Adaptive deep brain stimulation in advanced Parkinson disease.
Adaptive deep brain stimulation in advanced Parkinson disease.
复制标题
晚期帕金森病的自适应深脑刺激。
DOI：
10.1002/ana.23951
复制
发表时间：
2013-09
影响因子：
11.2
通讯作者：
Brown, Peter
中科院分区：
文献类型：
--
作者：
Little, Simon;Pogosyan, Alex;Neal, Spencer;Zavala, Baltazar;Zrinzo, Ludvic;Hariz, Marwan;Foltynie, Thomas;Limousin, Patricia;Ashkan, Keyoumars;FitzGerald, James;Green, Alexander L.;Aziz, Tipu Z.;Brown, Peter
目的：脑机接口（BCI）可能用于与病理性脑信号相互作用，以干预和改善其在疾病状态下的影响。在这里，我们通过使用BCI来解释晚期帕金森病（PD）患者的病理性脑活动，并使用这种反馈来控制何时提供治疗性脑深部电刺激（DBS），从而提供了这种方法的原理证明。我们的目标是证明，通过个性化和优化刺激在真实的时间，我们可以提高传统的连续DBS的疗效和效率。方法：对8例PD患者进行BCI控制的丘脑底核自适应DBS（aDBS）。通过处理直接从刺激电极记录的局部场电位来提供反馈。将结果与无刺激、常规连续刺激（cDBS）和随机间歇刺激进行比较。使用统一帕金森病评定量表进行运动效应的揭盲和设盲临床评估。结果如下：在aDBS期间，运动评分改善了66%（非盲）和50%（盲），分别比cDBS好29%（p = 0.03）和27%（p = 0.005）。与cDBS相比，刺激时间减少了56%，能量需求相应减少（p <0.001）。aDBS也比无刺激和随机间歇刺激更有效。解释BCI控制的DBS是易于处理的，并且可以比用于PD的常规连续神经调节更高效和有效。《神经学年鉴》2013; 74：449 - 457
Objective: Brain–computer interfaces (BCIs) could potentially be used to interact with pathological brain signals to intervene and ameliorate their effects in disease states. Here, we provide proof-of-principle of this approach by using a BCI to interpret pathological brain activity in patients with advanced Parkinson disease (PD) and to use this feedback to control when therapeutic deep brain stimulation (DBS) is delivered. Our goal was to demonstrate that by personalizing and optimizing stimulation in real time, we could improve on both the efficacy and efficiency of conventional continuous DBS. Methods: We tested BCI-controlled adaptive DBS (aDBS) of the subthalamic nucleus in 8 PD patients. Feedback was provided by processing of the local field potentials recorded directly from the stimulation electrodes. The results were compared to no stimulation, conventional continuous stimulation (cDBS), and random intermittent stimulation. Both unblinded and blinded clinical assessments of motor effect were performed using the Unified Parkinson's Disease Rating Scale. Results: Motor scores improved by 66% (unblinded) and 50% (blinded) during aDBS, which were 29% (p = 0.03) and 27% (p = 0.005) better than cDBS, respectively. These improvements were achieved with a 56% reduction in stimulation time compared to cDBS, and a corresponding reduction in energy requirements (p < 0.001). aDBS was also more effective than no stimulation and random intermittent stimulation. Interpretation BCI-controlled DBS is tractable and can be more efficient and efficacious than conventional continuous neuromodulation for PD. Ann Neurol 2013;74:449–457
登录
查看更多内容
影响因子：
2.9
作者：
Popovych OV;Tass PA
通讯作者：
Tass PA
影响因子：
3.4
作者：
Kühn, AA;Kupsch, A;Brown, P
通讯作者：
Brown, P
影响因子：
8.6
作者：
Blahak, Christian;Baezner, Hansjoerg;Krauss, Joachim K.
通讯作者：
Krauss, Joachim K.
影响因子：
1.7
作者：
O'Gorman, Ruth L.;Jarosz, Josef M.;Ashkan, Keyoumars
通讯作者：
Ashkan, Keyoumars
影响因子：
5.3
作者：
Brown, P;Oliviero, A;Di Lazzaro, V
通讯作者：
Di Lazzaro, V