Objectives

Programming deep brain stimulation (DBS) is still based on a trial-and-error approach, often becoming a time-consuming process for both treating physicians and patients. Several strategies have been proposed to streamline DBS programming, most of which are preliminary and mainly address Parkinson's disease, a condition readily responsive to DBS adjustments. In the present proof-of-principle pilot study, we successfully demonstrate that local field potential (LFP)-based programming can be an effective approach when used for DBS indications that have a delayed temporal onset of benefit.

Materials and Methods

A recently commercialized implantable pulse generator (IPG) with the capability to non-invasively and chronically stream live and/or record LFPs from a DBS electrode after implantation was used to program one pediatric patient with generalized dystonia and an adult with seizures refractory to multiple medications and vagal nerve stimulation.

Results

The IPG survey function detected a peak in the delta range (1.95 Hz) in the left globus pallidus of the first patient. This LFP was detected when recording in the brain area adjacent to contacts 9 and 10 and absent when recording from other areas. The chronic recording of the 1.95 Hz LFP with two sets of stimulation showed a greater power increase with the settings associated with a worsening of dystonia. Broadband LFP home recording of “absence seizure” and “focal/partial seizure” was used in the second patient and reviewer with the IPG “timeline” and “event” functions. The chronic recording of the 2.93 Hz and 8.79 Hz (spit sensing) showed a reduced power with the stimulation setting associated with seizure control.

Conclusions

The approach presented in this pilot proof-of-concept study may inform and streamline the DBS programming for conditions requiring clinicians and patients to wait weeks before appreciating any clinical benefit. Prospective studies on larger samples of patients are warranted.

中文翻译：

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基于局部场电位的编程：概念验证试点研究

目标

对深部脑刺激 (DBS) 进行编程仍然基于反复试验的方法，对于治疗医生和患者而言，这往往成为一个耗时的过程。已经提出了几种策略来简化 DBS 编程，其中大部分是初步的，主要解决帕金森病，这是一种很容易对 DBS 调整做出反应的疾病。在目前的原理验证试点研究中，我们成功地证明了基于局部场电位 (LFP) 的编程在用于具有延迟时间起效的 DBS 适应症时是一种有效的方法。

材料和方法

最近商业化的植入式脉冲发生器 (IPG) 能够在植入后从 DBS 电极进行无创和长期实时流式传输和/或记录 LFP，用于对一名患有全身性肌张力障碍的儿科患者和一名患有多种药物难以控制的癫痫发作的成人进行编程和迷走神经刺激。

结果

IPG 调查功能在第一位患者的左苍白球中检测到 delta 范围 (1.95 Hz) 的峰值。此 LFP 在与触点 9 和 10 相邻的大脑区域记录时检测到，而在其他区域记录时则不存在。1.95 Hz LFP 与两组刺激的慢性记录显示，随着与肌张力障碍恶化相关的设置，功率增加更大。“失神发作”和“局灶性/部分性发作”的宽带 LFP 家庭记录用于第二位患者和具有 IPG“时间线”和“事件”功能的审阅者。2.93 Hz 和 8.79 Hz（唾液感应）的慢性记录显示与癫痫控制相关的刺激设置降低了功率。

结论

该试点概念验证研究中提出的方法可以为需要临床医生和患者等待数周才能获得任何临床益处的情况提供信息并简化 DBS 编程。有必要对更大样本的患者进行前瞻性研究。