Practical Closed-Loop Strategies for Deep Brain Stimulation: Lessons From Chronic Pain.
Practical Closed-Loop Strategies for Deep Brain Stimulation: Lessons From Chronic Pain.
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DOI：
10.3389/fnins.2021.762097
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发表时间：
2021
影响因子：
4.3
通讯作者：
Shirvalkar P
中科院分区：
文献类型：
--
作者：
Prosky J;Cagle J;Sellers KK;Gilron R;de Hemptinne C;Schmitgen A;Starr PA;Chang EF;Shirvalkar P
脑深部电刺激（DBS）是一种治疗各种神经精神疾病的合理疗法，尽管不考虑潜在生理学（开环）的连续强直刺激已经取得了不同的成功。最近可用的DBS设备可以感测神经信号，该神经信号又可以用于以闭环模式控制刺激。闭环DBS策略可以减轻开环刺激的许多缺点，并提供更个性化的治疗。这些设备包含许多可调节的参数，这些参数控制闭环系统的运行方式，需要结合经验和临床信息决策进行优化。我们提供了一个实用的指南，实施一个闭环DBS系统，使用慢性疼痛患者的例子。重点关注Medtronic的两种研究器械，Activa PC+S和Summit RC+S，我们从临床医生的角度提供了实施闭环程控的实用细节。具体来说，通过将我们对慢性疼痛的理解与数据驱动的神经病学相结合，我们描述了如何调整关键参数以处理特征选择、状态阈值和刺激伪影。最后，我们讨论了临床医生在程控闭环器械时必须注意的后勤和实践考虑因素。
Deep brain stimulation (DBS) is a plausible therapy for various neuropsychiatric disorders, though continuous tonic stimulation without regard to underlying physiology (open-loop) has had variable success. Recently available DBS devices can sense neural signals which, in turn, can be used to control stimulation in a closed-loop mode. Closed-loop DBS strategies may mitigate many drawbacks of open-loop stimulation and provide more personalized therapy. These devices contain many adjustable parameters that control how the closed-loop system operates, which need to be optimized using a combination of empirically and clinically informed decision making. We offer a practical guide for the implementation of a closed-loop DBS system, using examples from patients with chronic pain. Focusing on two research devices from Medtronic, the Activa PC+S and Summit RC+S, we provide pragmatic details on implementing closed- loop programming from a clinician’s perspective. Specifically, by combining our understanding of chronic pain with data-driven heuristics, we describe how to tune key parameters to handle feature selection, state thresholding, and stimulation artifacts. Finally, we discuss logistical and practical considerations that clinicians must be aware of when programming closed-loop devices.
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影响因子：
4.1
作者：
ADAMS, JE;HOSOBUCHI, Y;FIELDS, HL
通讯作者：
FIELDS, HL
影响因子：
56.9
作者：
MELZACK, R;WALL, PD
通讯作者：
WALL, PD
影响因子：
4.3
作者：
Park, Seong-Cheol;Cha, Joon Hyuk;Lee, Jung Kyo
通讯作者：
Lee, Jung Kyo
影响因子：
4
作者：
Swann, Nicole C.;de Hemptinne, Coralie;Starr, Philip A.
通讯作者：
Starr, Philip A.
帕金森氏病患者的回路发现和适应性刺激的神经记录的长期无线流媒体流。
影响因子：
46.9
作者：
Gilron R;Little S;Perrone R;Wilt R;de Hemptinne C;Yaroshinsky MS;Racine CA;Wang SS;Ostrem JL;Larson PS;Wang DD;Galifianakis NB;Bledsoe IO;San Luciano M;Dawes HE;Worrell GA;Kremen V;Borton DA;Denison T;Starr PA
通讯作者：
Starr PA