Entraining Stepping Movements of Parkinson's Patients to Alternating Subthalamic Nucleus Deep Brain Stimulation.
Entraining Stepping Movements of Parkinson's Patients to Alternating Subthalamic Nucleus Deep Brain Stimulation.
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DOI：
10.1523/jneurosci.1767-20.2020
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发表时间：
2020-11-11
期刊：
影响因子：
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通讯作者：
Tan H
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文献类型：
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作者：
Fischer P;He S;de Roquemaurel A;Akram H;Foltynie T;Limousin P;Zrinzo L;Hyam J;Cagnan H;Brown P;Tan H
晚期帕金森氏症患者可以通过丘脑底核深部脑刺激（DBS）来治疗。这提供了一个独特的机会来记录这个核，并以一种可控的方式刺激它。先前的研究表明，当帕金森患者进行步进运动时，STN的活动以一种有节奏的模式进行调节，这就提出了STN是否参与步进的动态控制的问题。晚期帕金森氏症患者可以通过丘脑底核深部脑刺激（DBS）来治疗。这提供了一个独特的机会来记录这个核，并以一种可控的方式刺激它。先前的研究表明，当帕金森患者进行步进运动时，STN的活动以一种有节奏的模式进行调节，这就提出了STN是否参与步进的动态控制的问题。为了回答这个问题，我们测试了一种类似于STN中与步进相关的活动调节的交替刺激模式是否可以作为STN参与步进控制的证据来引导患者的步进运动。对10名帕金森氏症患者（1名女性）的小组分析表明，交替刺激显著地影响了步进节奏。我们发现，当刺激速度接近步速时，5例患者的步速与刺激周期之间存在显著的一致性。我们的研究表明，STN与步速的动态控制有因果关系，并激发了对这种仿生刺激模式的进一步探索，作为开发DBS策略改善步态障碍的潜在基础。我们测试了人类的丘脑下核（STN）是否与控制行走运动有因果关系。为此，我们研究了接受治疗性脑深部刺激（DBS）的帕金森病患者，因为在这些患者中，我们可以以一种可控的方式刺激stn。我们开发了一种交替的刺激模式，模仿了在步进过程中记录在该核中的活动调制模式。交替DBS （altDBS）可以使患者的步进节律紊乱，提示STN在动态步态控制中起因果作用。这种类型的刺激可能会成为改进DBS步态策略的基础。
Patients with advanced Parkinson's can be treated by deep brain stimulation (DBS) of the subthalamic nucleus (STN). This affords a unique opportunity to record from this nucleus and stimulate it in a controlled manner. Previous work has shown that activity in the STN is modulated in a rhythmic pattern when Parkinson's patients perform stepping movements, raising the question whether the STN is involved in the dynamic control of stepping. Patients with advanced Parkinson's can be treated by deep brain stimulation (DBS) of the subthalamic nucleus (STN). This affords a unique opportunity to record from this nucleus and stimulate it in a controlled manner. Previous work has shown that activity in the STN is modulated in a rhythmic pattern when Parkinson's patients perform stepping movements, raising the question whether the STN is involved in the dynamic control of stepping. To answer this question, we tested whether an alternating stimulation pattern resembling the stepping-related modulation of activity in the STN could entrain patients' stepping movements as evidence of the STN's involvement in stepping control. Group analyses of 10 Parkinson's patients (one female) showed that alternating stimulation significantly entrained stepping rhythms. We found a remarkably consistent alignment between the stepping and stimulation cycle when the stimulation speed was close to the stepping speed in the five patients that demonstrated significant individual entrainment to the stimulation cycle. Our study suggests that the STN is causally involved in dynamic control of step timing and motivates further exploration of this biomimetic stimulation pattern as a potential basis for the development of DBS strategies to ameliorate gait impairments. SIGNIFICANCE STATEMENT We tested whether the subthalamic nucleus (STN) in humans is causally involved in controlling stepping movements. To this end, we studied patients with Parkinson's disease who have undergone therapeutic deep brain stimulation (DBS), as in these individuals we can stimulate the STNs in a controlled manner. We developed an alternating pattern of stimulation that mimics the pattern of activity modulation recorded in this nucleus during stepping. The alternating DBS (altDBS) could entrain patients' stepping rhythm, suggesting a causal role of the STN in dynamic gait control. This type of stimulation may potentially form the basis for improved DBS strategies for gait.