Closing the loop of deep brain stimulation.
Closing the loop of deep brain stimulation.
复制标题
DOI：
10.3389/fnsys.2013.00112
复制
发表时间：
2013-12-20
影响因子：
3
通讯作者：
Hammond C
中科院分区：
文献类型：
--
作者：
Carron R;Chaillet A;Filipchuk A;Pasillas-Lépine W;Hammond C
高频脑深部刺激被用于治疗广泛的大脑疾病，如帕金森氏症。受刺激的神经网络通常具有共同的电生理特征，包括多动和/或心律失常。从临床角度来看，HFS有望在不产生不良反应的情况下缓解临床症状。在这里，我们考虑经典的开环HFS是否满足这些标准，并概述目前对不同类型的闭环式DBS的实验或理论研究，这些研究可以提供更好的临床结果。在综述的第一部分，探索了HFS诱发轴突棘波的两条途径。在一个方向上，顺序性棘波在功能上使受刺激的核团从其下游靶网络中去传入。在相反的方向上，反向棘波防止这个核团受到其传入网络的影响。结果，病理性的同步活动不再从皮质网络传播到受刺激的核。总体结果可以被描述为刺激核从其上游和下游核可逆的功能性去传入。在综述的第二部分中，讨论了闭环式DBS的最新进展。一些建议的方法是基于数学模型，这些模型强调帕金森氏症基底节的不同方面：过度同步，异常的放电率节律，以及丘脑皮质中继站的不足。刺激策略根据它们所基于的控制理论技术进行分类：自适应和按需刺激方案、延迟和多点方法、基于比例和/或导数控制动作的刺激、最优控制策略。这些策略中的一些已经在实验中得到了验证，但仍有大量的理论工作可能指向改进实际治疗的方法。
High-frequency deep brain stimulation is used to treat a wide range of brain disorders, like Parkinson's disease. The stimulated networks usually share common electrophysiological signatures, including hyperactivity and/or dysrhythmia. From a clinical perspective, HFS is expected to alleviate clinical signs without generating adverse effects. Here, we consider whether the classical open-loop HFS fulfills these criteria and outline current experimental or theoretical research on the different types of closed-loop DBS that could provide better clinical outcomes. In the first part of the review, the two routes followed by HFS-evoked axonal spikes are explored. In one direction, orthodromic spikes functionally de-afferent the stimulated nucleus from its downstream target networks. In the opposite direction, antidromic spikes prevent this nucleus from being influenced by its afferent networks. As a result, the pathological synchronized activity no longer propagates from the cortical networks to the stimulated nucleus. The overall result can be described as a reversible functional de-afferentation of the stimulated nucleus from its upstream and downstream nuclei. In the second part of the review, the latest advances in closed-loop DBS are considered. Some of the proposed approaches are based on mathematical models, which emphasize different aspects of the parkinsonian basal ganglia: excessive synchronization, abnormal firing-rate rhythms, and a deficient thalamo-cortical relay. The stimulation strategies are classified depending on the control-theory techniques on which they are based: adaptive and on-demand stimulation schemes, delayed and multi-site approaches, stimulations based on proportional and/or derivative control actions, optimal control strategies. Some of these strategies have been validated experimentally, but there is still a large reservoir of theoretical work that may point to ways of improving practical treatment.