Feed back and feed forward control of brain function by the deep brain stimulation system.

脑深部刺激（DBS）丘脑（Vo/Vim）已成为一种流行的手段，控制不自主运动，包括中风后的运动障碍。我们还发现中风后的运动障碍和运动无力有时可以通过运动皮质刺激（MCS）来控制。在某些形式的运动障碍中，只有当患者想要移动身体时，运动功能障碍才会变得明显。我们已经开发了一种按需型刺激系统，通过检测运动意图的内在信号来触发刺激。这种系统代表了无意识运动的前馈控制（FFC）。我们在此报告DBS和MCS控制脑卒中后运动障碍的经验，并讨论FFC的价值。在28例伴有半动脉粥样硬化、半偏瘫性震颤和运动无力的患者中，有20例通过常规DBS和/或MCS实现了卒中后运动障碍的良好控制。在6例通过常规DBS或MCS表现出卒中后姿势性震颤或运动无力良好控制的患者中测试了FFC。当向系统输入与姿势或运动意图相关的肌肉活动时，4例体位性震颤患者中的4例和2例运动无力患者中的2例的按需刺激提供了满意的FFC。这些发现为脑卒中后运动障碍患者DBS和MCS的进一步临床研究提供了依据。按需式刺激系统也可用于克服各种中风后运动障碍。

Deep brain stimulation (DBS) of the thalamus (Vo/Vim) has become popular as a means of controlling involuntary movements, including post-stroke movement disorders. We have also found that post-stroke movement disorders and motor weakness can sometimes be controlled by motor cortex stimulation (MCS). In some forms of movement disorders, motor dysfunction becomes evident only when patients intend to move their body. We have developed an on-demand type stimulation system which triggers stimulation by detecting intrinsic signals of intention to move. Such a system represents feed-forward control (FFC) of involuntary movements. We report here our experience of DBS and MCS for controlling post-stroke movement disorders, and discuss the value of FFC. Excellent control of post-stroke movement disorders was achieved by conventional DBS and/or MCS in 20 of 28 patients with hemichoreoathetosis, hemiballism tremor and motor weakness. FFC was tested in 6 patients who demonstrated excellent control of post-stroke postural tremor or motor weakness by conventional DBS or MCS. The on-demand stimulation provided satisfactory FFC in 4 of 4 patients with postural tremor and 2 of 2 patients with motor weakness, when the activity of muscles involved in posturing or intention to move was fed into the system. These findings justify further clinical studies on DBS and MCS in patients with post-stroke movement disorders. The on-demand type stimulation system may also be useful for overcoming various post-stroke movement disorders.