Motion sensor strategies for automated optimization of deep brain stimulation in Parkinson's disease.
Motion sensor strategies for automated optimization of deep brain stimulation in Parkinson's disease.
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DOI：
10.1016/j.parkreldis.2015.01.018
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发表时间：
2015-04
影响因子：
4.1
通讯作者：
Vitek JL
中科院分区：
文献类型：
--
作者：
Pulliam CL;Heldman DA;Orcutt TH;Mera TO;Giuffrida JP;Vitek JL
深部脑刺激（DBS）是一种公认的治疗帕金森病（PD）的方法。DBS设置的优化可能是一个挑战，因为必须考虑许多变量，包括多个运动信号的存在、副作用和电池寿命。9名PD患者在术后约1、2和4个月访问诊所进行编程。在每次会议中，评估各种刺激设置，受试者在佩戴运动传感器以量化震颤和运动迟缓的同时执行运动任务。在每个疗程结束时，临床医生使用标准做法确定最终的刺激设置。在编程过程中收集的基于传感器的运动症状严重程度评级，然后用于开发两种自动编程算法-一种用于优化症状益处，另一种用于优化电池寿命。将临床医生最终确定的DBS设置与自动算法计算的DBS设置之间的治疗效果进行比较。与临床医生的设置相比，使用症状优化算法确定的设置通常会以增加刺激幅度为代价，将运动症状额外减少13个百分点。通过增加电池寿命限制，该算法能够将刺激幅度平均降低50%，同时保持临床医生对部分编程会话设置观察到的治疗效果水平。DBS编程中的客观评估可以识别改善症状或获得与临床医生相似的电池寿命改善的设置。这两种选择都有可能改善术后患者的预后。
Deep brain stimulation (DBS) is a well-established treatment for Parkinson’s disease (PD). Optimization of DBS settings can be a challenge due to the number of variables that must be considered, including presence of multiple motor signs, side effects, and battery life. Nine PD subjects visited the clinic for programming at approximately 1, 2, and 4 months post-surgery. During each session, various stimulation settings were assessed and subjects performed motor tasks while wearing a motion sensor to quantify tremor and bradykinesia. At the end of each session, a clinician determined final stimulation settings using standard practices. Sensor-based ratings of motor symptom severities collected during programming were then used to develop two automated programming algorithms – one to optimize symptom benefit and another to optimize battery life. Therapeutic benefit was compared between the final clinician-determined DBS settings and those calculated by the automated algorithm. Settings determined using the symptom optimization algorithm would have reduced motor symptoms by an additional 13 percentage points when compared to clinician settings, typically at the expense of increased stimulation amplitude. By adding a battery life constraint, the algorithm would have been able to decrease stimulation amplitude by an average of 50% while maintaining the level of therapeutic benefit observed using clinician settings for a subset of programming sessions. Objective assessment in DBS programming can identify settings that improve symptoms or obtain similar benefit as clinicians with improvement in battery life. Both options have the potential to improve post-operative patient outcomes.
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影响因子：
8.6
作者：
Heldman, Dustin A.;Giuffrida, Joseph P.;Chen, Robert;Payne, Megan;Mazzella, Filomena;Duker, Andrew P.;Sahay, Alok;Kim, Sang Jin;Revilla, Fredy J.;Espay, Alberto J.
通讯作者：
Espay, Alberto J.
影响因子：
--
作者：
Moro, Elena;Poon, Yu-Yan W.;Lang, Anthony E.
通讯作者：
Lang, Anthony E.
影响因子：
4.1
作者：
Katayama, Y;Kasai, M;Mizutani, T
通讯作者：
Mizutani, T
影响因子：
4.1
作者：
Hariz, Marwan
通讯作者：
Hariz, Marwan
影响因子：
8.6
作者：
Volkmann, J;Moro, E;Pahwa, R
通讯作者：
Pahwa, R