An update on adaptive deep brain stimulation in Parkinson's disease.

An update on adaptive deep brain stimulation in Parkinson's disease.
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DOI:
10.1002/mds.115
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发表时间:
2018-12
期刊:
Movement disorders : official journal of the Movement Disorder Society
影响因子:
--
通讯作者:
Kubben PL
Kubben PL
中科院分区:
其他
文献类型:
--
作者:
Habets JGV;Heijmans M;Kuijf ML;Janssen MLF;Temel Y;Kubben PL

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推进传统的开环DBS作为PD的治疗方法对于克服一些重要问题至关重要,例如目前与治疗相关的有益和不良影响之间的微妙平衡以及有限的电池寿命。闭环或自适应DBS旨在通过基于代表患者临床状态的连续反馈输入信号实时调整刺激参数来克服这些限制。本次更新的重点是讨论PD中自适应DBS的潜在输入信号和可能的刺激参数调制的最新进展。自适应DBS的潜在输入信号包括基底节区局部场电位、皮质记录(皮质电成像)、可穿戴传感器以及电子健康和移动健康设备。此外,适应性DBS可以应用于不同的刺激参数调制方法,其可行性可以根据特定的PD表型进行调整。机器学习等技术发展的实施显示了这种方法设计的潜力;然而,能源消耗值得进一步关注。此外,我们还讨论了PD中适应性DBS临床实施的未来考虑因素。©2018作者。Wiley期刊公司代表国际帕金森和运动障碍学会出版的《运动障碍》。
Advancing conventional open‐loop DBS as a therapy for PD is crucial for overcoming important issues such as the delicate balance between beneficial and adverse effects and limited battery longevity that are currently associated with treatment. Closed‐loop or adaptive DBS aims to overcome these limitations by real‐time adjustment of stimulation parameters based on continuous feedback input signals that are representative of the patient's clinical state. The focus of this update is to discuss the most recent developments regarding potential input signals and possible stimulation parameter modulation for adaptive DBS in PD. Potential input signals for adaptive DBS include basal ganglia local field potentials, cortical recordings (electrocorticography), wearable sensors, and eHealth and mHealth devices. Furthermore, adaptive DBS can be applied with different approaches of stimulation parameter modulation, the feasibility of which can be adapted depending on specific PD phenotypes. Implementation of technological developments like machine learning show potential in the design of such approaches; however, energy consumption deserves further attention. Furthermore, we discuss future considerations regarding the clinical implementation of adaptive DBS in PD. © 2018 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.
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