PDF(Pubmed)
Abstract：
Deep brain stimulation (DBS) is a viable treatment for a variety of neurological conditions, however, the mechanisms through which DBS modulates large-scale brain networks are unresolved. Clinical effects of DBS are observed over multiple timescales. In some conditions, such as Parkinson\'s disease and essential tremor, clinical improvement is observed within seconds. In many other conditions, such as epilepsy, central pain, dystonia, neuropsychiatric conditions or Tourette syndrome, the DBS related effects are believed to require neuroplasticity or reorganization and often take hours to months to observe. To optimize DBS parameters, it is therefore essential to develop electrophysiological biomarkers that characterize whether DBS settings are successfully engaging and modulating the network involved in the disease of interest. In this study, 10 individuals with drug resistant epilepsy undergoing intracranial stereotactic EEG including a thalamus electrode underwent a trial of repetitive thalamic stimulation. We evaluated thalamocortical effective connectivity using single pulse electrical stimulation, both at baseline and following a 145 Hz stimulation treatment trial. We found that when high frequency stimulation was delivered for >1.5 hours, the evoked potentials measured from remote regions were significantly reduced in amplitude and the degree of modulation was proportional to the strength of baseline connectivity. When stimulation was delivered for shorter time periods, results were more variable. These findings suggest that changes in effective connectivity in the network targeted with DBS accumulate over hours of DBS. Stimulation evoked potentials provide an electrophysiological biomarker that allows for efficient data-driven characterization of neuromodulation effects, which could enable new objective approaches for individualized DBS optimization.
摘要：
深部脑刺激（DBS）是一种可行的治疗各种神经系统疾病，然而,DBS调节大规模大脑网络的机制尚未解决。在多个时间尺度上观察DBS的临床效果。在某些情况下,如帕金森病和特发性震颤，在几秒钟内观察到临床改善。在许多其他条件下，比如癫痫,中枢疼痛,肌张力障碍,神经精神疾病或Tourette综合征，DBS相关效应被认为需要神经可塑性或重组,通常需要数小时至数月才能观察到.要优化DBS参数，因此,开发电生理生物标志物是至关重要的,这些生物标志物表征DBS设置是否成功地参与和调节了所关注疾病的网络。在这项研究中,10名接受包括丘脑电极在内的颅内立体定向脑电图的耐药性癫痫患者接受了重复丘脑刺激的试验。我们使用单脉冲电刺激评估了丘脑皮质的有效连通性，在基线和145Hz刺激治疗试验后。我们发现当高频刺激持续>1.5小时时,从偏远地区测得的诱发电位的振幅显著降低,调制程度与基线连接强度成正比.当刺激传递的时间较短，结果变量更大。这些发现表明，以DBS为目标的网络中有效连接的变化会在数小时的DBS中累积。刺激诱发电位提供了一种电生理生物标志物，可以对神经调节效应进行有效的数据驱动表征。这可以为个性化的DBS优化提供新的客观方法。
