Optimizing deep brain stimulation based on isostable amplitude in essential tremor patient models.
Optimizing deep brain stimulation based on isostable amplitude in essential tremor patient models.
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DOI：
10.1088/1741-2552/abd90d
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发表时间：
2021-04-06
影响因子：
4
通讯作者：
Bogacz R
中科院分区：
文献类型：
--
作者：
Duchet B;Weerasinghe G;Bick C;Bogacz R
脑深部刺激是一种治疗难治性特发性震颤的方法。为了改进治疗，闭环方法被设计成根据系统的状态来提供刺激，系统状态通过记录与症状相关的病理信号(例如大脑信号或肢体震颤)来持续监测。由于可能的闭环刺激策略的空间很大，不能通过实验充分探索，如何根据状态进行刺激应该通过建模来告知。一个典型的建模目标是设计一种刺激策略，旨在最大限度地降低病理信号的希尔伯特幅度，以便将症状降至最低。等稳定参数提供了与吸引子收敛时间相关的幅度概念，这在基于模型的控制问题中是有益的。然而，在受数据约束的模型中优化对刺激的幅度响应时，等稳幅度和希尔伯特幅度如何比较尚不清楚。我们根据先前适用于来自特发性震颤患者的锁相深部脑刺激数据的模型，制定了一种简单的闭环式刺激策略。我们比较了该策略在基于Hilbert幅度和基于等稳幅度时抑制振荡功率的性能。我们还将性能与锁相刺激和开环高频刺激进行了比较。对于我们的闭环相空间刺激策略，当幅值计算时间被限制在分钟时，基于等稳幅度的刺激明显比基于希尔伯特幅度的刺激有效。在没有约束的情况下，性能是相似的，但是在临床应用中，对计算时间的约束是可以预期的。即使在计算时间限制为分钟的情况下，基于等稳幅度的闭环相空间刺激也比锁相刺激更具优势，并且比高频刺激更有效。我们的结果表明，在神经疾病中更广泛地使用等稳幅度来优化基于模型的刺激是一种潜在的好处。
Deep brain stimulation is a treatment for medically refractory essential tremor. To improve the therapy, closed-loop approaches are designed to deliver stimulation according to the system’s state, which is constantly monitored by recording a pathological signal associated with symptoms (e.g. brain signal or limb tremor). Since the space of possible closed-loop stimulation strategies is vast and cannot be fully explored experimentally, how to stimulate according to the state should be informed by modeling. A typical modeling goal is to design a stimulation strategy that aims to maximally reduce the Hilbert amplitude of the pathological signal in order to minimize symptoms. Isostables provide a notion of amplitude related to convergence time to the attractor, which can be beneficial in model-based control problems. However, how isostable and Hilbert amplitudes compare when optimizing the amplitude response to stimulation in models constrained by data is unknown. We formulate a simple closed-loop stimulation strategy based on models previously fitted to phase-locked deep brain stimulation data from essential tremor patients. We compare the performance of this strategy in suppressing oscillatory power when based on Hilbert amplitude and when based on isostable amplitude. We also compare performance to phase-locked stimulation and open-loop high-frequency stimulation. For our closed-loop phase space stimulation strategy, stimulation based on isostable amplitude is significantly more effective than stimulation based on Hilbert amplitude when amplitude field computation time is limited to minutes. Performance is similar when there are no constraints, however constraints on computation time are expected in clinical applications. Even when computation time is limited to minutes, closed-loop phase space stimulation based on isostable amplitude is advantageous compared to phase-locked stimulation, and is more efficient than high-frequency stimulation. Our results suggest a potential benefit to using isostable amplitude more broadly for model-based optimization of stimulation in neurological disorders.
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影响因子：
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