Microelectrode Recording Guided The Study Of Postoperative Program Control Strategy For PD After DBS Surgery

Parkinson's disease(PD)is a common neurodegenerative disease caused by the apoptosis of dopaminergic neurons in the substantia nigra striatum.In the early stage,levodopa and other drug therapy was the main treatment,while in the middle and late stage,PD patients with poor drug effect were mainly treated with Deep brain stimulation(DBS).DBS surgery is to implant microelectrodes in the deep brain nuclear mass,and give controlled and continuous electrical stimulation,by regulating the nerve loop,so as to achieve the purpose of controlling tremor,rigidity and other symptoms.It was first developed by professor Benabid and professor Siegfried in France in 1987,and was first developed nationwide in our institute in 1998.The key to the success of DBS surgery lies not only in the accurate positioning of the nuclear cluster target before surgery,but also in the postoperative program control.Program control,that is,the use of program controller to adjust the IPG electrical stimulation contacts and parameters,in order to achieve the appropriate control of Parkinson's disease symptoms.Generally starting at 4 weeks after surgery,the first program control is also known as boot.SPC clinical commonly used method is to point to try method,its drawback is time-consuming,process trival,including stimulus mode,the electrode contact,pulse width,the choice of voltage,current,frequency,especially in the choice of electrode contact,always,usually in four different sort of try to contact,until you find the best point of contact,significantly increased the time-consuming.Moreover,the stimulation and side effects brought by multiple program-controlled adjustments will increase patients' psychological burden and even lead to patients' distrust of doctors.At the same time,patients need to frequently endure the discomfort of the drug "off" period.Microelectrode recording(MER)is the nucleus of the gold standard,its response is a cellular level neurons electrophysiological signals,combining with the micro electrode stimulation technology,record the typical nuclei discharge signals,by calculating the length of the nucleus accumbens,used for assessment of the contact position,its accuracy is high,and convenient and flexible,therefore can provide guidance in SPC in the process of a new way of thinking.Comprehensive studies at home and abroad show that at present,point by point testing is still the main method for program control.Some studies put forward the method of computer fusion of preoperative MRI and postoperative CT.However,due to the histological drift and the fusion error of the software itself,the deviation in the evaluation of contact points is caused.Some postoperative magnetic resonance imaging showed the position of the contact points,but 3.0tmr examination was forbidden after DBS operation,and conventional 1.5t mri examination showed unclear nuclear mass.Therefore,this paper discussed the feasibility of microelectrode recording(MER)results to guide the postoperative program control of deep brain stimulation(DBS)for Parkinson's disease(PD).60 patients with primary PD were randomly selected and treated with bilateral subthalamic nucleus(STN)DBS in our hospital.They were divided into the experimental group and the control group,30 patients in the experimental group and 30 patients in the control group were treated with MER result-guided strategy during postoperative program control,and 30 patients in the control group were treated with routine point-by point program control strategy after postoperative program control.The average startup time of the two groups was recorded and compared,the number of adverse events occurred in the whole startup process,and the selection of the final program-controlled contact.Finally,the average startup time of the control group was(130.77±12.36)min,and that of the experimental group was(33.95±2.10)min,which was significantly less than that of the control group(P < 0.05).The average number of adverse events was(1.47±1.04)in the experimental group and(2.03±0.93)in the control group(P < 0.05).There was no significant difference in the final selected contact points between the two groups(P >0.05).Through this experimental study,it can be seen that the program control method guided by MER can be used as a new program control strategy to improve the efficiency of program control,reduce the adverse reactions of patients,and provide a new idea to update the program control method clinically.