Effect of subthalamic coordinated reset deep brain stimulation on Parkinsonian gait.
Effect of subthalamic coordinated reset deep brain stimulation on Parkinsonian gait.
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DOI：
10.3389/fninf.2023.1185723
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发表时间：
2023
影响因子：
3.5
通讯作者：
Wang, Jing
中科院分区：
文献类型：
--
作者：
Bosley, Kai M.;Luo, Ziling;Amoozegar, Sana;Acedillo, Kit;Nakajima, Kanon;Johnson, Luke A.;Vitek, Jerrold L.;Wang, Jing
协调复位脑深部电刺激（CR DBS）是一种用于治疗帕金森病（PD）的新型DBS方法，通过DBS电极导线的多个触点使用较低水平的爆发刺激。尽管CR DBS已被证明对刺激停止后的僵硬、震颤、运动迟缓和运动不能具有持续的治疗效果，即，携带效应，其对帕金森病步态的影响尚未得到很好的研究。步态受损是PD的一种致残症状，通常与跌倒风险较高和生活质量降低相关。本研究的目的是探讨丘脑底CR DBS对帕金森病步态的遗留效应。使三只非人类灵长类动物（NHP）患帕金森病，并在丘脑底核（DBS）中植入DBS电极导线。对于每只动物，在连续5天内每天输送几个小时的TCR-DBS。每天早晨使用针对NHP使用而修改的临床评定量表（mHRS），以监测CR DBS对僵硬、震颤、运动不能和运动迟缓的遗留效应。对DBS前后步态进行定量评估。计算步幅和摆动速度，并与基线、刺激前条件进行比较。在所有三只动物中，CR DBS后观察到僵硬、运动迟缓和运动不能的遗留改善。在所有动物中均观察到摆动速度增加;然而，仅在NHP B2中观察到步长改善。此外，在NHP B2中评价了使用两种不同脉冲串频率的TCR-DBS，并观察到了对mCR-RS评分和步态的不同影响。虽然是初步的，我们的研究结果表明，当刺激参数选择得当时，TCR-DBS可以改善帕金森病步态以及其他运动体征。本研究进一步支持CR DBS作为PD的新型治疗方法的持续发展，并强调了其临床应用中参数选择的重要性。
Coordinated Reset Deep Brain Stimulation (CR DBS) is a novel DBS approach for treating Parkinson's disease (PD) that uses lower levels of burst stimulation through multiple contacts of the DBS lead. Though CR DBS has been demonstrated to have sustained therapeutic effects on rigidity, tremor, bradykinesia, and akinesia following cessation of stimulation, i.e., carryover effect, its effect on Parkinsonian gait has not been well studied. Impaired gait is a disabling symptom of PD, often associated with a higher risk of falling and a reduced quality of life. The goal of this study was to explore the carryover effect of subthalamic CR DBS on Parkinsonian gait. Three non-human primates (NHPs) were rendered Parkinsonian and implanted with a DBS lead in the subthalamic nucleus (STN). For each animal, STN CR DBS was delivered for several hours per day across five consecutive days. A clinical rating scale modified for NHP use (mUPDRS) was administered every morning to monitor the carryover effect of CR DBS on rigidity, tremor, akinesia, and bradykinesia. Gait was assessed quantitatively before and after STN CR DBS. The stride length and swing speed were calculated and compared to the baseline, pre-stimulation condition. In all three animals, carryover improvements in rigidity, bradykinesia, and akinesia were observed after CR DBS. Increased swing speed was observed in all the animals; however, improvement in stride length was only observed in NHP B2. In addition, STN CR DBS using two different burst frequencies was evaluated in NHP B2, and differential effects on the mUPDRS score and gait were observed. Although preliminary, our results indicate that STN CR DBS can improve Parkinsonian gait together with other motor signs when stimulation parameters are properly selected. This study further supports the continued development of CR DBS as a novel therapy for PD and highlights the importance of parameter selection in its clinical application.
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