Caffi Laura, Romito Luigi M, Palmisano Chiara, Aloia Vanessa, Arlotti Mattia, Rossi Lorenzo, Marceglia Sara, Priori Alberto, Eleopra Roberto, Levi Vincenzo, Mazzoni Alberto, Isaias Ioannis U
Parkinson Institute of Milan, ASST G.Pini-CTO, 20126 Milano, Italy.
University Hospital of Würzburg and Julius Maximilian University of Würzburg, 97070 Würzburg, Germany.
Bioengineering (Basel). 2024 Sep 30;11(10):990. doi: 10.3390/bioengineering11100990.
Conventional DBS (cDBS) for Parkinson's disease uses constant, predefined stimulation parameters, while the currently available adaptive DBS (aDBS) provides the possibility of adjusting current amplitude with respect to subthalamic activity in the beta band (13-30 Hz). This preliminary study on one patient aims to describe how these two stimulation modes affect basal ganglia dynamics and, thus, behavior in the long term. We collected clinical data (UPDRS-III and -IV) and subthalamic recordings of one patient with Parkinson's disease treated for one year with aDBS, alternated with short intervals of cDBS. Moreover, after nine months, the patient discontinued all dopaminergic drugs while keeping aDBS. Clinical benefits of aDBS were superior to those of cDBS, both with and without medications. This improvement was paralleled by larger daily fluctuations of subthalamic beta activity. Moreover, with aDBS, subthalamic beta activity decreased during asleep with respect to awake hours, while it remained stable in cDBS. These preliminary data suggest that aDBS might be more effective than cDBS in preserving the functional role of daily beta fluctuations, thus leading to superior clinical benefit. Our results open new perspectives for a restorative brain network effect of aDBS as a more physiological, bidirectional, brain-computer interface.
用于帕金森病的传统深部脑刺激（cDBS）使用恒定的、预先设定的刺激参数，而目前可用的自适应深部脑刺激（aDBS）则提供了根据β波段（13 - 30赫兹）丘脑底核活动调整电流幅度的可能性。这项针对一名患者的初步研究旨在描述这两种刺激模式如何长期影响基底神经节动力学，进而影响行为。我们收集了一名接受aDBS治疗一年的帕金森病患者的临床数据（统一帕金森病评定量表第三部分和第四部分）以及丘脑底核记录，期间穿插了短时间的cDBS。此外，九个月后，患者在持续接受aDBS的同时停用了所有多巴胺能药物。无论是否用药，aDBS的临床益处均优于cDBS。这种改善与丘脑底核β活动的每日较大波动同时出现。此外，在aDBS模式下，丘脑底核β活动在睡眠期间相对于清醒时减少，而在cDBS模式下则保持稳定。这些初步数据表明，在保留每日β波动的功能作用方面，aDBS可能比cDBS更有效，从而带来更好的临床益处。我们的结果为aDBS作为一种更具生理性、双向性的脑机接口的恢复性脑网络效应开辟了新的前景。
