Computer-Guided Deep Brain Stimulation Programming for Parkinson's Disease.
Computer-Guided Deep Brain Stimulation Programming for Parkinson's Disease.
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DOI：
10.1111/ner.12372
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发表时间：
2016-02
期刊：
影响因子：
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通讯作者：
Revilla FJ
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文献类型：
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作者：
Heldman DA;Pulliam CL;Urrea Mendoza E;Gartner M;Giuffrida JP;Montgomery EB Jr;Espay AJ;Revilla FJ
评估计算机引导的深部脑刺激（DBS）程序的初步研究，该程序旨在利用基于客观运动传感器的运动评估优化刺激设置。7名帕金森病（PD）患者（5名男性，54-71岁）近期植入DBS系统参与了本初步研究。在铅植入两个月内，受试者返回诊所接受计算机引导编程和参数选择。运动传感器被放置在受影响更严重的那只手的食指上。软件引导单极调查，在此期间，对每次接触的单极刺激迭代增加，随后自动评估震颤和运动迟缓。在完成每种设置的评估后，软件算法确定刺激设置，以最大限度地减少症状严重程度、副作用和电池使用。根据运动传感器测量的运动症状的平均严重程度选择最佳DBS设置。软件算法选择的设置确定了治疗窗口，与“关闭”状态下的基线相比，平均改善了35.7%的震颤和运动迟缓（p<0.01）。基于运动传感器的计算机引导DBS程序确定了刺激参数，可以在最少的临床医生参与下显著改善震颤和运动迟缓。基于自动运动传感器的绘图值得进一步研究，也许有一天可以将编程扩展到无法进入专门DBS中心的人群。
Pilot study to evaluate computer-guided deep brain stimulation (DBS) programming designed to optimize stimulation settings using objective motion sensor-based motor assessments. Seven subjects (5 males; 54-71 years) with Parkinson's disease (PD) and recently implanted DBS systems participated in this pilot study. Within two months of lead implantation, the subject returned to the clinic to undergo computer-guided programming and parameter selection. A motion sensor was placed on the index finger of the more affected hand. Software guided a monopolar survey during which monopolar stimulation on each contact was iteratively increased followed by an automated assessment of tremor and bradykinesia. After completing assessments at each setting, a software algorithm determined stimulation settings designed to minimize symptom severities, side effects, and battery usage. Optimal DBS settings were chosen based on average severity of motor symptoms measured by the motion sensor. Settings chosen by the software algorithm identified a therapeutic window and improved tremor and bradykinesia by an average of 35.7% compared to baseline in the “off” state (p<0.01). Motion sensor-based computer-guided DBS programming identified stimulation parameters that significantly improved tremor and bradykinesia with minimal clinician involvement. Automated motion sensor-based mapping is worthy of further investigation and may one day serve to extend programming to populations without access to specialized DBS centers.