BackgroundOrthostatic 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.ObjectivesThe 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.MethodsA 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.ResultsStrong 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.ConclusionsThis 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.

中文翻译：

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直立性震颤中的丘脑局部场电位和闭环深部脑刺激


背景直立性震颤 （OT） 是一种罕见的运动障碍，其特征是腿部感觉不稳定和高频震颤 （13-18 Hz），坐着或走路可以缓解。目的目的是使用双侧腹侧中间核深部脑刺激 （DBS） （Medtronic Percept PC） 研究药物难治性 OT 患者在站立和行走以及半卧位时慢性捕获的脑电生理学，并描述闭环 DBS 的临床应用。方法使用传感调查来捕获站立时的基线局部场电位 （LFP）。直播 LFP 与从 OFF 刺激期间从两个加速度计（腿）收集的数据以及连续和闭环 DBS 期间的步态分析同步。结果在负重过程中发现丘脑 LFP 和腿部震颤之间存在强振荡耦合，在 14.65 Hz 时具有显着的相干性。单阈值自适应 DBS （在此频率下感应） 在减少震颤和刺激相关的步态共济失调方面优于连续刺激。结论本研究为 OT 的病理生理学和管理提供了新的见解。© 2024 作者。由 Wiley Periodicals LLC 代表国际帕金森和运动障碍协会出版的《运动障碍》。