Electrophysiological interpretations of the clinical response to stimulation parameters of pallidal deep brain stimulation for cervical dystonia

IF 1.9 3区 医学 Q3 CLINICAL NEUROLOGY
Ryoong Huh, Moonyoung Chung
{"title":"Electrophysiological interpretations of the clinical response to stimulation parameters of pallidal deep brain stimulation for cervical dystonia","authors":"Ryoong Huh,&nbsp;Moonyoung Chung","doi":"10.1007/s00701-016-2942-x","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><p>Deep brain stimulation (DBS) at the posterolateral ventral portion of the globus pallidus internus (GPi) has been regarded as a good therapeutic modality. Because the theoretical principle behind the stimulation parameters is yet to be determined, this study aimed to interpret analyses of the stimulation parameters used in our department based on an electrophysiological review.</p><h3>Methods</h3><p>Nineteen patients with medically refractory idiopathic cervical dystonia who underwent GPi DBS were enrolled. The baseline and follow-up parameters were analyzed according to their dependence on time after DBS. The pattern of changes in the stimulation parameters over time, the differences across the four active contacts, and the relationship between the stimulation parameters and clinical benefits were evaluated.</p><h3>Results</h3><p>Mean age and disease duration were 50.9 years and 54.7 months, respectively. Mean follow-up duration was 22.6 months. The amplitude and frequency exhibited significant increasing temporal patterns, i.e., a mean amplitude and frequency of 3.1 V and 132.2 Hz at the initial setting and 4.0 V and 142.6 Hz at the last follow-up, respectively. The better clinical response group (clinical improvement rate of 65–100 %) used a narrower pulse width (mean value of 78.4 μs) than the worse clinical response group (clinical improvement rate of 5–60 %, mean of value of 88.6 μs). Active contact at the GPe was used more often in the worse clinical response group than in the better response group.</p><h3>Conclusions</h3><p>Based on electrophysiological considerations, these patterns of stimulation parameters could be interpreted. This interpretation was based on a theoretical understanding of the mechanisms of action of DBS, i.e., that the abnormal neural signal is substituted by an induced neural signal, which is generated by therapeutic DBS.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"158 10","pages":"2029 - 2038"},"PeriodicalIF":1.9000,"publicationDate":"2016-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00701-016-2942-x","citationCount":"4","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Acta Neurochirurgica","FirstCategoryId":"3","ListUrlMain":"https://link.springer.com/article/10.1007/s00701-016-2942-x","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 4

Abstract

Objective

Deep brain stimulation (DBS) at the posterolateral ventral portion of the globus pallidus internus (GPi) has been regarded as a good therapeutic modality. Because the theoretical principle behind the stimulation parameters is yet to be determined, this study aimed to interpret analyses of the stimulation parameters used in our department based on an electrophysiological review.

Methods

Nineteen patients with medically refractory idiopathic cervical dystonia who underwent GPi DBS were enrolled. The baseline and follow-up parameters were analyzed according to their dependence on time after DBS. The pattern of changes in the stimulation parameters over time, the differences across the four active contacts, and the relationship between the stimulation parameters and clinical benefits were evaluated.

Results

Mean age and disease duration were 50.9 years and 54.7 months, respectively. Mean follow-up duration was 22.6 months. The amplitude and frequency exhibited significant increasing temporal patterns, i.e., a mean amplitude and frequency of 3.1 V and 132.2 Hz at the initial setting and 4.0 V and 142.6 Hz at the last follow-up, respectively. The better clinical response group (clinical improvement rate of 65–100 %) used a narrower pulse width (mean value of 78.4 μs) than the worse clinical response group (clinical improvement rate of 5–60 %, mean of value of 88.6 μs). Active contact at the GPe was used more often in the worse clinical response group than in the better response group.

Conclusions

Based on electrophysiological considerations, these patterns of stimulation parameters could be interpreted. This interpretation was based on a theoretical understanding of the mechanisms of action of DBS, i.e., that the abnormal neural signal is substituted by an induced neural signal, which is generated by therapeutic DBS.

脊髓深部脑刺激治疗颈肌张力障碍临床反应的电生理解释
目的对内苍白球(GPi)后外侧腹侧部位进行深部脑刺激(DBS)是一种较好的治疗方法。由于刺激参数背后的理论原理尚未确定,本研究旨在根据电生理综述解释我科使用的刺激参数分析。方法19例难治性特发性颈肌张力障碍患者行GPi DBS。根据基线和随访参数对DBS后时间的依赖性进行分析。评估了刺激参数随时间的变化模式、四种主动接触的差异以及刺激参数与临床效益之间的关系。结果患者平均年龄50.9岁,病程54.7个月。平均随访时间为22.6个月。振幅和频率在时间上呈显著的增加趋势,初始时的平均振幅和频率分别为3.1 V和132.2 Hz,最后一次随访时的平均振幅和频率分别为4.0 V和142.6 Hz。临床疗效较好的组(临床改良率65 ~ 100%)比临床疗效较差组(临床改良率5 ~ 60%,平均值88.6 μs)使用的脉宽更窄(平均值78.4 μs)。临床反应较差的组比临床反应较好的组更常使用GPe的主动接触。结论基于电生理学的考虑,这些刺激参数的模式是可以解释的。这种解释是基于对DBS作用机制的理论认识,即异常神经信号被治疗性DBS产生的诱导神经信号所取代。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
Acta Neurochirurgica
Acta Neurochirurgica 医学-临床神经学
CiteScore
4.40
自引率
4.20%
发文量
342
审稿时长
1 months
期刊介绍: The journal "Acta Neurochirurgica" publishes only original papers useful both to research and clinical work. Papers should deal with clinical neurosurgery - diagnosis and diagnostic techniques, operative surgery and results, postoperative treatment - or with research work in neuroscience if the underlying questions or the results are of neurosurgical interest. Reports on congresses are given in brief accounts. As official organ of the European Association of Neurosurgical Societies the journal publishes all announcements of the E.A.N.S. and reports on the activities of its member societies. Only contributions written in English will be accepted.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信