Local Field Potential-Based Programming: A Proof-of-Concept Pilot Study
Local Field Potential-Based Programming: A Proof-of-Concept Pilot Study
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DOI：
10.1111/ner.13520
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发表时间：
2021-08-18
期刊：
影响因子：
2.8
通讯作者：
Kalia, Suneil K.
中科院分区：
文献类型：
--
作者：
Fasano, Alfonso;Gorodetsky, Carolina;Kalia, Suneil K.
目标
深部脑刺激（DBS）编程仍然基于试错法，对于治疗医生和患者来说往往是一个耗时的过程。已经提出了几种策略来简化DBS编程，其中大多数是初步的，并且主要针对帕金森病，这种疾病对DBS调整反应良好。在本原理验证性试点研究中，我们成功地证明，当用于受益具有延迟时间发作的DBS适应症时，基于局部场电位（LFP）的编程可以是一种有效的方法。
材料和方法
使用一种最近商业化的植入式脉冲发生器（IPG），其具有在植入后能够无创且长期传输来自DBS电极的实时和/或记录LFP的能力，对一名患有全身性肌张力障碍的儿童患者和一名对多种药物和迷走神经刺激均难治的癫痫成年患者进行编程。
结果
IPG检测功能在第一名患者的左侧苍白球的δ波段（1.95Hz）检测到一个峰值。当在靠近触点9和10的脑区域记录时检测到这种LFP，而在从其他区域记录时则不存在。对1.95Hz LFP的长期记录以及两组刺激显示，与肌张力障碍恶化相关的设置下功率增加更大。在第二名患者中，使用“失神发作”和“局灶性/部分性发作”的宽带LFP家庭记录，并使用IPG的“时间轴”和“事件”功能进行查看。对2.93Hz和8.79Hz（尖峰检测）的长期记录显示，与癫痫控制相关的刺激设置下功率降低。
结论
本试点概念验证研究中提出的方法可能为需要临床医生和患者等待数周才能看到任何临床益处的疾病的DBS编程提供信息并简化其过程。有必要对更大样本的患者进行前瞻性研究。
Objectives Programming deep brain stimulation (DBS) is still based on a trial-and-error approach, often becoming a time-consuming process for both treating physicians and patients. Several strategies have been proposed to streamline DBS programming, most of which are preliminary and mainly address Parkinson's disease, a condition readily responsive to DBS adjustments. In the present proof-of-principle pilot study, we successfully demonstrate that local field potentials (LFP)-based programming can be an effective approach when used for DBS indications that have a delayed temporal onset of benefit. Materials and Methods A recently commercialized implantable pulse generator (IPG) with the capability to non-invasively and chronically stream live and/or record LFPs from DBS electrode after implantation was used to program one pediatric patient with generalized dystonia and an adult with seizures refractory to multiple medications and vagal nerve stimulation. Results The IPG survey function detected a peak in the delta range (1.95 Hz) in the left globus pallidus of first patient. This LFP was detected when recording in the brain area adjacent to contacts 9 and 10 and absent when recording from other areas. The chronic recording of the 1.95 Hz LFP with two sets of stimulation showed a greater power increase with the settings associated with a worsening of dystonia. Broadband LFP home recording of "absence seizure" and "focal/partial seizure" was used in the second patient and reviewer with the IPG "timeline" and "event" functions. The chronic recording of the 2.93 Hz and 8.79 Hz (spit sensing) showed a reduced power with the stimulation setting associated with seizure control. Conclusions The approach presented in this pilot proof-of-concept study may inform and streamline the DBS programming for conditions requiring clinicians and patients to wait weeks before appreciating any clinical benefit. Prospective studies on larger samples of patients are warranted.