals around the electrode contacts were collected before and after stimulation. The stimulating contact at 6 months of programming was regarded as the optimal and effective stimulating contact. The LFP signal of this contact during surgery was analyzed to identify potential LFP biomarkers. Next, we randomly assigned another 30 PD patients who had undergone DBS to physician empirical programming and LFP biomarker-guided programming groups and compared the outcomes.
In the first part of the study, LFP signals of electrode contacts changed after electrical stimulation. Electrical stimulation reduced gamma energy and the beta/alpha oscillation ratio. The different programming method groups were compared, indicating the superiority of beta/alpha oscillations ratio-guided programming over physician experience programming for patients' improvement rate (IR) of UPDRS-III. There were no significant differences in the IR of UPDRS-III, post-LED, IR-PDQ39, number of programmings, and the contact change rate between the gamma oscillations-guided programming and empirical programming groups.
Overall, the findings reveal that gamma oscillations and the beta/alpha oscillations ratio are potential biomarkers for programming in PD patients after DBS. Instead of relying solely on spike action potential signals from single neurons, LFP biomarkers can provide the appropriate depth for electrode placement.
接受脑深部电刺激（DBS）手术的帕金森病（PD）患者需要后续的程控，这一过程复杂且繁琐。脑深部的局部场电位（LFP）与运动症状改善相关。本研究旨在识别与DBS术后PD患者运动症状改善相关的LFP生物标志物，并验证其在术后程控中的指导作用。
最初，该研究纳入了36例接受DBS手术的PD患者。在电极植入期间进行临时外部电刺激，并在刺激前后收集电极触点周围的LFP信号。将程控6个月时的刺激触点视为最佳有效刺激触点。分析该触点在手术期间的LFP信号以识别潜在的LFP生物标志物。接下来，我们将另外30例接受DBS的PD患者随机分为医生经验程控组和LFP生物标志物指导程控组，并比较结果。
在研究的第一部分中，电刺激后电极触点的LFP信号发生了变化。电刺激降低了γ能量和β/α振荡比率。对不同的程控方法组进行比较，结果表明，对于患者的帕金森病统一评分量表第三部分（UPDRS-III）改善率（IR），β/α振荡比率指导的程控优于医生经验程控。γ振荡指导的程控组和经验程控组在UPDRS-III的IR、左旋多巴等效剂量（LED）后、IR-帕金森病问卷39项（PDQ39）、程控次数以及触点变化率方面均无显著差异。
总体而言，研究结果表明，γ振荡和β/α振荡比率是DBS术后PD患者程控的潜在生物标志物。LFP生物标志物无需仅依赖单个神经元的动作电位信号，还可为电极放置提供合适的深度。
