Adaptive deep brain stimulation for Parkinson's disease using motor cortex sensing
Adaptive deep brain stimulation for Parkinson's disease using motor cortex sensing
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DOI：
10.1088/1741-2552/aabc9b
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发表时间：
2018-08-01
影响因子：
4
通讯作者：
Starr, Philip A.
中科院分区：
文献类型：
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作者：
Swann, Nicole C.;de Hemptinne, Coralie;Starr, Philip A.
Objective.现代帕金森病的深部脑刺激（DBS）是连续进行的，必须由训练有素的临床医生根据患者不断变化的症状进行手动调整。患者可能在不需要时接受能量密集型设置，可能导致刺激诱导的不良反应，如运动障碍。一种解决方案是“自适应”DBS，其中刺激基于与运动体征或刺激诱导的不良反应的严重性共同变化的神经信号而在真实的时间中被修改。在这里，我们展示了使用完全植入的神经假体进行自适应DBS的可行性。Approach.我们使用完全植入的神经假体对两名帕金森病患者进行了自适应脑深部刺激，该假体能够利用大脑传感来控制刺激幅度（Activa PC + S）。我们使用与运动障碍相关的皮质窄带伽马（60-90 Hz）振荡，以在伽马振荡活动高（指示运动障碍）时降低刺激电压，并在其低时增加刺激电压。主要结果。我们证明了“自适应脑深部电刺激”在两名帕金森病患者中的可行性。在短期临床试验中，能量节省显著（38%-45%），并且保持了治疗效果。意义这是首次使用完全植入的设备和神经感知证明帕金森病的自适应DBS。我们的方法是不同的其他策略，利用基底神经节信号的反馈控制。
Objective. Contemporary deep brain stimulation (DBS) for Parkinson's disease is delivered continuously, and adjustments based on patient's changing symptoms must be made manually by a trained clinician. Patients may be subjected to energy intensive settings at times when they are not needed, possibly resulting in stimulation-induced adverse effects, such as dyskinesia. One solution is 'adaptive' DBS, in which stimulation is modified in real time based on neural signals that co-vary with the severity of motor signs or of stimulation-induced adverse effects. Here we show the feasibility of adaptive DBS using a fully implanted neural prosthesis. Approach. We demonstrate adaptive deep brain stimulation in two patients with Parkinson's disease using a fully implanted neural prosthesis that is enabled to utilize brain sensing to control stimulation amplitude (Activa PC + S). We used a cortical narrowband gamma (60-90 Hz) oscillation related to dyskinesia to decrease stimulation voltage when gamma oscillatory activity is high (indicating dyskinesia) and increase stimulation voltage when it is low. Main results. We demonstrate the feasibility of 'adaptive deep brain stimulation' in two patients with Parkinson's disease. In short term in-clinic testing, energy savings were substantial (38%-45%), and therapeutic efficacy was maintained. Significance. This is the first demonstration of adaptive DBS in Parkinson's disease using a fully implanted device and neural sensing. Our approach is distinct from other strategies utilizing basal ganglia signals for feedback control.