Thalamic Local Field Potentials and Closed-Loop Deep Brain Stimulation in Orthostatic Tremor

IF 7.4 1区医学 Q1 CLINICAL NEUROLOGY

Movement Disorders Pub Date : 2024-10-25 DOI:10.1002/mds.30035

Wilson K.W. Fung MBBCh, Srdjan Sumarac BEng, Gianluca Sorrento PhD, Brendan Santyr MD, Luka Milosevic PhD, Anthony E. Lang MD, Andres M. Lozano MD, PhD, Suneil K. Kalia MD, PhD, Alfonso Fasano MD, PhD, FAAN

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Abstract

Background

Orthostatic tremor (OT) is a rare movement disorder characterized by a feeling of unsteadiness and a high-frequency tremor in the legs (13–18 Hz) relieved by sitting or walking.

Objectives

The aims were to study the brain electrophysiology captured chronically in a person with medication-refractory OT while standing and walking and in the semi-recumbent position using bilateral ventral intermedius nucleus deep brain stimulation (DBS) (Medtronic Percept PC) and to describe the clinical use of closed-loop DBS.

Methods

A sensing survey was used to capture baseline local field potentials (LFPs) while standing. Livestreamed LFPs were synchronized with data collected from two accelerometers (legs) and gait analysis during OFF stimulation and continuous and closed-loop DBS.

Results

Strong oscillatory coupling between thalamic LFP and leg tremor with significant coherence at 14.65 Hz was found during weight-bearing. Single-threshold adaptive DBS (sensing at this frequency) was superior to continuous stimulation in reducing tremor and stimulation-related gait ataxia.

Conclusions

This study provides new insights into both the pathophysiology and management of OT. © 2024 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

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丘脑局部场电位和闭环深部脑刺激治疗直立性震颤

背景静止性震颤（OT）是一种罕见的运动障碍，其特征是坐着或行走时会感到腿部不稳和高频震颤（13-18 赫兹）。目的研究药物难治性 OT 患者在站立、行走和半卧位时使用双侧腹侧中间核深部脑刺激（DBS）（美敦力 Percept PC）长期捕获的脑电生理学，并描述闭环 DBS 的临床应用。结果在负重时发现丘脑 LFP 与腿部震颤之间有很强的振荡耦合，在 14.65 Hz 处有显著的一致性。在减少震颤和与刺激相关的步态共济失调方面，单阈值自适应 DBS（感知该频率）优于连续刺激。© 2024 The Author(s).运动障碍》由 Wiley Periodicals LLC 代表国际帕金森和运动障碍协会出版。

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来源期刊

Movement Disorders 医学-临床神经学

CiteScore

13.30

自引率

8.10%

发文量

371

审稿时长

12 months

期刊介绍： Movement Disorders publishes a variety of content types including Reviews, Viewpoints, Full Length Articles, Historical Reports, Brief Reports, and Letters. The journal considers original manuscripts on topics related to the diagnosis, therapeutics, pharmacology, biochemistry, physiology, etiology, genetics, and epidemiology of movement disorders. Appropriate topics include Parkinsonism, Chorea, Tremors, Dystonia, Myoclonus, Tics, Tardive Dyskinesia, Spasticity, and Ataxia.