Unraveling the complexities of programming neural adaptive deep brain stimulation in Parkinson's disease.
Unraveling the complexities of programming neural adaptive deep brain stimulation in Parkinson's disease.
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DOI：
10.3389/fnhum.2023.1310393
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发表时间：
2023
影响因子：
2.9
通讯作者：
Bronte-Stewart, Helen M.
中科院分区：
文献类型：
--
作者：
Wilkins, Kevin B.;Melbourne, Jillian A.;Akella, Pranav;Bronte-Stewart, Helen M.
关键词：
在过去的三十年里，深度脑刺激（DBS）治疗帕金森病（PD）一直以连续开环的方式应用，对给定患者的状态或症状在一天中的变化没有反应。近期神经刺激器技术的进步使得闭环自适应DBS （aDBS）在不久的将来作为PD的治疗选择成为可能，其中刺激以需求为基础的方式进行调整。虽然aDBS为治疗运动症状提供了巨大的临床潜力，但它也带来了更好地了解如何实施以最大化其益处的需要。从这个角度来看，我们根据我们在几种aDBS功能研究神经刺激器上的经验，概述了aDBS编程几个关键参数的考虑因素。aDBS的核心是成功识别相关的生物标志物，这些生物标志物可以实时可靠地测量，并与控制刺激适应的控制策略相结合。然而，辅助参数，如允许增产的适应窗口，以及它的变化速度，也会对性能产生影响，并根据控制策略和患者而变化。一个标准化的aDBS编程方案是保证其在临床实践中有效应用的关键。
Over the past three decades, deep brain stimulation (DBS) for Parkinson’s disease (PD) has been applied in a continuous open loop fashion, unresponsive to changes in a given patient’s state or symptoms over the course of a day. Advances in recent neurostimulator technology enable the possibility for closed loop adaptive DBS (aDBS) for PD as a treatment option in the near future in which stimulation adjusts in a demand-based manner. Although aDBS offers great clinical potential for treatment of motor symptoms, it also brings with it the need for better understanding how to implement it in order to maximize its benefits. In this perspective, we outline considerations for programing several key parameters for aDBS based on our experience across several aDBS-capable research neurostimulators. At its core, aDBS hinges on successful identification of relevant biomarkers that can be measured reliably in real-time working in cohesion with a control policy that governs stimulation adaption. However, auxiliary parameters such as the window in which stimulation is allowed to adapt, as well as the rate it changes, can be just as impactful on performance and vary depending on the control policy and patient. A standardize protocol for programming aDBS will be crucial to ensuring its effective application in clinical practice.
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