Directional steering A novel approach to deep brain stimulation
Directional steering A novel approach to deep brain stimulation
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DOI：
10.1212/wnl.0000000000000823
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发表时间：
2014-09-23
期刊：
影响因子：
9.9
通讯作者：
Schuurman, P. R.
中科院分区：
文献类型：
--
作者：
Contarino, M. Fiorella;Bour, Lo J.;Schuurman, P. R.
目的：本研究的目的是探讨通过新型 32 接触电极进行定向转向是否安全，是否可以调节刺激有益和副作用的阈值。方法：该研究是一项单中心、性能和安全性研究。对 8 名帕金森病患者进行了双盲术中治疗益处阈值和副作用阈值评估，同时以球形模式和 32 接触电极的 4 种不同转向模式以及商业电极的单极模式以随机顺序进行刺激。此外，还通过所有 32 个触点同时记录局部场电位。结果：没有与实验装置相关的不良事件。对于 15 种副作用中的 13 种 (87%)，与传统的球形刺激相比，在至少一个方向转向时阈值可以增加 >= 1 mA，从而将治疗窗口增加最多 1.5mA。通过所有 32 个电极触点记录局部场电位，产生了病理神经元活动的时空信息。结论：控制通过大脑的电流转向可以提高深部脑刺激 (DBS) 的有效性，允许新的应用，并提供更好地探索大脑病理生理活动的工具。证据分类：本研究提供了IV级证据，表明对于帕金森病患者来说，与目前标准的球形刺激相比，引导DBS电流具有良好的耐受性，增加了副作用的阈值，并且可以改善丘脑底核DBS的治疗窗。
Objective: The aim of this study was to investigate whether directional steering through a novel 32-contact electrode is safe and can modulate the thresholds for beneficial and side effects of stimulation.Methods: The study is a single-center, performance and safety study. Double-blind intraoperative evaluations of the thresholds for therapeutic benefit and for side effects were performed in 8 patients with Parkinson disease while stimulating in randomized order in spherical mode and in 4 different steering modeswith the 32-contact electrode, and in monopolar mode with a commercial electrode. In addition, simultaneous recordings of local field potentials through all 32 contacts were performed.Results: There were no adverse events related to the experimental device. For 13 of 15 side effects (87%), the threshold could be increased by >= 1 mA while steering in at least one direction in comparison to conventional spherical stimulation, thereby increasing the therapeutic window by up to 1.5mA. Recording local field potentials through all 32 electrode contacts yielded spatiotemporal information on pathologic neuronal activity.Conclusions: Controlled steering of current through the brain may improve the effectiveness of deep brain stimulation (DBS), allow for novel applications, and provide a tool to better explore pathophysiologic activity in the brain. Classification of evidence: This study provides Class IV evidence that for patients with Parkinson disease, steering DBS current is well tolerated, increases the threshold for side effects, and may improve the therapeutic window of subthalamic nucleus DBS as compared with current standard spherical stimulation.