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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Past, Present, and Future of Deep Brain Stimulation: Hardware, Software, Imaging, Physiology and Novel Approaches

Frontiers in Neurology, Год журнала: 2022, Номер 13

Опубликована: Март 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.

Язык: Английский

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Insights and opportunities for deep brain stimulation as a brain circuit intervention

Trends in Neurosciences, Год журнала: 2023, Номер 46(6), С. 472 - 487

Опубликована: Апрель 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.

Язык: Английский

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Chronic adaptive deep brain stimulation versus conventional stimulation in Parkinson’s disease: a blinded randomized feasibility trial

Nature Medicine, Год журнала: 2024, Номер 30(11), С. 3345 - 3356

Опубликована: Авг. 19, 2024

Язык: Английский

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Diurnal modulation of subthalamic beta oscillatory power in Parkinson’s disease patients during deep brain stimulation

npj Parkinson s Disease, Год журнала: 2022, Номер 8(1)

Опубликована: Июль 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.

Язык: Английский

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Personalized chronic adaptive deep brain stimulation outperforms conventional stimulation in Parkinson’s disease

medRxiv (Cold Spring Harbor Laboratory), Год журнала: 2023, Номер unknown

Опубликована: Авг. 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.

Язык: Английский

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Single threshold adaptive deep brain stimulation in Parkinson's disease depends on parameter selection, movement state and controllability of subthalamic beta activity

Brain stimulation, Год журнала: 2024, Номер 17(1), С. 125 - 133

Опубликована: Янв. 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.

Язык: Английский

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Multi-night cortico-basal recordings reveal mechanisms of NREM slow-wave suppression and spontaneous awakenings in Parkinson’s disease

Nature Communications, Год журнала: 2024, Номер 15(1)

Опубликована: Фев. 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.

Язык: Английский

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Pathological pallidal beta activity in Parkinson’s disease is sustained during sleep and associated with sleep disturbance

Nature Communications, Год журнала: 2023, Номер 14(1)

Опубликована: Сен. 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

Язык: Английский

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Beta-triggered adaptive deep brain stimulation during reaching movement in Parkinson’s disease

Brain, Год журнала: 2023, Номер 146(12), С. 5015 - 5030

Опубликована: Июль 11, 2023

Abstract Subthalamic nucleus (STN) beta-triggered adaptive deep brain stimulation (ADBS) has been shown to provide clinical improvement comparable conventional continuous DBS (CDBS) with less energy delivered the and induced side effects. However, several questions remain unanswered. First, there is a normal physiological reduction of STN beta band power just prior during voluntary movement. ADBS systems will therefore reduce or cease movement in people Parkinson’s disease could compromise motor performance compared CDBS. Second, was smoothed estimated over time period 400 ms most previous studies, but shorter smoothing have advantage being more sensitive changes power, which enhance performance. In this study, we addressed these two by evaluating effectiveness using standard 200 window reaching movements. Results from 13 showed that reducing for quantifying did lead shortened burst durations increasing number bursts than frequent switching on/off stimulator had no behavioural Both CDBS improved an equivalent extent DBS. Secondary analysis revealed were independent effects decrease increase gamma predicting faster speed, while event related desynchronization (ERD) predicted quicker initiation. suppressed both ADBS, whereas ERD reduced similar level DBS, together explained achieved movements ADBS. addition, significantly tremor not as effective These results suggest improving disease, shortening does result any additional benefit. When developing it might be necessary track very fast dynamics; combining beta, gamma, information decoding beneficial biomarkers needed optimal treatment tremor.

Язык: Английский

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