Unraveling the complexities of programming neural adaptive deep brain stimulation in Parkinson’s disease DOI Creative Commons
Kevin B. Wilkins, Jillian A. Melbourne,

Pranav Akella

et al.

Frontiers in Human Neuroscience, Journal Year: 2023, Volume and Issue: 17

Published: Nov. 28, 2023

Over the past three decades, deep brain stimulation (DBS) for Parkinson’s disease (PD) has been applied in a continuous open loop fashion, unresponsive to changes given patient’s state or symptoms over course of day. Advances recent neurostimulator technology enable possibility closed adaptive DBS (aDBS) PD as treatment option near future which adjusts demand-based manner. Although aDBS offers great clinical potential motor symptoms, it also brings with need better understanding how implement order maximize its benefits. In this perspective, we outline considerations programing several key parameters based on our experience across aDBS-capable research neurostimulators. At core, hinges successful identification relevant biomarkers that can be measured reliably real-time working cohesion control policy governs adaption. However, auxiliary such window is allowed adapt, well rate changes, just impactful performance and vary depending patient. A standardize protocol programming will crucial ensuring effective application practice.

Language: Английский

Adaptive Deep Brain Stimulation: From Experimental Evidence Toward Practical Implementation DOI Creative Commons
Wolf‐Julian Neumann, Ro’ee Gilron, Simon Little

et al.

Movement Disorders, Journal Year: 2023, Volume and Issue: 38(6), P. 937 - 948

Published: May 6, 2023

Abstract Closed‐loop adaptive deep brain stimulation (aDBS) can deliver individualized therapy at an unprecedented temporal precision for neurological disorders. This has the potential to lead a breakthrough in neurotechnology, but translation clinical practice remains significant challenge. Via bidirectional implantable brain‐computer‐interfaces that have become commercially available, aDBS now sense and selectively modulate pathophysiological circuit activity. Pilot studies investigating different control strategies showed promising results, short experimental study designs not yet supported analyses of patient‐specific factors biomarker therapeutic response dynamics. Notwithstanding clear theoretical advantages patient‐tailored approach, these new possibilities open vast mostly unexplored parameter space, leading practical hurdles implementation development trials. Therefore, thorough understanding neurophysiological neurotechnological aspects related is crucial develop evidence‐based treatment regimens practice. Therapeutic success will depend on integrated feedback signal identification, artifact mitigation, processing, policy adjustment, precise delivery tailored individual patients. The present review introduces reader foundation Parkinson's disease (PD) other network disorders, explains currently available policies, highlights pitfalls difficulties be addressed upcoming years. Finally, it importance interdisciplinary research within across DBS centers, toward patient‐centered approach invasive stimulation. © 2023 Authors. Movement Disorders published by Wiley Periodicals LLC behalf International Parkinson Disorder Society.

Language: Английский

Citations

79
Past, Present, and Future of Deep Brain Stimulation: Hardware, Software, Imaging, Physiology and Novel Approaches DOI Creative Commons
Jessica Frey, Jackson Cagle, Kara A. Johnson

et al.

Frontiers in Neurology, Journal Year: 2022, Volume and Issue: 13

Published: March 9, 2022

Deep brain stimulation (DBS) has advanced treatment options for a variety of neurologic and neuropsychiatric conditions. As the technology DBS continues to progress, efficacy will continue improve disease indications expand. Hardware advances such as longer-lasting batteries reduce frequency battery replacement segmented leads facilitate improvements in effectiveness have potential minimize side effects. Targeting specialized imaging sequences “connectomics” improved accuracy lead positioning trajectory planning. Software closed-loop remote programming enable be more personalized accessible technology. The future promising holds further quality life. In this review we address past, present DBS.

Language: Английский

Citations

73
Insights and opportunities for deep brain stimulation as a brain circuit intervention DOI Creative Commons
Wolf‐Julian Neumann, Andreas Horn, Andrea A. Kühn

et al.

Trends in Neurosciences, Journal Year: 2023, Volume and Issue: 46(6), P. 472 - 487

Published: April 25, 2023

Deep brain stimulation (DBS) is an effective treatment and has provided unique insights into the dynamic circuit architecture of disorders. This Review illustrates our current understanding pathophysiology movement disorders their underlying circuits that are modulated with DBS. It proposes principles pathological network synchronization patterns like beta activity (13–35 Hz) in Parkinson's disease. We describe alterations from microscale including local synaptic via modulation mesoscale hypersynchronization to changes whole-brain macroscale connectivity. Finally, outlook on advances for clinical innovations next-generation neurotechnology provided: preoperative connectomic targeting feedback controlled closed-loop adaptive DBS as individualized network-specific interventions.

Language: Английский

Citations

49
Chronic adaptive deep brain stimulation versus conventional stimulation in Parkinson’s disease: a blinded randomized feasibility trial DOI
Carina R. Oehrn, Stephanie Cernera, Lauren H. Hammer

et al.

Nature Medicine, Journal Year: 2024, Volume and Issue: 30(11), P. 3345 - 3356

Published: Aug. 19, 2024

Language: Английский

Citations

45
Diurnal modulation of subthalamic beta oscillatory power in Parkinson’s disease patients during deep brain stimulation DOI Creative Commons
Joram J. van Rheede, Lucia K. Feldmann, Johannes L. Busch

et al.

npj Parkinson s Disease, Journal Year: 2022, Volume and Issue: 8(1)

Published: July 8, 2022

Beta-band activity in the subthalamic local field potential (LFP) is correlated with Parkinson's disease (PD) symptom severity and therapeutic target of deep brain stimulation (DBS). While beta fluctuations PD patients are well characterized on shorter timescales, it not known how evolves around diurnal cycle, outside a clinical setting. Here, we obtained chronic recordings (34 ± 13 days) power implanted Percept DBS device during high-frequency analysed their properties as sensitivity to artifacts. Time day explained 41 9% variance (p < 0.001 all patients), increased reduced at night. Certain movements affected LFP quality, which may have contributed patterns some patients. Future algorithms benefit from taking such artifactual into account.

Language: Английский

Citations

59
Personalized chronic adaptive deep brain stimulation outperforms conventional stimulation in Parkinson’s disease DOI Creative Commons
Carina R. Oehrn, Stephanie Cernera, Lauren H. Hammer

et al.

medRxiv (Cold Spring Harbor Laboratory), Journal Year: 2023, Volume and Issue: unknown

Published: Aug. 8, 2023

Deep brain stimulation is a widely used therapy for Parkinson's disease (PD) but currently lacks dynamic responsiveness to changing clinical and neural states. Feedback control has the potential improve therapeutic effectiveness, optimal strategy additional benefits of "adaptive" neurostimulation are unclear. We implemented adaptive subthalamic nucleus stimulation, controlled by or cortical signals, in three PD patients (five hemispheres) during normal daily life. identified neurophysiological biomarkers residual motor fluctuations using data-driven analyses field potentials over wide frequency range varying amplitudes. Narrowband gamma oscillations (65-70 Hz) at either site emerged as best signal sensing stimulation. A blinded, randomized trial demonstrated improved symptoms quality life compared clinically optimized standard Our approach highlights promise personalized based on selection signals may be applied other neurological disorders.

Language: Английский

Citations

30
Single threshold adaptive deep brain stimulation in Parkinson's disease depends on parameter selection, movement state and controllability of subthalamic beta activity DOI Creative Commons
Johannes L. Busch,

Jonathan Kaplan,

Jeroen Habets

et al.

Brain stimulation, Journal Year: 2024, Volume and Issue: 17(1), P. 125 - 133

Published: Jan. 1, 2024

BackgroundDeep brain stimulation (DBS) is an invasive treatment option for patients with Parkinson's disease. Recently, adaptive DBS (aDBS) systems have been developed, which adjust timing and amplitude in real-time. However, it unknown how changes parameters, movement states the controllability of subthalamic beta activity affect aDBS performance.ObjectiveTo characterize parameter choice, state interactively electrophysiological behavioral response to single threshold aDBS.MethodsWe recorded local field potentials 12 disease receiving acute post-operative state. We investigated two parameters: onset time smoothing real-time power. Electrophysiological patterns motor performance were assessed while at rest during a simple task. further studied impact on by comparing without power modulation continuous stimulation.ResultsOur findings reveal that control extent suppression achievable rest. Behavioral data indicate only specific combinations yield beneficial effect aDBS. During movement, action induced reduces responsivity closed loop algorithm. demonstrate prerequisite effective dependent activity.ConclusionOur results highlight interaction between selection, driving performance. By this means, we identify directions development closed-loop algorithms.

Language: Английский

Citations

12
Multi-night cortico-basal recordings reveal mechanisms of NREM slow-wave suppression and spontaneous awakenings in Parkinson’s disease DOI Creative Commons
Md Fahim Anjum, Clay Smyth,

Rafael Zuzuárregui

et al.

Nature Communications, Journal Year: 2024, Volume and Issue: 15(1)

Published: Feb. 27, 2024

Abstract Sleep disturbance is a prevalent and disabling comorbidity in Parkinson’s disease (PD). We performed multi-night (n = 57) at-home intracranial recordings from electrocorticography subcortical electrodes using sensing-enabled Deep Brain Stimulation (DBS), paired with portable polysomnography four PD participants one cervical dystonia (clinical trial: NCT03582891). Cortico-basal activity delta increased beta decreased during NREM (N2 + N3) versus wakefulness PD. DBS caused further elevation cortical decrease alpha low-beta compared to OFF state. Our primary outcome demonstrated an inverse interaction between slow-wave NREM. secondary revealed increases prior spontaneous awakenings classified vs. high accuracy both traditional (30 s: 92.6 ± 1.7%) rapid (5 88.3 2.1%) data epochs of signals. findings elucidate sleep neurophysiology impacts on informing adaptive for dysfunction.

Language: Английский

Citations

12
Could adaptive deep brain stimulation treat freezing of gait in Parkinson’s disease? DOI Creative Commons
Philipp Klocke, M. Loeffler, Simon J.G. Lewis

et al.

Journal of Neurology, Journal Year: 2025, Volume and Issue: 272(4)

Published: March 12, 2025

Abstract Next-generation neurostimulators capable of running closed-loop adaptive deep brain stimulation (aDBS) are about to enter the clinical landscape for treatment Parkinson’s disease. Already promising results using aDBS have been achieved symptoms such as bradykinesia, rigidity and motor fluctuations. However, heterogeneity freezing gait (FoG) with its wide range presentations exacerbation cognitive emotional load make it more difficult predict treat. Currently, a successful strategy ameliorate FoG lacks robust oscillatory biomarker. Furthermore, technical implementation suppressing an upcoming episode in real-time represents significant challenge. This review describes neurophysiological signals underpinning explains how is currently being implemented. we offer discussion addressing both theoretical practical areas that will need be resolved if going able unlock full potential treat FoG.

Language: Английский

Citations

1
Pathological pallidal beta activity in Parkinson’s disease is sustained during sleep and associated with sleep disturbance DOI Creative Commons
Zixiao Yin, Ruoyu Ma,

Qi An

et al.

Nature Communications, Journal Year: 2023, Volume and Issue: 14(1)

Published: Sept. 5, 2023

Parkinson's disease (PD) is associated with excessive beta activity in the basal ganglia. Brain sensing implants aim to leverage this biomarker for demand-dependent adaptive stimulation. Sleep disturbance among most common non-motor symptoms PD, but its relationship unknown. To investigate clinical potential of as a sleep quality we recorded pallidal local field potentials during polysomnography PD patients off dopaminergic medication and compared results dystonia patients. exhibited sustained elevated across wakefulness, rapid eye movement (REM), non-REM sleep, which was correlated disturbance. Simulation stimulation revealed that sleep-related changes remain unaccounted by current algorithms, negative outcomes overall life

Language: Английский

Citations

23