Directional deep brain stimulation leads reveal spatially distinct oscillatory activity in the globus pallidus internus of Parkinson's disease patients
Directional deep brain stimulation leads reveal spatially distinct oscillatory activity in the globus pallidus internus of Parkinson's disease patients
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DOI：
10.1016/j.nbd.2020.104819
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发表时间：
2020-06-01
影响因子：
6.1
通讯作者：
Vitek, Jerrold L.
中科院分区：
文献类型：
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作者：
Aman, Joshua E.;Johnson, Luke A.;Vitek, Jerrold L.
本研究的目的是利用定向(分段)脑深部刺激(DDBS)导联，研究帕金森病患者苍白球(GPI)内节段局部场电位(LFP)活动的频谱特征和空间地形图。数据是从三名特发性帕金森病患者的外化dDBS导联中收集的，这些患者在帕金森药物停药一夜后，在休息时和在提示的达到目标任务期间。在共同登记的术前7特斯拉(T)磁共振成像和术后CT扫描确定的导联位置和接触方向的背景下，检查了导联触点/节段的振荡活动。这三名患者中的每一位都在苍白球中表现出独特的振荡活动频谱，突出的峰值在5至35赫兹之间，在自愿运动期间在不同受试者之间进行不同的调制。尽管受试者的频谱特征不同，但患者中一致的发现是，在面向GPI后外侧“感觉运动”区域的LFP中，振荡功率最强，并且在运动期间具有最大的调制幅度，而面对内囊和/或GPI前部的前内侧定向节段性接触，在5至35赫兹时，LFP功率相对较弱，调制较少。在每个受试者中，选择用于临床治疗刺激的触点配置(遵循数据收集并对生理记录失明)，与在5-35赫兹范围内显示最大幅度的LFP振荡的触点对一致。虽然仅限于三个受试者，但这些发现支持这样的假设，即GPI的感觉运动区域对应于5至35赫兹振荡活动的最大功率位置，并在刺激GPI期间提供最大的运动体征益处。患者之间振荡活动的可变性可能与帕金森氏病的表型以及记录位置(即导联位置)的微小差异有关，这突显了导联位置对优化刺激效果的重要性。这些数据还为利用LFP活动开发预测性刺激模型提供了令人信服的证据，该模型可能会优化患者的利益，同时减少编程所需的临床时间。
The goal of this study was to characterize the spectral characteristics and spatial topography of local field potential (LFP) activity in the internal segment of the globus pallidus (GPi) in patients with Parkinson's disease utilizing directional (segmented) deep brain stimulation (dDBS) leads. Data were collected from externalized dDBS leads of three patients with idiopathic Parkinson's disease after overnight withdrawal of parkinsonian medication at rest and during a cued reach-to-target task. Oscillatory activity across lead contacts/segments was examined in the context of lead locations and contact orientations determined using co-registered preoperative 7 Tesla (T) MRI and postoperative CT scans. Each of the three patients displayed a unique frequency spectrum of oscillatory activity in the pallidum, with prominent peaks ranging from 5 to 35 Hz, that modulated variably across subjects during volitional movement. Despite subject-specific spectral profiles, a consistent finding across patients was that oscillatory power was strongest and had the largest magnitude of modulation during movement in LFPs recorded from segments facing the postero-lateral "sensorimotor" region of GPi, whereas antero-medially-directed segmented contacts facing the internal capsule and/or anterior GPi, had relatively weaker LFP power and less modulation in the 5 to 35 Hz. In each subject, contact configurations chosen for clinically therapeutic stimulation (following data collection and blinded to physiology recordings), were in concordance with the contact pairs showing the largest amplitude of LFP oscillations in the 5-35 Hz range. Although limited to three subjects, these findings provide support for the hypothesis that the sensorimotor territory of the GPi corresponds to the site of maximal power of oscillatory activity in the 5 to 35 Hz and provides the greatest benefit in motor signs during stimulation in the GPi. Variability in oscillatory activity across patients is likely related to Parkinson's disease phenotype as well as small differences in recording location (i.e. lead location), highlighting the importance of lead location for optimizing stimulation efficacy. These data also provide compelling evidence for the use of LFP activity for the development of predictive stimulation models that may optimize patient benefits while reducing clinic time needed for programming.