Subthalamic Nucleus Deep Brain Stimulation in Parkinson's Disease: The Effect of Varying Stimulation Parameters.
Subthalamic Nucleus Deep Brain Stimulation in Parkinson's Disease: The Effect of Varying Stimulation Parameters.
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DOI：
10.3233/jpd-171077
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发表时间：
2017
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影响因子：
--
通讯作者：
Foltynie T
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文献类型：
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作者：
Dayal V;Limousin P;Foltynie T
丘脑下核深部脑刺激（STN DBS）是一种行之有效的治疗帕金森病（PD）的方法。自其问世以来，人们系统地探索了刺激参数的影响，包括刺激强度、频率和脉宽，以建立最佳的治疗范围。这篇综述从治疗效果和不良反应的角度检查了这些刺激参数的已发表数据。通过改变电压或电流设置来改变刺激强度是DBS编程滴定的主要方法，其特点是较低的疗效阈值和较高的副作用阈值，这两个阈值定义了治疗窗口。此外，在探索频率调制的效果方面已经做了很多工作，这可能有助于步态冻结和其他轴向症状的患者。然而，关于使用超短脉冲宽度设置的数据缺乏，而随着技术的进步，超短脉冲宽度设置现在是可能的。我们还讨论了目前使用新编程技术的证据，包括定向和自适应刺激，并强调了未来研究的领域。
Subthalamic Nucleus Deep Brain Stimulation (STN DBS) is a well-established and effective treatment modality for selected patients with Parkinson’s disease (PD). Since its advent, systematic exploration of the effect of stimulation parameters including the stimulation intensity, frequency, and pulse width have been carried out to establish optimal therapeutic ranges. This review examines published data on these stimulation parameters in terms of efficacy of treatment and adverse effects. Altering stimulation intensity is the mainstay of titration in DBS programming via alterations in voltage or current settings, and is characterised by a lower efficacy threshold and a higher side effect threshold which define the therapeutic window. In addition, much work has been done in exploring the effects of frequency modulation, which may help patients with gait freezing and other axial symptoms. However, there is a paucity of data on the use of ultra-short pulse width settings which are now possible with technological advances. We also discuss current evidence for the use of novel programming techniques including directional and adaptive stimulation, and highlight areas for future research.