Phase dependent modulation of tremor amplitude in essential tremor through thalamic stimulation.
Phase dependent modulation of tremor amplitude in essential tremor through thalamic stimulation.
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DOI：
10.1093/brain/awt239
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发表时间：
2013-10
期刊：
影响因子：
--
通讯作者：
Brown P
中科院分区：
文献类型：
--
作者：
Cagnan H;Brittain JS;Little S;Foltynie T;Limousin P;Zrinzo L;Hariz M;Joint C;Fitzgerald J;Green AL;Aziz T;Brown P
丘脑的高频脑深部刺激可以帮助改善严重的原发性震颤。在这里，我们将探讨如何在这种情况下提高丘脑深部脑刺激的疗效，效率和选择性。我们从这样的假设开始，即电刺激对特发性震颤的影响可能是相位依赖性的，并且特别是，存在刺激优先导致震颤幅度降低的震颤相位。后者可以用来改善脑深部电刺激，特别是如果震颤抑制可以通过累积效应得到加强。因此，我们刺激10例原发性震颤和丘脑电极，同时记录震颤幅度和相位。姿势性震颤频率附近的刺激夹带震颤。震颤幅度也根据在震颤周期中递送刺激脉冲的相位进行调制。在震颤周期的一半中的刺激使中位震颤幅度降低了10%，而在震颤周期的另一半中的刺激使震颤幅度增加了类似的量。在最佳相位对准时，震颤抑制达到27%。此外，震颤幅度表现出非线性增加的抑制程度与连续的刺激，震颤抑制增加三倍，如果刺激之前由四个刺激与震颤，表明累积的，可能是塑料的，效果类似的相位关系。本结果为跟踪震颤相位以控制何时递送深部脑刺激脉冲以治疗原发性震颤的刺激系统铺平了道路。这将允许通过将刺激集中在用于抑制的最佳阶段上并且通过确保这在许多周期内重复以便利用累积效应来使治疗效果最大化。这样的系统可能以比当前高频刺激方法少得多的功率需求和更大的特异性实现震颤控制，并且可以降低耐受性和反弹的风险。
High frequency deep brain stimulation of the thalamus can help ameliorate severe essential tremor. Here we explore how the efficacy, efficiency and selectivity of thalamic deep brain stimulation might be improved in this condition. We started from the hypothesis that the effects of electrical stimulation on essential tremor may be phase dependent, and that, in particular, there are tremor phases at which stimuli preferentially lead to a reduction in the amplitude of tremor. The latter could be exploited to improve deep brain stimulation, particularly if tremor suppression could be reinforced by cumulative effects. Accordingly, we stimulated 10 patients with essential tremor and thalamic electrodes, while recording tremor amplitude and phase. Stimulation near the postural tremor frequency entrained tremor. Tremor amplitude was also modulated depending on the phase at which stimulation pulses were delivered in the tremor cycle. Stimuli in one half of the tremor cycle reduced median tremor amplitude by ∼10%, while those in the opposite half of the tremor cycle increased tremor amplitude by a similar amount. At optimal phase alignment tremor suppression reached 27%. Moreover, tremor amplitude showed a non-linear increase in the degree of suppression with successive stimuli; tremor suppression was increased threefold if a stimulus was preceded by four stimuli with a similar phase relationship with respect to the tremor, suggesting cumulative, possibly plastic, effects. The present results pave the way for a stimulation system that tracks tremor phase to control when deep brain stimulation pulses are delivered to treat essential tremor. This would allow treatment effects to be maximized by focussing stimulation on the optimal phase for suppression and by ensuring that this is repeated over many cycles so as to harness cumulative effects. Such a system might potentially achieve tremor control with far less power demand and greater specificity than current high frequency stimulation approaches, and may lower the risk for tolerance and rebound.
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影响因子：
14.5
作者：
HASSLER, R;RIECHERT, T;GANGLBERGER, JA
通讯作者：
GANGLBERGER, JA
影响因子：
2.9
作者：
Ermentrout, B
通讯作者：
Ermentrout, B
影响因子：
5.5
作者：
JAHNSEN, H;LLINAS, R
通讯作者：
LLINAS, R
影响因子：
25
作者：
Egger, V;Feldmeyer, D;Sakmann, B
通讯作者：
Sakmann, B
影响因子：
168.9
作者：
Hellwig, B;Häussler, S;Lücking, CH
通讯作者：
Lücking, CH