Entraining stepping movements of Parkinson's patients to alternating subthalamic nucleus deep brain stimulation
Entraining stepping movements of Parkinson's patients to alternating subthalamic nucleus deep brain stimulation
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交替丘脑底核深部脑电刺激帕金森病患者的步进运动
DOI：
10.1101/2020.08.16.253062
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发表时间：
2020
期刊：
影响因子：
--
通讯作者：
Fischer P
中科院分区：
文献类型：
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作者：
Fischer P
晚期帕金森病患者可以通过丘脑底核 (STN) 的深部脑刺激 (DBS) 进行治疗。这提供了一个独特的机会来记录这个核并以受控的方式刺激它。先前的研究表明，当帕金森病患者进行迈步运动时，STN 的活动会以有节奏的模式进行调节，这提出了 STN 是否参与迈步动态控制的问题。为了回答这个问题，我们测试了类似于 STN 中与迈步相关的活动调节的交替刺激模式是否可以引导患者的迈步运动，作为 STN 参与迈步控制的证据。对 10 名帕金森病患者（一名女性）的分组分析表明，交替刺激显着地控制了踏步节奏。我们发现，当刺激速度接近五名患者的步进速度时，步进和刺激周期之间存在非常一致的一致性，这表明刺激周期具有显着的个体夹带作用。我们的研究表明，STN 因果性地参与了步伐计时的动态控制，并激发了对这种仿生刺激模式的进一步探索，作为开发改善步态障碍的 DBS 策略的潜在基础。意义陈述我们测试了人类的丘脑底核 (STN) 是否因果性地参与了控制步进运动。为此，我们研究了接受过深部脑刺激 (DBS) 治疗的帕金森病患者，因为我们可以以受控方式刺激这些个体的 STN。我们开发了一种交替刺激模式，模仿步进过程中该核中记录的活动调节模式。交替 DBS (altDBS) 可以控制患者的步态节奏，表明 STN 在动态步态控制中具有因果作用。这种类型的刺激可能成为改进 DBS 步态策略的基础。
Patients with advanced Parkinson's can be treated by deep brain stimulation (DBS) of the subthalamic nucleus (STN). This affords a unique opportunity to record from this nucleus and stimulate it in a controlled manner. Previous work has shown that activity in the STN is modulated in a rhythmic pattern when Parkinson's patients perform stepping movements, raising the question whether the STN is involved in the dynamic control of stepping. To answer this question, we tested whether an alternating stimulation pattern resembling the stepping-related modulation of activity in the STN could entrain patients' stepping movements as evidence of the STN's involvement in stepping control. Group analyses of 10 Parkinson's patients (one female) showed that alternating stimulation significantly entrained stepping rhythms. We found a remarkably consistent alignment between the stepping and stimulation cycle when the stimulation speed was close to the stepping speed in the five patients that demonstrated significant individual entrainment to the stimulation cycle. Our study suggests that the STN is causally involved in dynamic control of step timing and motivates further exploration of this biomimetic stimulation pattern as a potential basis for the development of DBS strategies to ameliorate gait impairments.SIGNIFICANCE STATEMENTWe tested whether the subthalamic nucleus (STN) in humans is causally involved in controlling stepping movements. To this end, we studied patients with Parkinson's disease who have undergone therapeutic deep brain stimulation (DBS), as in these individuals we can stimulate the STNs in a controlled manner. We developed an alternating pattern of stimulation that mimics the pattern of activity modulation recorded in this nucleus during stepping. The alternating DBS (altDBS) could entrain patients' stepping rhythm, suggesting a causal role of the STN in dynamic gait control. This type of stimulation may potentially form the basis for improved DBS strategies for gait.