可感知脑起搏器在丘脑底核脑深部电刺激治疗帕金森病中的初步应用

A preliminary study on the application of brain sensing technology in the treatment of Parkinson's disease with deep brain stimulation of the subthalamic nucleus

目的初步观察可感知脑起搏器(Percept PC)在丘脑底核(STN)脑深部电刺激(DBS)治疗帕金森病(PD)中的应用,并与Lead-DBS成像技术对比在开机程控中的作用。方法纳入2023年1-9月在解放军总医院第一医学中心神经外科医学部(10例)及其他两家医院神经外科(5例)接受STN-DBS的原发性PD患者进行回顾性研究。其中Percept PC组5例、Lead-DBS组10例。Percept PC组根据监测到的电生理信息选择程控触点,β频段局部场电位(LFP)振幅最高的触点作为开机触点;Lead-DBS组由Lead-DBS成像软件辅助,针对核团内触点采用传统的方法开机程控。观察Percept PC的记录情况,比较两组首次开机程控情况。结果5例Percept PC组患者,术后开启Timeline功能,均记录到微毁损效应的LFP表现;通过"Survey"功能和"Streaming"功能观察到的LFP波动,确定开机触点和刺激电流后,5例患者的临床症状均有所改善。首次开机测试,Percept PC组与Lead-DBS组的程控耗时分别为(44.0±4.2)min、(63.9±6.2)min,测试中出现不良反应的次数[M(Q_(1),Q_(3))]分别为0(0,1)次、2(1,3)次,差异均有统计学意义(均P<0.05)。开机后,Percept PC组与Lead-DBS组的统一帕金森病评定量表第三部分评分的改善率分别为(65.2±7.3)%、(75.4±18.7)%;服药后每日左旋多巴等效剂量的减少率[M(Q_(1),Q_(3))]分别为37.2(7.1,44.8)%、28.9(11.0,42.5)%,差异均无统计学意义(均P>0.05)。结论STN-DBS治疗PD中应用可感知脑起搏器通过感知功能选择程控触点,可有效缓解患者的临床症状;与Lead-DBS成像技术辅助程控比较,开机程控时间短、发生不良反应的次数少。

Objective To preliminarily explore the application of Percept PC in the treatment of Parkinson's disease(PD)with deep brain stimulation(DBS)of the subthalamic nucleus(STN),and to compare the effect on initial programming with Lead-DBS imaging technology.Methods A retrospective study was conducted on 15 patients with primary PD who received STN-DBS at the Department of Neurosurgery,the First Medical Center of Chinese PLA General Hospital and the Neurosurgery Department of two other hospitals from January 2023 to September 2023.Among them,there were 5 cases in the Percept PC group and 10 cases in the Lead-DBS group.In the Percept PC group,the programmed contacts were chosen based on the monitored electrophysiological information,and the contacts with the highest local field potential(LFP)amplitude in the beta frequency band were used as the active contact in initial programming.In the Lead-DBS group,Lead-DBS imaging software was used to assist in choosing active contacts located in the targets and performing initial programming with the traditional method.We then observed the recording status of Percept PC and compared the initial programming of the two groups.Results In 5 patients in the Percept PC group,the Timeline function was turned on after surgery,and the LFP change of the micro-lesion effect was recorded in all case.The LFP fluctuations were observed through the Survey function and Streaming function.The clinical symptoms of all 5 patients were improved after determining the active stimulation contacts and currents.In initial programming,the programming time of the Percept PC group and the Lead-DBS group were 44.0±4.2 min and 63.9±6.2 min respectively;the median(Q_(1),Q_(3))number of adverse reactions during the test was 0(0,1)times and 2(1,3)times,and the differences were statistically significant(both P<0.05).After turning on the device,the improvement rate of the score assessed based on the third part of the Unified Parkinson's Disease Rating Scale in the Percept PC group and the Lead-DBS group was(65.2±7.3)%and(75.4±18.7)%respectively;the median(Q_(1),Q_(3))reduction rate of equivalent dose of levodopa after surgery in the Percept PC group and the Lead-DBS group was 37.2%(7.1%,44.8%)and 28.9%(11.0%,42.5%)respectively,and the diferences were not statistically significant(both P>O.05).Conclusions The application of Percept PC in STN-DBS treatment of PD can effectively alleviate the clinical symptoms of patients by selecting programmed contacts through brain sensing function.Compared with Lead-DBS imaging technology-assisted programming,Percept PC is associated with shorter initial programming time and less occurrence of adverse reactions.