Adaptive Brain Stimulation for Movement Disorders.
Adaptive Brain Stimulation for Movement Disorders.
复制标题
DOI：
10.1159/000481107
复制
发表时间：
2018-01-01
影响因子：
--
通讯作者：
Little, Simon
中科院分区：
文献类型：
--
作者：
Beudel, Martijn;Cagnan, Hayriye;Little, Simon
脑深部刺激(DBS)显著改变了我们治疗运动障碍的方式，包括帕金森氏病(PD)、肌张力障碍和特发性震颤(ET)。然而，尽管DBS有明显的临床益处，但它往往受到副作用和部分疗效的限制。这些局限性可能部分归因于DBS干扰病理和生理神经活动的事实。因此，如果只在病理活动增强的时候选择性地应用DBS，DBS可能会得到潜在的改善。这种形式的刺激被称为闭环式或自适应DBS(ADBS)。在使用皮质神经元棘波触发的灵长类动物和使用局部场电位生物标记物的人类中，aDBS方法被证明优于传统的DBS方法。同样，aDBS对特发性和帕金森氏震颤的研究正在进行中，并显示出巨大的前景，使用外周或中枢感觉和刺激。ADBS还没有在肌张力障碍中进行试验，但令人兴奋和有前途的生物标记物表明，它在这里也可能是有益的。在这一章中，我们将回顾关于aDBS在运动障碍中的现有文献，并探索潜在的生物标志物和刺激算法在PD、ET和肌张力障碍中的应用。
Deep brain stimulation (DBS) has markedly changed how we treat movement disorders including Parkinson's disease (PD), dystonia, and essential tremor (ET). However, despite its demonstrable clinical benefit, DBS is often limited by side effects and partial efficacy. These limitations may be due in part to the fact that DBS interferes with both pathological and physiological neural activities. DBS could, therefore, be potentially improved were it applied selectively and only at times of enhanced pathological activity. This form of stimulation is known as closed-loop or adaptive DBS (aDBS). An aDBS approach has been shown to be superior to conventional DBS in PD in primates using cortical neuronal spike triggering and in humans employing local field potential biomarkers. Likewise, aDBS studies for essential and Parkinsonian tremor are advancing and show great promise, using both peripheral or central sensing and stimulation. aDBS has not yet been trialed in dystonia and yet exciting and promising biomarkers suggest it could be beneficial here too. In this chapter, we will review the existing literature on aDBS in movement disorders and explore potential biomarkers and stimulation algorithms for applying aDBS in PD, ET, and dystonia.