Fung Wilson K W, Sumarac Srdjan, Sorrento Gianluca, Santyr Brendan, Milosevic Luka, Lang Anthony E, Lozano Andres M, Kalia Suneil K, Fasano Alfonso
Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, Ontario, Canada.
Krembil Research Institute, Toronto, Ontario, Canada.
Mov Disord. 2025 Jan;40(1):141-146. doi: 10.1002/mds.30035. Epub 2024 Oct 25.
Orthostatic tremor (OT) is a rare movement disorder characterized by a feeling of unsteadiness and a high-frequency tremor in the legs (13-18 Hz) relieved by sitting or walking.
The aims were to study the brain electrophysiology captured chronically in a person with medication-refractory OT while standing and walking and in the semi-recumbent position using bilateral ventral intermedius nucleus deep brain stimulation (DBS) (Medtronic Percept PC) and to describe the clinical use of closed-loop DBS.
A sensing survey was used to capture baseline local field potentials (LFPs) while standing. Livestreamed LFPs were synchronized with data collected from two accelerometers (legs) and gait analysis during OFF stimulation and continuous and closed-loop DBS.
Strong oscillatory coupling between thalamic LFP and leg tremor with significant coherence at 14.65 Hz was found during weight-bearing. Single-threshold adaptive DBS (sensing at this frequency) was superior to continuous stimulation in reducing tremor and stimulation-related gait ataxia.
This study provides new insights into both the pathophysiology and management of OT. © 2024 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
直立性震颤（OT）是一种罕见的运动障碍，其特征是感觉不稳定以及腿部出现高频震颤（13 - 18赫兹），坐下或行走可缓解。
旨在研究使用双侧腹中间核深部脑刺激（DBS）（美敦力Percept PC）在一名药物难治性OT患者站立、行走和半卧位时长期记录的脑电生理，并描述闭环DBS的临床应用。
采用传感测量来记录站立时的基线局部场电位（LFP）。在刺激关闭以及持续和闭环DBS期间，将实时传输的LFP与从两个加速度计（腿部）收集的数据以及步态分析进行同步。
在负重期间发现丘脑LFP与腿部震颤之间存在强烈的振荡耦合，在14.65赫兹处具有显著的相干性。单阈值自适应DBS（在此频率进行传感）在减少震颤和与刺激相关的步态共济失调方面优于持续刺激。
本研究为OT的病理生理学和治疗提供了新的见解。© 2024作者。《运动障碍》由威利期刊公司代表国际帕金森病和运动障碍协会出版。
