Electromyography Biomarkers for Quantifying the Intraoperative Efficacy of Deep Brain Stimulation in Parkinson's Patients With Resting Tremor

Frontiers in Neurology

Kai-Liang Wang¹  Qiao Wang¹  Dan Xu¹  Shi-Ying Fan¹  Chun-Lei Han¹  Shimabukuro Michitomo¹  Wei Hu³  Mathew Burns³  Xiao-Tong Xia⁴  Jian-Guo Zhang⁴  Fan-Gang Meng⁴  Feng Wang⁵ 

[1] Beijing Key Laboratory of Neurostimulation, Beijing, China;Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China;Department of Neurology, Fixel Center for Neurological Diseases, Program in Movement Disorders and Neurorestoration, University of Florida, Gainesville, FL, United States;Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China;Department of Neurosurgery, General Hospital of Ningxia Medical University, Yinchuan, China;

关键词: Parkinson;    DBS;    efficacy quantifying;    resting tremor;    EMG;   

DOI  :  10.3389/fneur.2020.00142

来源: DOAJ

【 摘 要 】

Introduction: Deep brain stimulation (DBS) is an effective therapy for resting tremor in Parkinson's disease (PD). However, quick and objective biomarkers for quantifying the efficacy of DBS intraoperatively are lacking. Therefore, we aimed to study how DBS modulates the intraoperative neuromuscular pattern of resting tremor in PD patients and to find predictive surface electromyography (sEMG) biomarkers for quantifying the intraoperative efficacy of DBS.Methods: Intraoperative sEMG of 39 PD patients with resting tremor was measured with the DBS on and off, respectively, during the intraoperative DBS testing stage. Twelve signal features (time and frequency domains) were extracted from the intraoperative sEMG data. These sEMG features were associated with the clinical outcome to evaluate the efficacy of intraoperative DBS. Also, an sEMG-based prediction model was established to predict the clinical improvement rate (IR) of resting tremor with DBS therapy.Results: A typical resting tremor with a peak frequency of 4.93 ± 0.98 Hz (mean ± SD) was measured. Compared to the baseline, DBS modulated significant neuromuscular pattern changes in most features except for the peak frequency, by decreasing the motor unit firing rate, amplitude, or power and by changing the regularity pattern. Three sEMG features were detected with significant associations with the clinical improvement rate (IR) of the tremor scale: peak frequency power (R = 0.37, p = 0.03), weighted root mean square (R = 0.42, p = 0.01), and modified mean amplitude power (R = 0.48, p = 0.003). These were adopted to train a Gaussian process regression model with a leave-one-out cross-validation procedure. The prediction values from the trained sEMG prediction model (1,000 permutations, p = 0.003) showed a good correlation (r = 0.47, p = 0.0043) with the true IR of the tremor scale.Conclusion: DBS acutely modulated the intraoperative resting tremor, mainly by suppressing the amplitude and motor unit firing rate and by changing the regularity pattern, but not by modifying the frequency pattern. Three features showed strong robustness and could be used as quick intraoperative biomarkers to quantify and predict the efficacy of DBS in PD patients with resting tremor.

【 授权许可】

Unknown