帕金森病深部脑刺激基于传感的临床实施初始编程：一项回顾性研究。
Clinically Implemented Sensing-Based Initial Programming of Deep Brain Stimulation for Parkinson's Disease: A Retrospective Study.
作者信息
Swinnen Bart E K S, Fuentes Andrea, Volz Monica M, Heath Susan, Starr Philip A, Little Simon J, Ostrem Jill L
机构信息
University of California San Francisco Department of Neurology, University of California San Francisco, San Francisco, CA, USA; University of California San Francisco Weill Institute for Neurosciences, Movement Disorders and Neuromodulation Centre, University of California San Francisco, San Francisco, CA, USA.
University of California San Francisco Weill Institute for Neurosciences, Movement Disorders and Neuromodulation Centre, University of California San Francisco, San Francisco, CA, USA; University of California San Francisco Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA; University of California San Francisco Department of Physiology, University of California San Francisco, San Francisco, CA, USA.
出版信息
Neuromodulation. 2025 Apr;28(3):501-510. doi: 10.1016/j.neurom.2024.11.002. Epub 2024 Dec 2.
OBJECTIVES
Initial deep brain stimulation (DBS) programming using a monopolar review is time-consuming, subjective, and burdensome. Incorporating neurophysiology has the potential to expedite, objectify, and automatize initial DBS programming. We aimed to assess the feasibility and performance of clinically implemented sensing-based initial DBS programming for Parkinson's disease (PD).
MATERIALS AND METHODS
We conducted a single-center retrospective study in 15 patients with PD (25 hemispheres) implanted with a sensing-enabled neurostimulator in whom initial subthalamic nucleus/globus pallidus pars interna DBS programming was guided by beta power in real-time local field potential recordings, instead of a monopolar review.
RESULTS
The initial sensing-based programming visit lasted on average 42.2 minutes (SD 18) per hemisphere. During the DBS optimization phase, a conventional monopolar clinical review was not required in any patients. The initial stimulation contact level remained the same at the final follow-up visit in all hemispheres except three. The final amplitude was on average 0.8 mA (SD 0.9) higher than initially set after the original sensing-based programming visit. One year after surgery, off-medication International Parkinson and Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS) III total score, tremor subscore, MDS-UPDRS IV, and levodopa-equivalent dose improved by 47.0% (p < 0.001), 77.7% (p = 0.001), 51.1% (p = 0.006), and 44.8% (p = 0.011) compared with preoperatively using this approach.
CONCLUSIONS
This study shows that sensing-based initial DBS programming for PD is feasible and rapid, and selected clinically effective contacts in most patients, including those with tremor. Technologic innovations and practical developments could improve sensing-based programming.
目的
使用单极评估进行初始脑深部电刺激（DBS）编程既耗时、主观又繁琐。纳入神经生理学有可能加快、客观化并自动化初始DBS编程。我们旨在评估临床上实施的基于传感的帕金森病（PD）初始DBS编程的可行性和性能。
材料与方法
我们对15例植入了具有传感功能神经刺激器的PD患者（25个脑半球）进行了单中心回顾性研究，其中初始丘脑底核/苍白球内侧部DBS编程由实时局部场电位记录中的β功率引导，而非单极评估。
结果
基于传感的初始编程访视每个脑半球平均持续42.2分钟（标准差18）。在DBS优化阶段，所有患者均无需进行传统的单极临床评估。除3个脑半球外，所有脑半球在最终随访时的初始刺激触点水平保持不变。最终振幅比基于传感的初始编程访视后最初设定的平均高0.8 mA（标准差0.9）。术后一年，与术前相比，非药物状态下国际帕金森和运动障碍协会统一帕金森病评定量表（MDS-UPDRS）III总分、震颤分项评分、MDS-UPDRS IV以及左旋多巴等效剂量分别改善了47.0%（p < 0.001）、77.7%（p = 0.001）、51.1%（p = 0.006）和44.8%（p = 0.011）。
结论
本研究表明，基于传感的PD初始DBS编程是可行且快速的，并且在大多数患者中，包括震颤患者，选择了临床有效的触点。技术创新和实际进展可能会改善基于传感的编程。
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