可穿戴式周围神经刺激器通过靶向脑调制减轻特发性震颤症状。

Wearable peripheral nerve stimulator reduces essential tremor symptoms through targeted brain modulation.

作者信息

Luu Cuong P, Ranum Jordan, Youn Youngwon, Perrault Jennifer L, Krause Bryan M, Banks Matthew I, Buyan-Dent Laura, Ludwig Kip A, Lake Wendell B, Suminski Aaron J

机构信息

Department of Neurological Surgery, University of Wisconsin-Madison, USA; Wisconsin Institute for Translational Neuroengineering, University of Wisconsin-Madison, USA.

Wisconsin Institute for Translational Neuroengineering, University of Wisconsin-Madison, USA.

出版信息

Brain Stimul. 2025 Jul-Aug;18(4):1162-1173. doi: 10.1016/j.brs.2025.06.004. Epub 2025 Jun 6.

DOI:10.1016/j.brs.2025.06.004

PMID:40484122

Abstract

BACKGROUND

Essential tremor (ET), the most common movement disorder in adults, presents with involuntary shaking of the upper extremities during postural hold and kinetic tasks linked to dysfunction in the cerebello-thalamo-cortical network. Recently, transcutaneous afferent patterned stimulation (TAPS), applied through a wrist-worn device, has emerged as a non-invasive treatment for medication-refractory ET. However, its mechanism remains unclear.

OBJECTIVE

We hypothesize that TAPS reduces tremors through modulation of the VIM thalamus in the cerebello-thalamo-cortical network.

METHODS

Employing refractory pure ET patients seeking VIM deep brain stimulation (DBS), we quantified clinical tremor improvement following TAPS treatment in a pre-operative setting, followed by intra-operative microelectrode recording of the contralateral thalamus with concurrent TAPS treatment on and off.

RESULTS

After one preoperative session, TAPS significantly reduces upper limb tremor average (0.61, p = 0.002), with an asymmetric effect favoring the treated limb (p = 0.047) and the greatest improvement tending to kinetic tremor (R2 = 0.943, p = 0.002). The magnitude of TAPS-related tremor reduction demonstrates a positive correlation with the modulation of alpha (R2 = 0.213, p < 0.001) and beta band LFPs (R2 = 0.255, p < 0.001) in the VIM. TAPS also suppressed spiking activity in the VIM (R2 = 0.104, p = 0.029), though it was uncorrelated with the degree of tremor reduction. Of note, TAPS-related modulation of LFPs and spiking activity was greatest near the optimal placement location for the DBS lead in treating ET (R2 = 0.122, p = 0.006).

CONCLUSION

In sum, TAPS likely reduces tremor in ET by modulating the VIM and connected nodes in the cerebello-thalamo-cortical pathway.

摘要

背景

特发性震颤（ET）是成年人中最常见的运动障碍，表现为在姿势保持和与小脑 - 丘脑 - 皮质网络功能障碍相关的运动任务期间上肢的不自主抖动。最近，通过腕戴设备应用的经皮传入模式刺激（TAPS）已成为药物难治性ET的一种非侵入性治疗方法。然而，其机制仍不清楚。

目的

我们假设TAPS通过调节小脑 - 丘脑 - 皮质网络中的丘脑腹中间核（VIM）来减少震颤。

方法

我们招募了寻求VIM脑深部电刺激（DBS）的难治性纯ET患者，在术前环境中对TAPS治疗后的临床震颤改善情况进行量化，然后在术中使用微电极记录对侧丘脑，同时开启和关闭TAPS治疗。

结果

在一次术前治疗后，TAPS显著降低上肢震颤平均值（0.61，p = 0.002），对治疗侧肢体有不对称效应（p = 0.047），并且对运动性震颤的改善最为明显（R2 = 0.943，p = 0.002）。TAPS相关的震颤减轻幅度与VIM中α频段（R2 = 0.213，p < 0.001）和β频段局部场电位（LFP）的调制呈正相关（R2 = 0.255，p < 0.001）。TAPS还抑制了VIM中的放电活动（R2 = 0.104，p = 0.029），尽管它与震颤减轻程度无关。值得注意的是，TAPS相关的LFP和放电活动调制在治疗ET的DBS电极最佳放置位置附近最为明显（R2 = 0.122，p = 0.006）。