CN112774048A - Closed-loop ultrasonic nerve regulation and control system and method - Google Patents
Closed-loop ultrasonic nerve regulation and control system and method Download PDFInfo
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Abstract
The application discloses a closed-loop ultrasonic nerve regulation and control system and a method, wherein the regulation and control system selects matched ultrasonic transducers through a positioning selection module according to the observed intracranial condition and skull structure of a patient, and calculates the fixed positions and the ultrasonic action distances of the ultrasonic transducers; the skull structure is three-dimensionally reconstructed through a fixing module to determine a fixing device matched with the skull structure, and a matched treatment scheme is formulated to select an ultrasonic stimulation target point; the ultrasonic stimulation module is used for performing ultrasonic stimulation on an ultrasonic stimulation target point of a patient; the feedback module controls the work of the ultrasonic module, observes the blood oxygen change of the ultrasonic stimulation target point after stimulation, determines whether the selection of the target point is accurate, observes the treatment effect at the same time, and outputs the treatment effect to the evaluation module for evaluation. The application enables the patient to receive accurate treatment under the non-invasive or minimally-invasive condition and quickly adjust the treatment scheme by monitoring the state of an illness, thereby better improving the state of the illness.
Description
Technical Field
The application relates to the technical field of neural regulation, in particular to a closed-loop ultrasonic neural regulation system and a method.
Background
Improvements in neuromodulation techniques and tools are an important driver in the development of neuroscience. From 1870, German scientists reported that electrical stimulation is used to induce specific somatic reactions in canine cerebral cortex, and electrical, magnetic, optical and other technologies are combined with neuroscience to generate deep brain electrical stimulation, transcranial magnetic stimulation, light gene regulation and other nerve stimulation and regulation technologies. In recent years, with the increase of the prevalence rate of neurological functional diseases and the development of a neurological regulation technology, the connection between acoustics and neuroscience is gradually tightened, and an ultrasonic regulation technology is developed, namely, a plurality of technologies such as deep brain stimulation, vagus nerve electrical stimulation, transcranial magnetic stimulation, median nerve electrical stimulation and the like appear, so that a great number of patients obtain better curative effect. At present, deep electroencephalogram stimulation, transcranial magnetic stimulation and the like are applied to treatment of chronic disturbance of consciousness.
Deep Brain Stimulation (DBS) is a method of modulating nerve activity by high-frequency discharge by implanting a stimulating electrode at a specific site or nucleus in the Brain. DBS has been used to treat a number of diseases, including parkinson's disease, essential tremor, and epilepsy. As early as 1969, researchers published a case report, one of the earliest clinical descriptions of DBS treatment for disturbance of consciousness, in which authors used DBS to stimulate the anterior thalamic nucleus of a 26 year old patient to cause limb movement. [ Hassler R, Ore GD, Bricolo A, Dieckmann G, Dolce G: EEG and clinical arousal induced by biological Long-term simulation of pallidal systems in murine visual coma. Electroencephalog Clin neurological 27: 689-. In a study of the feasibility of DBS treatment in the united states, a significant improvement in the baseline stimulation response before and after DBS onset was shown. [ Giacino J, Fins JJ, Machado A, et al, central venous depletion vaccine simulation to molar recovery from cyclic post-transaction minimal coherence state: pulleys and opportunities [ J ] Neuromodular, 2012,15(4):339 349 ]. However, in reality, the parameter setting can only depend on the experience of the operator, and the change of the parameters can only be performed in the next review, and the open-loop treatment method cannot be adjusted in time according to the change of the state of an illness, so that the closed-loop research and application are more and more directed to the above problems.
Transcranial Magnetic Stimulation (TMS) utilizes the principle of electromagnetic induction, discharges energy-storing high-voltage capacitors to a Stimulation coil through an electronic switch, the Stimulation coil generates a transient Magnetic field to permeate the skull, induced current is induced in the superficial cortex of the brain, intracranial nerves are stimulated, and the change of the membrane potential and the excitability of nerve cells are caused to regulate the nerve function. Transcranial magnetic stimulation is widely used in basic and clinical studies of neuroscience. In recent years, research on nervous system diseases such as cerebral infarction, epilepsy and Parkinson's disease by transcranial magnetic stimulation has been greatly advanced, and in recent years, Bai et al reported that TMS treatment is performed on 16 patients with disturbance of consciousness, CRS-R scores (coma rehabilitation scores) of 9 patients are improved after TMS treatment, and the observation of waveforms in brain electricity of patients with micro-consciousness state is complex, has increased components and has positive effects. [ Bai Y, Xia X, Kang J, et al, evaluating the effect of a reactive therapeutic simulation on disorders of a diagnostic by using TMS-EEG [ J ] Front Neurosci,2016,10:473 ].
The electrical stimulation (MNS) of the median nerve is a stimulation method for placing electrodes at the median nerve point 10cm near the palmar surface of the bilateral wrist joint, and is mainly used for treating various coma and wakefulness. The median nerve electrical stimulation has the advantages of non-traumatic property, no complication, easy operation, low cost and the like, and is widely applied. In 1996, the japanese scholars Yokoyama first reported that central nerve electrical stimulation was used to treat coma patients, and was applied not only to arousal in patients with persistent vegetative state, but also to arousal with various etiologies and persistent decreased levels of consciousness.
Vagal Nerve Stimulation (VNS) is a commonly used method for treating refractory epilepsy. In clinical application, VNS is mainly applied to epileptic patients with wide discharge source, undefined focus or focus in main functional area, and the treatment effect is confirmed.
The DBS, TMS, MNS, and VNS described above have their own advantages, but also have many disadvantages, such as:
DBS is currently considered a safe and effective method of deep brain stimulation, but the following problems remain:
1. the equipment cost is high;
2. the pulse generator of DBS requires battery power, has a limited battery life, requires secondary surgery to replace the battery, and is more costly to charge ex vivo.
3. The operation technique of doctors is required to be high, the difficulty is high, and the operation time is long.
4. The action range is limited, most patients can only implant 2 electrodes, the maximum number of the electrodes is only 4, and the electrodes cannot act on more targets.
5. The wound surface of a patient is large, foreign matters are embedded from the head to the neck to the chest, and operation injury can be caused; side effects are numerous, and the stimulator and the connecting wires may have rejection reactions, pain and other discomfort as foreign bodies embedded in the body.
TMS is a non-invasive nerve stimulation mode, the magnetic stimulation intensity decreases exponentially with the increase of the distance, generally, the effective stimulation depth of TMS is only 2-2.5 cm, the TMS is difficult to reach deep nuclei, the stimulation range of TMS is wide, and the TMS is difficult to accurately focus on local focuses.
MNS is a method for treating diseases related to disturbance of consciousness, but the stimulation position of MNS is in the median nerve of the wrist, belongs to an indirect stimulation method and is easily influenced by external factors.
VNS is a method of treating epilepsy-related disorders, and is also an indirect stimulation method, which is effective in some cases, but is easy to recur, requires high surgery and is relatively expensive to treat.
Therefore, how to improve the existing deficiencies while improving the treatment effect becomes a breakthrough for finding a new technology for treating the neurological functional diseases. With the development of the ultrasonic technology, the ultrasonic is not only a tool for examining a human body, the high-intensity focused ultrasound is used as a treatment mode for directly damaging a focus, and the low-intensity focused ultrasound also fully plays a role in the field of nerve regulation. The focus of the focused ultrasonic radiation sound field is in an oblong shape, and the characteristic also enables the focused ultrasonic radiation sound field to obtain good spatial precision and have better spatial resolution than transcranial magnetic stimulation and the like. However, if the treatment is not performed simultaneously with the monitoring, the optimal treatment effect cannot be achieved, and if a feedback system is introduced during the treatment, the better treatment effect can be obtained.
Disclosure of Invention
The purpose of the present application is to provide a closed-loop ultrasound neural regulation system and method, which can allow a patient to receive accurate treatment under non-invasive or minimally-invasive conditions and quickly adjust the treatment scheme by monitoring the condition of the patient, thereby improving the condition of the patient.
In order to solve the above-mentioned problems, the technical scheme adopted by the application is as follows:
a closed-loop ultrasonic nerve regulation and control system comprises a positioning selection module, a fixing module, an ultrasonic module and a feedback module;
the positioning selection module is used for selecting the matched ultrasonic transducer according to the intracranial condition and the skull structure of the patient and calculating the fixed position and the ultrasonic action distance of the ultrasonic transducer on the skin of the patient;
the fixing module is used for performing three-dimensional reconstruction according to the skull structure of the patient, determining a fixing device matched with the skull structure according to the reconstructed three-dimensional structure and determining an ultrasonic stimulation target point on the skin of the patient; fixing the ultrasonic transducer at an ultrasonic stimulation target point by a fixing device in combination with the fixing position and the ultrasonic action distance of the ultrasonic transducer;
the ultrasonic module carries out ultrasonic stimulation on the ultrasonic stimulation target point through the ultrasonic transducer and outputs a stimulation result to the feedback module;
the feedback module is used for judging whether the position of the ultrasonic stimulation target point is accurate according to the blood oxygen change of the ultrasonic stimulation target point after ultrasonic stimulation, and if the position is wrong, the judgment result is fed back to the ultrasonic transducer to reposition the ultrasonic stimulation target point.
The technical scheme adopted by the embodiment of the application further comprises the following steps: the ultrasonic module comprises a signal generator, a power amplifier and an ultrasonic transducer;
the signal generator is used for generating an ultrasonic nerve regulation pulse waveform and outputting the pulse waveform to the power amplifier;
the power amplifier is used for improving the energy of the pulse waveform output by the signal generator and outputting the energy to the ultrasonic transducer;
the ultrasonic transducer focuses on the ultrasonic stimulation target point through ultrasound according to the received energy.
The technical scheme adopted by the embodiment of the application further comprises the following steps: the ultrasonic module also comprises an oscilloscope which is used for observing the pulse waveform output by the signal generator.
The technical scheme adopted by the embodiment of the application further comprises the following steps: the ultrasonic module also comprises an impedance matching circuit which is used for outputting the energy output by the power amplifier to an ultrasonic transducer without attenuation.
The technical scheme adopted by the embodiment of the application further comprises the following steps: the signal generator adopts an independent dual-channel signal generator, the fundamental wave frequency of the signal generator is 0.1MHz-5MHz, the signal generator can independently generate sine signals and square signals, and the signal generator has a TTL gate trigger output function.
The technical scheme adopted by the embodiment of the application further comprises the following steps: the ultrasonic transducer adopts a single piezoelectric array element, and the piezoelectric array element adopts materials including power type piezoelectric ceramics, composite piezoelectric materials and crystal materials.
The technical scheme adopted by the embodiment of the application further comprises the following steps: the positioning selection module adopts a nerve navigation technology, and comprises: stereotactic neuronavigation includes stereotactic guided neurosurgery or framed stereotactic neurosurgery; the magnetic resonance image nerve navigation comprises magnetic resonance image guided neurosurgery or frameless stereotactic neurosurgery; ultrasound image neural navigation includes ultrasound guided neurosurgery or echogenic stereotactic neurosurgery.
The technical scheme adopted by the embodiment of the application further comprises the following steps: deionized water is filled between the ultrasonic transducer and the fixing device; the fixing device is made of light materials with high compatibility with human tissues, and comprises a Peek material, photosensitive resin and organic glass.
The technical scheme adopted by the embodiment of the application further comprises the following steps: the feedback module observes the patient by adopting the imaging and the electrophysiological monitoring, wherein the imaging comprises magnetic resonance, CT, BOLD-MRI, f-MRI and MRS; the electrophysiological monitoring comprises electroencephalogram, electrocardio and myoelectricity.
Another technical scheme adopted by the application is as follows: a regulation method of a closed-loop ultrasonic nerve regulation system comprises the following steps:
step S1: acquiring intracranial conditions and skull structures of a patient;
step S2: selecting an ultrasonic transducer matched with the acting deep part and the acting range of the ultrasonic transducer according to the intracranial condition and the skull structure, and calculating the fixed position of the ultrasonic transducer on the skin of a patient and the ultrasonic acting distance;
step S3: carrying out three-dimensional reconstruction according to the skull structure, determining a fixing device matched with the skull structure according to the reconstructed three-dimensional structure, determining an ultrasonic stimulation target point on the skin of a patient, and fixing the ultrasonic transducer on the ultrasonic stimulation target point on the skin of the patient through the fixing device by combining the fixing position and the ultrasonic action distance of the ultrasonic transducer;
step S4: performing ultrasonic stimulation on the ultrasonic stimulation target point through the ultrasonic transducer, and outputting a stimulation result to a feedback module;
step S5: and judging whether the position of the ultrasonic stimulation target point is accurate or not through the feedback module according to the blood oxygen change of the ultrasonic stimulation target point after ultrasonic stimulation, and if the position is wrong, feeding the judgment result back to the ultrasonic transducer to reposition the ultrasonic stimulation target point.
Compared with the prior art, the beneficial effect of this application lies in:
according to the ultrasonic treatment system, the positioning selection module, the fixing module, the ultrasonic module, the feedback module and the evaluation module are used for enabling a patient to receive accurate treatment under the non-invasive or minimally-invasive condition, namely, the ultrasonic transducer and an accurate ultrasonic stimulation target point are determined through positioning selection to realize ultrasonic stimulation, and the treatment scheme is rapidly adjusted through monitoring of the state of an illness, so that the state of the illness of the patient is better improved.
In addition, the piezoelectric array elements in the ultrasonic module adopt high-power piezoelectric materials such as piezoelectric ceramics and the like, deep brain positioning is carried out through positioning technologies such as a nerve navigation technology and BOLD-fMRI, an individualized fixing device is formulated through a three-dimensional reconstruction technology, and the individualized fixing device can be well connected with the head of a treated person, so that the direction and focus of ultrasonic stimulation are accurate.
Compared with DBS in the prior art, the application has the advantages that the application is noninvasive and easy to use, and the action condition of the action position can be observed more clearly through the combination with the technologies such as BOLD-fMRI and the like; compared with TMS regulation, the application can act on deeper deep brain regions; compared with MNS, the application can act in the target area more accurately and directly.
Compared with a non-closed loop type ultrasonic nerve regulation and control technology, the method and the device can track the change of the state of an illness of a patient in time, change a treatment scheme in time and enable the patient to obtain the optimal treatment effect.
Drawings
FIG. 1 is a schematic diagram of a closed loop ultrasound neuromodulation system of the present application.
Fig. 2 is a schematic diagram of an ultrasound module of the present application.
FIG. 3 is a schematic diagram of an ultrasonic neuromodulation pulse waveform of the present application.
Fig. 4 is a schematic structural diagram of the fixing device of the present application.
Fig. 5 is a schematic diagram of the installation and ultrasonic stimulation site point selection in practical application of the present application.
FIG. 6 is a flow chart of the closed-loop ultrasound neuromodulation method of the present application.
Description of reference numerals: 1-a wire; 2-an ultrasonic transducer; 3-a fixing device; 4-deionized water; 5-skull bone; 6-an ultrasound path; 7-thalamus; 8-ultrasonic focal range.
Detailed Description
To facilitate an understanding of the present application, the present application will now be described more fully with reference to the accompanying drawings. Preferred embodiments of the present application are shown in the drawings. This application may, however, be embodied in many different forms and should not be construed as limited to the embodiments set forth herein. Rather, these embodiments are provided so that this disclosure will be thorough and complete.
Unless defined otherwise, all technical and scientific terms used herein have the same meaning as commonly understood by one of ordinary skill in the art to which this application belongs. The terminology used herein in the description of the present application is for the purpose of describing particular embodiments only and is not intended to be limiting of the application.
Please refer to fig. 1, which is a schematic structural diagram of a closed-loop ultrasound neuromodulation system according to an embodiment of the present application. The closed-loop ultrasonic nerve regulation and control system comprises a positioning selection module, a fixing module, an ultrasonic module, a feedback module and an evaluation module.
The positioning selection module selects matched ultrasonic transducers, namely the ultrasonic transducers matched with the acting deep parts and the acting range of the ultrasonic transducers according to the observed intracranial condition and the skull structure of the patient, and calculates the fixed positions and the ultrasonic acting distances of the ultrasonic transducers. Specifically, the intracranial condition and the skull structure of a patient are observed by performing head positioning magnetic resonance scanning on the patient, including whether the thalamus and peripheral blood vessels are complete or not, the distance between the thalamus position and the top of the head is determined by the technologies such as nerve navigation and the like, the thalamus volume is calculated, and the matched ultrasonic transducer is selected according to the calculation result.
The fixing module carries out three-dimensional reconstruction according to the skull structure of a patient, determines a fixing device matched with the skull structure according to the reconstructed three-dimensional structure, formulates a matched treatment scheme, selects an ultrasonic stimulation target point, and fixes the ultrasonic transducer on the skin of the patient through the fixing device in combination with the fixing position and the ultrasonic action distance of the ultrasonic transducer before ultrasonic treatment.
The ultrasonic module is used for carrying out ultrasonic stimulation on an ultrasonic stimulation target point of the patient through the selected ultrasonic transducer and outputting a stimulation result to the feedback module.
The feedback module predicts the disease attack of the patient before the ultrasonic stimulation and controls the ultrasonic module to work; determining whether the selection of the target point is accurate or not according to the blood oxygen change of the ultrasonic stimulation target point after the observation and stimulation; meanwhile, the treatment effect is observed, the progress of the illness state is further known, the result is fed back to the ultrasonic transducer in time, and the ultrasonic transducer is convenient to adjust the ultrasonic parameters at any time; the effect of the treatment is also output to the evaluation module.
The evaluation module evaluates according to the received treatment effect, and the evaluation module comprises indexes such as vital signs, patient consciousness recovery conditions, patient motion function recovery conditions and the like.
Fig. 2 is a schematic diagram of an ultrasound module according to the present application. The ultrasonic module is used for transmitting a high-energy pulse signal, and acts on an ultrasonic stimulation target point to perform ultrasonic stimulation on the ultrasonic stimulation target point. The ultrasonic module specifically comprises a signal generator, a power amplifier, an oscilloscope, an impedance matching circuit and an ultrasonic transducer.
The signal generator is used for generating an ultrasonic nerve regulation pulse waveform (as shown in figure 3) and outputting the pulse waveform to the oscilloscope and the power amplifier respectively. The signal generator adopts an independent dual-channel signal generator, the fundamental wave frequency is at least 0.1MHz-5MHz, sinusoidal signals and square wave signals can be independently generated, and the TTL gate trigger output function is provided. Where channel 1 is used to control the Pulse Repetition Frequency (PRF) and pulse period SD. The channel 2 is used to control the fundamental frequency f, the fundamental number TBD and the input voltage AI. The triggering mode of the channel 2 selects external triggering, and the external triggering source is the TTL signal of the channel 1. And the signal of the channel 2 is respectively connected to the oscilloscope and the power amplifier through a three-way BNC wiring.
The oscilloscope is used for observing the pulse waveform output by the signal generator.
The power amplifier is used for improving the energy of the pulse waveform output by the signal generator and outputting the energy to the impedance matching circuit. Further, the frequency band of the power amplifier is 0.1MHz-5MHz, and the power range is 50W-150W.
The impedance matching circuit is used for outputting the energy output by the power amplifier to the ultrasonic transducer without attenuation. Specifically, the impedance matching circuit is designed correspondingly according to the actually measured impedance value of the prepared piezoelectric array element, and 50-ohm impedance matching of the power amplifier and the piezoelectric array element can be guaranteed, so that energy of the power amplifier can enter the ultrasonic transducer without attenuation, and enough energy can be guaranteed to successfully excite the ultrasonic transducer to work.
The ultrasonic transducer focuses on the animal brain region target point, namely the ultrasonic stimulation target point, through the ultrasonic according to the received energy. Specifically, the ultrasonic transducer adopts a single piezoelectric array element, namely, the ultrasonic transducer preferentially uses a low-frequency (<0.5MHz) single array element, can achieve an arc-shaped structure for regulating and controlling the nerve depth, and is used for focusing the ultrasound generated by the piezoelectric array element on a target spot of an animal brain area, namely, the arc-shaped characteristic of the ultrasonic transducer enables the focusing transverse length and the focusing longitudinal length of a sound field focus caused by bending to cover the target spot of the brain area according to different action distances. Furthermore, the piezoelectric array elements are made of power type piezoelectric ceramics, composite piezoelectric materials and crystal materials. The piezoelectric array element is connected with the cable through a lead wire so as to receive the electric signal generated by the signal generator. The cable lines are all selected to be 50 ohms.
When the ultrasonic module is used, the ultrasonic transducer can realize ultrasonic nerve regulation and control according to the general conditions of a patient, such as the disease severity, stimulation part and stimulation effect of the patient by adopting different ultrasonic parameters including pulse repetition frequency, pulse duration, fundamental wave frequency, fundamental wave number, pulse number and the like, and has wide application range and convenient operation. In addition, when in use, piezoelectric materials with different areas and different materials can be selected according to the size of a brain stimulation area (mainly thalamus), thereby further enhancing the practicability of the application.
In the above, the positioning selection module determines the distance between the thalamus position and the vertex by using the neuronavigation technology, and specifically includes: stereotactic neuronavigation (SNN) includes stereotactic-guided neurosurgery or framed stereotactic neurosurgery; magnetic resonance image neuronavigation (INN) includes MR image-guided neurosurgery (MR-guided neurosurgery) or frameless stereotactic neurosurgery (MR-guided neurosurgery); ultrasonic acoustic image neuronavigation (ENN) includes ultrasonic-guided neurosurgery or echo stereotactic neurosurgery.
In the above, the fixing module determines the body surface position of the anterior thalamic nucleus on the skull by MRI, calculates the surface shape of the skull by a three-dimensional reconstruction technique, determines the shape of the fixing device (as shown in fig. 4), calculates the arc parameters by magnetic resonance scanning three-dimensional reconstruction before operation of the patient, and performs printing or die cutting by a 3D printer after the design by using three-dimensional drawing software. The fixing device is made of materials such as Peek materials, photosensitive resin, organic glass and the like which are light and have high compatibility with human tissues.
Further, in order to enable the fixing device to be tightly connected with the skin, a human body adhesive is used for being adhered with the skin, in order to prevent moisture from leaking, deionized water is filled between the ultrasonic transducer and the fixing device, and after the fixing device and the ultrasonic transducer are used, the fixing device and the ultrasonic transducer are taken down by using an organic solvent. Turpentine oil is used as the organic solvent.
In the above-mentioned, the feedback module adopts the imaging and the monitoring of electrophysiology to observe, and wherein the imaging includes: magnetic resonance, CT, BOLD-MRI (blood oxygen level dependent magnetic resonance imaging), f-MRI (functional magnetic resonance imaging), MRS (magnetic resonance spectroscopy), etc.; the electrophysiological monitoring includes: brain electricity, electrocardio electricity, myoelectricity, etc. The feedback module may also employ other medical detection methods to achieve the objectives of the present application.
The present application further provides a regulation method based on a closed-loop ultrasound neuromodulation system, which is further described in detail below with reference to embodiments and drawings applied to patients with disturbance of consciousness.
Please refer to fig. 5, which is a schematic diagram of installation and ultrasonic stimulation site point selection for practical application of the present application. Depending on the location of the ultrasound stimulation target points, either a median direction stimulation, as shown in fig. 5(a), or a non-median direction stimulation, as shown in fig. 5(b), may be selected. The ultrasonic transducer 2 is connected with the power amplifier through a lead 1 and is connected with the fixing device 3, and deionized water 4 is filled between the ultrasonic transducer 2 and the fixing device 3. The fixing device 3 is directly connected with the skin by adopting waterproof glue which can be used for a human body to be used as an ultrasonic stimulation target point, ultrasonic energy generated by the ultrasonic transducer 2 penetrates through the skull 5 to form an ultrasonic path 6 which is converged into an ultrasonic focus 8, and the thalamus 7 is covered in the ultrasonic focus 8.
Assuming that the patient is a disturbance of consciousness patient, as shown in fig. 6, the specific steps of the closed-loop ultrasound neuromodulation method for the patient are as follows:
step S1: the patient is subjected to a localized head magnetic resonance scan to observe intracranial conditions and cranial structures, including the thalamus and peripheral blood vessels, intact.
Step S2: the positioning selection module determines the distance between the thalamus position and the top of the head according to the intracranial condition, calculates the thalamus volume, selects the ultrasonic transducer matched with the action deep part and the action range of the ultrasonic transducer, and calculates the fixed position and the ultrasonic action distance of the ultrasonic transducer.
In step S2, the positioning and selecting module determines the distance between the thalamic position and the parietal region by using a neuronavigation technique, including: stereotactic neuronavigation (SNN) includes stereotactic-guided neurosurgery or framed stereotactic neurosurgery; magnetic resonance image neuronavigation (INN) includes MR image-guided neurosurgery (MR-guided neurosurgery) or frameless stereotactic neurosurgery (MR-guided neurosurgery); ultrasonic acoustic image neuronavigation (ENN) includes ultrasonic-guided neurosurgery or echo stereotactic neurosurgery.
Step S3: the fixing module carries out three-dimensional reconstruction on the skull structure, determines a fixing device matched with the skull structure according to the reconstructed three-dimensional structure, and individually sets a matched treatment scheme and selects an ultrasonic stimulation target point.
In step S3, the fixing module determines the body surface position of the anterior thalamic nucleus on the skull by MRI, calculates the surface shape of the skull by a three-dimensional reconstruction technique, determines the shape of the fixing device, calculates the arc parameters of the fixing device by magnetic resonance scanning three-dimensional reconstruction before surgery, and performs printing or die cutting by a 3D printer after the fixing device is designed by using three-dimensional drawing software. The fixing device is made of materials with high human tissue compatibility, such as photosensitive resin, organic glass and the like.
Step S4: after the ultrasonic transducer is mounted on the fixing device according to the determined fixing position and the ultrasonic action distance of the ultrasonic transducer, the fixing device is fixed on the skin of the patient before ultrasonic treatment.
In step S4, in order to tightly connect the fixing device to the skin, a human body adhesive is used to adhere to the skin, and in order to prevent moisture from leaking, deionized water is filled between the ultrasonic transducer and the fixing device, and after the use, the fixing device and the ultrasonic transducer are taken off by using an organic solvent. Turpentine oil is used as the organic solvent.
Step S5: selecting ultrasonic parameters of an ultrasonic transducer, setting a signal generator, and connecting the signal generator with a power amplifier and an oscilloscope; the power amplifier is connected with the impedance coupling circuit and then connected with the ultrasonic transducer.
In step S5, the signal generator is preferably a dual-channel signal generator; the power amplifier is preferably a 100W power amplifier, and the output end of the power amplifier is connected with the selected ultrasonic transducer; the ultrasonic transducer is preferably a low frequency ultrasonic transducer.
Step S6: and before ultrasonic stimulation, predicting the onset of the disease through a feedback module, controlling an ultrasonic module to work, and performing ultrasonic stimulation on the determined ultrasonic stimulation target point.
Step S7: the feedback module judges whether the position selection of the target point is accurate or not by observing the local blood oxygen change of the ultrasonic stimulation target point, if the local blood oxygen change is normal, the target point selection is indicated to be correct, and the step S8 is executed; if the local blood oxygen variation is abnormal, it indicates that the target point selection is not correct, and the method returns to step S3 to re-determine the treatment plan and select the ultrasound stimulation target point.
Step S8: the feedback module further knows the progress of the state of an illness by observing the treatment effect, and feeds the result back to the ultrasonic transducer in time, thereby being capable of adjusting ultrasonic parameters at any time. Specifically, the feedback module uses the Glasgow scoring table, MRI, electroencephalogram and other technologies commonly used for the conscious disturbance treatment to observe the treatment effect in the treatment process.
In the above steps S6 and S7, the feedback module performs observation by using imaging and electrophysiological monitoring, wherein the imaging includes: magnetic resonance, CT, BOLD-MRI, f-MRI, MRS, etc.; electrophysiological monitoring: brain electricity, electrocardio electricity, myoelectricity, etc.
Step S9: after sufficient treatment, the evaluation module is used for evaluating the treatment effect, and the evaluation on the treatment effect comprises indexes such as vital signs, the recovery condition of consciousness of the patient, the recovery condition of motor function of the patient and the like.
The regulation and control method not only has the function of a single array element transducer, but also comprises a multi-array element ultrasonic transducer such as an arc array or a plane array, and the like, and the frequency range of the multi-array element ultrasonic transducer is 0.3 MHz-1.2 MHz. The single-array-element transducer only works, emits ultrasonic waves in one direction and reaches a position to be reached; the multi-array element ultrasonic transducer combines a plurality of single-array element transducers together, thereby achieving the effect of three-dimensional irradiation and leading the energy to be more concentrated in a target area.
The scope of the application is not limited to disorders associated with disturbance of consciousness, including all neurological disorders such as epilepsy, Parkinson's disease, Alzheimer's disease, and the like.
The above embodiments are preferred embodiments of the present application, but the present application is not limited to the above embodiments, and any other changes, modifications, substitutions, combinations, and simplifications which do not depart from the spirit and principle of the present application should be construed as equivalents and are included in the scope of the present application.
Claims (10)
1. A closed-loop ultrasound neuromodulation system, comprising: the device comprises a positioning selection module, a fixing module, an ultrasonic module and a feedback module;
the positioning selection module is used for selecting the matched ultrasonic transducer according to the intracranial condition and the skull structure of the patient and calculating the fixed position and the ultrasonic action distance of the ultrasonic transducer on the skin of the patient;
the fixing module is used for performing three-dimensional reconstruction according to the skull structure of the patient, determining a fixing device matched with the skull structure according to the reconstructed three-dimensional structure and determining an ultrasonic stimulation target point on the skin of the patient; fixing the ultrasonic transducer at an ultrasonic stimulation target point by a fixing device in combination with the fixing position and the ultrasonic action distance of the ultrasonic transducer;
the ultrasonic module carries out ultrasonic stimulation on the ultrasonic stimulation target point through the ultrasonic transducer and outputs a stimulation result to the feedback module;
the feedback module is used for judging whether the position of the ultrasonic stimulation target point is accurate according to the blood oxygen change of the ultrasonic stimulation target point after ultrasonic stimulation, and if the position is wrong, the judgment result is fed back to the ultrasonic transducer to reposition the ultrasonic stimulation target point.
2. The closed-loop ultrasound neuromodulation system of claim 1, wherein: the ultrasonic module comprises a signal generator, a power amplifier and an ultrasonic transducer;
the signal generator is used for generating an ultrasonic nerve regulation pulse waveform and outputting the pulse waveform to the power amplifier;
the power amplifier is used for improving the energy of the pulse waveform output by the signal generator and outputting the energy to the ultrasonic transducer;
the ultrasonic transducer focuses on the ultrasonic stimulation target point through ultrasound according to the received energy.
3. The closed-loop ultrasound neuromodulation system of claim 2, wherein: the ultrasonic module also comprises an oscilloscope which is used for observing the pulse waveform output by the signal generator.
4. The closed-loop ultrasonic neuromodulation system of claim 3, wherein: the ultrasonic module also comprises an impedance matching circuit which is used for outputting the energy output by the power amplifier to an ultrasonic transducer without attenuation.
5. The closed-loop ultrasound neuromodulation system of claim 2, wherein: the signal generator adopts an independent dual-channel signal generator, the fundamental wave frequency of the signal generator is 0.1MHz-5MHz, the signal generator can independently generate sine signals and square signals, and the signal generator has a TTL gate trigger output function.
6. The closed-loop ultrasound neuromodulation system of claim 2, wherein: the ultrasonic transducer adopts a single piezoelectric array element, and the piezoelectric array element adopts materials including power type piezoelectric ceramics, composite piezoelectric materials and crystal materials.
7. The closed-loop ultrasonic neuromodulation system of claim 2 or 6, wherein: the positioning selection module adopts a nerve navigation technology, and comprises: stereotactic neuronavigation includes stereotactic guided neurosurgery or framed stereotactic neurosurgery; the magnetic resonance image nerve navigation comprises magnetic resonance image guided neurosurgery or frameless stereotactic neurosurgery; ultrasound image neural navigation includes ultrasound guided neurosurgery or echogenic stereotactic neurosurgery.
8. The closed-loop ultrasonic neuromodulation system of claim 7, wherein: deionized water is filled between the ultrasonic transducer and the fixing device; the fixing device is made of light materials with high compatibility with human tissues, and comprises a Peek material, photosensitive resin and organic glass.
9. The closed loop ultrasonic neuromodulation system as in claim 2 or 8, wherein: the feedback module observes the patient by adopting the imaging and the electrophysiological monitoring, wherein the imaging comprises magnetic resonance, CT, BOLD-MRI, f-MRI and MRS; the electrophysiological monitoring comprises electroencephalogram, electrocardio and myoelectricity.
10. A method of regulating a closed-loop ultrasound neuromodulation system according to claims 1-9, comprising the steps of:
step S1: acquiring intracranial conditions and skull structures of a patient;
step S2: selecting an ultrasonic transducer matched with the acting deep part and the acting range of the ultrasonic transducer according to the intracranial condition and the skull structure, and calculating the fixed position of the ultrasonic transducer on the skin of a patient and the ultrasonic acting distance;
step S3: carrying out three-dimensional reconstruction according to the skull structure, determining a fixing device matched with the skull structure according to the reconstructed three-dimensional structure, determining an ultrasonic stimulation target point on the skin of a patient, and fixing the ultrasonic transducer on the ultrasonic stimulation target point on the skin of the patient through the fixing device by combining the fixing position and the ultrasonic action distance of the ultrasonic transducer;
step S4: performing ultrasonic stimulation on the ultrasonic stimulation target point through the ultrasonic transducer, and outputting a stimulation result to a feedback module;
step S5: and judging whether the position of the ultrasonic stimulation target point is accurate or not through the feedback module according to the blood oxygen change of the ultrasonic stimulation target point after ultrasonic stimulation, and if the position is wrong, feeding the judgment result back to the ultrasonic transducer to reposition the ultrasonic stimulation target point.
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