Adaptive Deep Brain Stimulation: From Experimental Evidence Toward Practical Implementation

Movement Disorders, Год журнала: 2023, Номер 38(6), С. 937 - 948

Опубликована: Май 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.

Язык: Английский

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A systematic review of local field potential physiomarkers in Parkinson’s disease: from clinical correlations to adaptive deep brain stimulation algorithms

Journal of Neurology, Год журнала: 2022, Номер 270(2), С. 1162 - 1177

Опубликована: Окт. 8, 2022

Deep brain stimulation (DBS) treatment has proven effective in suppressing symptoms of rigidity, bradykinesia, and tremor Parkinson's disease. Still, patients may suffer from disabling fluctuations motor non-motor symptom severity during the day. Conventional DBS consists continuous but can potentially be further optimised by adapting settings to presence or absence through closed-loop control. This critically relies on use 'physiomarkers' extracted (neuro)physiological signals. Ideal physiomarkers for adaptive (aDBS) are indicative severity, detectable every patient, technically suitable implementation. In last decades, much effort been put into detection local field potential (LFP) their clinical practice. We conducted a research synthesis correlations that have reported between LFP signal features one more specific PD symptoms. Features based spectral beta band (~ 13 30 Hz) explained ~ 17% individual variability bradykinesia rigidity severity. Limitations oscillations as physiomarker discussed, strategies improvement aDBS explored.

Язык: Английский

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Evoked resonant neural activity in subthalamic local field potentials reflects basal ganglia network dynamics

Neurobiology of Disease, Год журнала: 2023, Номер 178, С. 106019 - 106019

Опубликована: Янв. 24, 2023

Evoked resonant neural activity (ERNA) is induced by subthalamic deep brain stimulation (DBS) and was recently suggested as a marker of lead placement contact selection in Parkinson's disease. Yet, its underlying mechanisms how it modulated parameters are unclear. Here, we recorded local field potentials from 27 disease patients, while leads were externalised to scrutinise the ERNA. First, show that ERNA time series waveform spectrogram likely represent same activity, which contested before. Second, our results has fast slow dynamics during stimulation, consistent with synaptic failure hypothesis. Third, different DBS frequencies, intensities, medication states modes (continuous vs. adaptive DBS). These suggest might prove useful predictor best frequency lowest effective intensity addition selection. Changes levodopa mode may indicate state cortico-basal ganglia circuit making putative biomarker track clinical DBS.

Язык: Английский

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From Prodromal Stages to Clinical Trials: The Promise of Digital Speech Biomarkers in Parkinson's Disease

Neuroscience & Biobehavioral Reviews, Год журнала: 2024, Номер 167, С. 105922 - 105922

Опубликована: Окт. 18, 2024

Язык: Английский

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Neurophysiological gradient in the Parkinsonian subthalamic nucleus as a marker for motor symptoms and apathy

npj Parkinson s Disease, Год журнала: 2025, Номер 11(1)

Опубликована: Янв. 3, 2025

Abstract Sensing-based deep brain stimulation should optimally consider both the motor and neuropsychiatric domain to maximize quality of life Parkinson’s disease (PD) patients. Here we characterize neurophysiological properties subthalamic nucleus (STN) in 69 PD patients using a newly established gradient metric contextualize it with symptoms apathy. We could evidence STN power that holds most spectral information between 5 30 Hz spanning along dorsal-ventral axis. It shows elevated sub-beta range (8-12 Hz) toward ventral STN, dorsal beta (16–24 indicative for hemispheres contralateral more affected hemi-body side. The rigidity response DBS was highest dorsally on Importantly, apathetic can be related reduced alpha power. In conclusion, may inform about domain, supporting integrative closed-loop strategies.

Язык: Английский

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Neuronal oscillations predict deep brain stimulation outcome in Parkinson's disease

Brain stimulation, Год журнала: 2022, Номер 15(3), С. 792 - 802

Опубликована: Май 1, 2022

BackgroundNeuronal oscillations are linked to symptoms of Parkinson's disease. This relation can be exploited for optimizing deep brain stimulation (DBS), e.g. by informing a device or human about the optimal location, time and intensity stimulation. Whether predict individual DBS outcome is not clear so far.ObjectiveTo motor symptom improvement from subthalamic power subthalamo-cortical coherence.MethodsWe applied machine learning techniques simultaneously recorded magnetoencephalography local field potential data 36 patients with Gradient-boosted tree was in combination feature importance analysis generate understand out-of-sample predictions.ResultsA few features sufficed making accurate predictions. A model operating on five coherence features, example, achieved correlations r > 0.8 between actual predicted outcomes. Coherence comprised more information less than power, although general their content comparable. Both signals akinesia/rigidity reduction best. The most important high-beta (20–35 Hz). connectivity were subthalamo-parietal very high frequency band (>200 Hz) low-gamma (36–60 Successful prediction due inferring distance target severity neuronal oscillations.ConclusionThis study demonstrates first that predictive outcome. parietal particularly informative. These results highlight clinical relevance inter-areal synchrony basal ganglia-cortex loops might facilitate further improvements future.

Язык: Английский

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Local Field Potential-Guided Contact Selection Using Chronically Implanted Sensing Devices for Deep Brain Stimulation in Parkinson’s Disease

Brain Sciences, Год журнала: 2022, Номер 12(12), С. 1726 - 1726

Опубликована: Дек. 16, 2022

Intra- and perioperatively recorded local field potential (LFP) activity of the nucleus subthalamicus (STN) has been suggested to guide contact selection in patients undergoing deep brain stimulation (DBS) for Parkinson’s disease (PD). Despite invention sensing capacities chronically implanted devices, a comprehensible algorithm that enables using such recordings is still lacking. We evaluated fully automated uses weighted average bipolar determine effective monopolar contacts based on elevated beta band. LFPs from 14 hemispheres seven PD with newly directional DBS leads STN were recorded. First, determined level highest activity. Based prior level, was chosen second step. The mean clinical efficacy did not statistically differ standard as performed routine. All recording sites projected into MNI space investigate feasibility respect anatomical boundaries STN. conclude proposed first step towards LFP-based STN-DBS devices.

Язык: Английский

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Spectral Topography of the Subthalamic Nucleus to Inform Next‐Generation Deep Brain Stimulation

Movement Disorders, Год журнала: 2023, Номер 38(5), С. 818 - 830

Опубликована: Март 28, 2023

Abstract Background The landscape of neurophysiological symptoms and behavioral biomarkers in basal ganglia signals for movement disorders is expanding. clinical translation sensing‐based deep brain stimulation (DBS) also requires a thorough understanding the anatomical organization spectral within subthalamic nucleus (STN). Objectives aims were to systematically investigate topography, including wide range sub‐bands STN local field potentials (LFP) Parkinson's disease (PD) patients, evaluate its predictive performance response DBS. Methods STN‐LFPs recorded from 70 PD patients (130 hemispheres) awake at rest using multicontact DBS electrodes. A comprehensive spatial characterization, hot spot localization focality estimation, was performed multiple (delta, theta, alpha, low‐beta, high‐beta, low‐gamma, high‐gamma, fast‐gamma (FG) as well low‐ fast high‐frequency oscillations [HFO]) compared rigidity biomarker map established used predict Results shows heterogeneous topographic distribution different biomarkers, with strongest segregation inferior‐superior axis. Relative superiorly localized beta spot, HFOs (FG, slow HFO) up 2 mm more inferiorly. Beta are spatially spread other sub‐bands. Both proximity contacts distance higher‐frequency spots best Conclusions properties target structure can additionally be informative implementation next‐generation © 2023 Authors. Movement Disorders published by Wiley Periodicals LLC on behalf International Parkinson Disorder Society.

Язык: Английский

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Dopamine depletion leads to pathological synchronization of distinct basal ganglia loops in the beta band

PLoS Computational Biology, Год журнала: 2023, Номер 19(4), С. e1010645 - e1010645

Опубликована: Апрель 27, 2023

Motor symptoms of Parkinson's Disease (PD) are associated with dopamine deficits and pathological oscillation basal ganglia (BG) neurons in the β range ([12-30] Hz). However, how depletion affects dynamics BG nuclei is still unclear. With a spiking model, we here capture features interactions leading to oscillations dopamine-depleted condition. We highlight that both loop between subthalamic nucleus (STN) Globus Pallidus pars externa (GPe) striatal fast medium spiny GPe display resonances range, synchronize common frequency through interaction. Crucially, synchronization depends on depletion: two loops largely independent for high levels dopamine, but progressively as depleted due increased strength loop. The model validated against recent experimental reports role cortical inputs, STN activity generation oscillations. Our results interplay GPe-STN GPe-striatum generating sustained PD subjects, explain this level dopamine. This paves way design therapies specifically addressing onset

Язык: Английский

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Towards biomarker-based optimization of deep brain stimulation in Parkinson’s disease patients

Frontiers in Neuroscience, Год журнала: 2023, Номер 16

Опубликована: Янв. 11, 2023

Subthalamic deep brain stimulation (DBS) is an established therapy to treat Parkinson's disease (PD). To maximize therapeutic outcome, optimal DBS settings must be carefully selected for each patient. Unfortunately, this not always achieved because of: (1) increased technological complexity of devices, (2) time restraints, or lack expertise, and (3) delayed response some symptoms. Biomarkers accurately predict the most effective patient could streamline process improve outcomes.To investigate use evoked potentials (EPs) clinical outcomes in PD patients with DBS.In ten (12 hemispheres), a monopolar review was performed by systematically stimulating on contact measuring window. Standard imaging data were collected. EEG-based EPs then recorded at 10 Hz 50 s DBS-contact. Linear mixed models used assess how well both image-derived information predicted data.Evoked potential peaks 3 ms (P3) (P10) observed nine eleven hemispheres, respectively. Clinical using either P3 P10. A separate model showed that also similar accuracy. Combining one yielded highest predictive value.Evoked can responses. further improves prediction. Future refinement approach may programming, thereby improving outcomes.ClinicalTrials.gov, identifier NCT04658641.

Язык: Английский

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