Combining Multimodal Biomarkers to Guide Deep Brain Stimulation Programming in Parkinson Disease

Neuromodulation Technology at the Neural Interface, Год журнала: 2022, Номер 26(2), С. 320 - 332

Опубликована: Фев. 24, 2022

Deep brain stimulation (DBS) programming of multicontact DBS leads relies on a very time-consuming manual screening procedure, and strategies to speed up this process are needed. Beta activity in subthalamic nucleus (STN) local field potentials (LFP) has been suggested as promising marker index optimal contacts patients with Parkinson disease.In study, we investigate the advantage algorithmic selection combination multiple resting movement state features from STN LFPs imaging markers predict three relevant clinical parameters (clinical efficacy, therapeutic window, side-effect threshold).STN were recorded at rest during voluntary movements 27 hemispheres. Resting- movement-state frequency bands (alpha, low beta, high gamma, fast oscillations [HFO]) used outcome parameters. Subanalyses included an anatomical sweet spot additional feature.Both resting- contributed prediction, (fast) gamma activity, resting/movement-modulated beta movement-modulated HFO being most predictive. With proposed algorithm, best contact for can be identified probability almost 90% after considering half lead contacts, it outperforms use single marker. The electrophysiological further improve prediction.LFP-guided based efficient approach routine patients.

Язык: Английский

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Sensing data and methodology from the Adaptive DBS Algorithm for Personalized Therapy in Parkinson’s Disease (ADAPT-PD) clinical trial

npj Parkinson s Disease, Год журнала: 2024, Номер 10(1)

Опубликована: Сен. 17, 2024

Язык: Английский

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Neuroscience fundamentals relevant to neuromodulation: Neurobiology of deep brain stimulation in Parkinson's disease

Neurotherapeutics, Год журнала: 2024, Номер 21(3), С. e00348 - e00348

Опубликована: Апрель 1, 2024

Deep Brain Stimulation (DBS) has become a pivotal therapeutic approach for Parkinson's Disease (PD) and various neuropsychiatric conditions, impacting over 200,000 patients. Despite its widespread application, the intricate mechanisms behind DBS remain subject of ongoing investigation. This article provides an overview current knowledge surrounding local, circuit, neurobiochemical effects DBS, focusing on subthalamic nucleus (STN) as key target in PD management.The local once thought to mimic reversible lesion, now reveal more nuanced interplay with myelinated axons, neurotransmitter release, microenvironment. Circuit illuminate modulation oscillatory activities within basal ganglia emphasize communication between STN primary motor cortex. Neurobiochemical effects, encompassing changes dopamine levels epigenetic modifications, add further complexity landscape.Finally, context understanding PD, highlights controversial question whether exerts disease-modifying PD. While preclinical evidence suggests neuroprotective potential, clinical trials such EARLYSTIM face challenges assessing long-term disease modification due enrollment timing methodology limitations. The discussion underscores need robust biomarkers large-scale prospective conclusively determine DBS's potential therapy

Язык: Английский

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Proceedings of the 11th Annual Deep Brain Stimulation Think Tank: pushing the forefront of neuromodulation with functional network mapping, biomarkers for adaptive DBS, bioethical dilemmas, AI-guided neuromodulation, and translational advancements

Frontiers in Human Neuroscience, Год журнала: 2024, Номер 18

Опубликована: Фев. 21, 2024

The Deep Brain Stimulation (DBS) Think Tank XI was held on August 9–11, 2023 in Gainesville, Florida with the theme of “Pushing Forefront Neuromodulation”. keynote speaker Dr. Nico Dosenbach from Washington University St. Louis, Missouri. He presented his research recently published Nature inn a collaboration Evan Gordon to identify and characterize somato-cognitive action network (SCAN), which has redefined motor homunculus led new hypotheses about integrative networks underpinning therapeutic DBS. DBS founded 2012 provides an open platform where clinicians, engineers, researchers (from industry academia) can freely discuss current emerging technologies, as well logistical ethical issues facing field. group estimated that globally more than 263,000 devices have been implanted for neurological neuropsychiatric disorders. This year's meeting focused advances following areas: cutting-edge translational neuromodulation, physiology, neuromodulation Europe Asia, neuroethical dilemmas, artificial intelligence computational modeling, time scales mood disorders, future devices.

Язык: Английский

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Sleep-Aware Adaptive Deep Brain Stimulation Control: Chronic Use at Home With Dual Independent Linear Discriminate Detectors

Frontiers in Neuroscience, Год журнала: 2021, Номер 15

Опубликована: Окт. 18, 2021

Adaptive deep brain stimulation (aDBS) is a promising new technology with increasing use in experimental trials to treat diverse array of indications such as movement disorders (Parkinson's disease, essential tremor), psychiatric (depression, OCD), chronic pain and epilepsy. In many aDBS trials, neural biomarker interest compared predefined threshold amplitude adjusted accordingly. Across implant locations, potential biomarkers are greatly influenced by sleep. Successful embedded adaptive detectors must incorporate strategy account for sleep, avoid unwanted or unexpected algorithm behavior. Here, we show dual design two independent detectors, one used track sleep state (wake/sleep) the other parkinsonian motor (medication-induced fluctuations). six hemispheres (four patients) 47 days, our detector successfully transitioned mode while patients were sleeping, resumed tracking when awake. Designing "sleep aware" algorithms may prove crucial deployment clinically effective fully algorithms.

Язык: Английский

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Concurrent stimulation and sensing in bi-directional brain interfaces: a multi-site translational experience

Journal of Neural Engineering, Год журнала: 2022, Номер 19(2), С. 026025 - 026025

Опубликована: Март 2, 2022

Objective. To provide a design analysis and guidance framework for the implementation of concurrent stimulation sensing during adaptive deep brain (aDBS) with particular emphasis on artifact mitigations.Approach. We defined general architecture feedback-enabled devices, identified key components in signal chain which might result unwanted artifacts proposed methods that ultimately enable improved aDBS therapies. gathered data from research subjects chronically-implanted an investigational system, Summit RC + S, to characterize explore mitigations arising sensing. then used prototype implantable device, DyNeuMo, bench-setup accounts tissue-electrode properties, confirm our observations verify mitigations. The strategies reduce transient improve performance were confirmed chronic implant using updated configuration settings.Main results.We derived validated 'checklist' settings system areas future device improvement. Key considerations include (a) active instead passive recharge, (b) sense-channel blanking amplifier, (c) high-pass filter settings, (d) impedance mismatch management, (e) time-frequency trade-offs classifier, (f) algorithm transition rate limits. Without proper channel configuration, was susceptible limit-cycles oscillating independent physiological state. By applying checklist, we could optimize each block's characteristics within overall system. With system-level optimization, 'fast' demonstrated be feasible without reentrant loops, noise suitable subcortical circuits.Significance. present study sources propose devices aDBS. This work highlights as novel translate clinic. Finding appropriate balance constraints is imperative successful translation therapies.Clinical trial:Institutional Review Board Investigational Device Exemption numbers: NCT02649166/IRB201501021 (University Florida), NCT04043403/IRB52548 (Stanford University), NCT03582891/IRB1824454 California San Francisco). IDE #180 097.

Язык: Английский

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Deep brain stimulation in Parkinson’s disease: state of the art and future perspectives

Arquivos de Neuro-Psiquiatria, Год журнала: 2022, Номер 80(5 suppl 1), С. 105 - 115

Опубликована: Май 1, 2022

ABSTRACT For more than 30 years, Deep Brain Stimulation (DBS) has been a therapeutic option for Parkinson’s disease (PD) treatment. However, this therapy is still underutilized mainly due to misinformation regarding risks and clinical outcomes. DBS can ameliorate several motor non-motor symptoms, improving patients’ quality of life. Furthermore, most the improvement after long-lasting present even in advanced PD. Adequate patient selection, precise electric leads placement, correct programming are paramount good surgical Nonetheless, many limitations: axial symptoms signs, such as speech, balance gait, do not improve same extent appendicular be worsened direct or indirect consequence surgery stimulation. In addition, there unanswered questions patient’s planning techniques, role surgicogenomics, imaging-based lead new brain targets, strategies hardware features. The net effect these innovations should only refine beneficial we currently observe on selected signs but also treatment resistant facets PD, review, discuss current state art implant, programming, explore advances field.

Язык: Английский

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Proceedings of the 10th annual deep brain stimulation think tank: Advances in cutting edge technologies, artificial intelligence, neuromodulation, neuroethics, interventional psychiatry, and women in neuromodulation

Frontiers in Human Neuroscience, Год журнала: 2023, Номер 16

Опубликована: Янв. 27, 2023

The deep brain stimulation (DBS) Think Tank X was held on August 17–19, 2022 in Orlando FL. session organizers and moderators were all women with the theme neuromodulation . Dr. Helen Mayberg from Mt. Sinai, NY keynote speaker. She discussed milestones her experiences developing depression DBS. DBS founded 2012 provides an open platform where clinicians, engineers researchers (from industry academia) can freely discuss current emerging technologies as well logistical ethical issues facing field. consensus among speakers that has continued to expand scope however several indications have reached “trough of disillusionment.” for considered “re-emerging” approaching a slope enlightenment. will soon re-enter clinical trials. group estimated globally more than 244,000 devices been implanted neurological neuropsychiatric disorders. This year’s meeting focused advances following areas: Europe, Asia, Australia; cutting-edge technologies, closed loop DBS, tele-health, neuroethics, lesion therapy, interventional psychiatry, adaptive

Язык: Английский

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Pallidal Beta Activity Is Linked to Stimulation‐Induced Slowness in Dystonia

Movement Disorders, Год журнала: 2023, Номер 38(5), С. 894 - 899

Опубликована: Фев. 20, 2023

ABSTRACT Background Pallidal deep brain stimulation (DBS) effectively alleviates symptoms in dystonia patients, but may induce movement slowness as a side‐effect. In Parkinson's disease, hypokinetic have been associated with increased beta oscillations (13–30 Hz). We hypothesize that this pattern is symptom‐specific, thus accompanying DBS‐induced dystonia. Methods 6 pallidal rest recordings sensing‐enabled DBS device were performed and tapping speed was assessed using marker‐less pose estimation over 5 time points following cessation of DBS. Results After stimulation, ( P < 0.01). A linear mixed‐effects model revealed activity explained 77% the variance across patients = Conclusions The association between disease entities provides further evidence for symptom‐specific oscillatory patterns motor circuit. Our findings might help therapy improvements, DBS‐devices able to adapt are already commercially available. © 2023 Authors. Movement Disorders published by Wiley Periodicals LLC on behalf International Parkinson Disorder Society.

Язык: Английский

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Oscillatory and non-oscillatory features of the magnetoencephalic sensorimotor rhythm in Parkinson’s disease

npj Parkinson s Disease, Год журнала: 2024, Номер 10(1)

Опубликована: Март 5, 2024

Abstract Parkinson’s disease (PD) is associated with changes in neural activity the sensorimotor alpha and beta bands. Using magnetoencephalography (MEG), we investigated role of spontaneous neuronal within somatosensory cortex a large cohort early- to mid-stage PD patients ( N = 78) on Parkinsonian medication age- sex-matched healthy controls 60) using source reconstructed resting-state MEG. We quantified features time series data terms oscillatory power central frequency, 1/f broadband characteristics spectral density. Furthermore, characterised transient burst events mu-beta band time-domain signals. examined relationship between these signal patients’ state, symptom severity, age, sex, cortical thickness. differed PSD characteristics, showing steeper exponential slope higher offset. further showed age-related decrease rate. Out all activity, rate was increased severity bradykinesia, whereas duration axial symptoms. Our study shows that general non-oscillatory (broadband exponent offset) signals are related state scales PD.

Язык: Английский

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