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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Could adaptive deep brain stimulation treat freezing of gait in Parkinson’s disease?

Journal of Neurology, Год журнала: 2025, Номер 272(4)

Опубликована: Март 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.

Язык: Английский

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Embedding digital chronotherapy into bioelectronic medicines

iScience, Год журнала: 2022, Номер 25(4), С. 104028 - 104028

Опубликована: Март 4, 2022

Biological rhythms pervade physiology and pathophysiology across multiple timescales. Because of the limited sensing algorithm capabilities neuromodulation device technology to-date, insight into influence these on efficacy bioelectronic medicine has been infeasible. As development new devices begins to mitigate previous limitations, we propose that future should integrate chronobiological considerations in their control structures maximize benefits therapy. We motivate this proposition with preliminary longitudinal data recorded from patients Parkinson's disease epilepsy during deep brain stimulation therapy, where periodic symptom biomarkers are synchronized sub-daily, daily, longer timescale rhythms. suggest a physiological structure for incorporates time-based adaptation control, locked patient-specific biological rhythms, as an adjunct classical methods illustrate concept initial results three our recent case studies using chronotherapy-enabled prototypes.

Язык: Английский

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Pallidal activities during sleep and sleep decoding in dystonia, Huntington's, and Parkinson's disease

Neurobiology of Disease, Год журнала: 2023, Номер 182, С. 106143 - 106143

Опубликована: Май 3, 2023

Sleep disturbances are highly prevalent in movement disorders, potentially due to the malfunctioning of basal ganglia structures. Pallidal deep brain stimulation (DBS) has been widely used for multiple disorders and reported improve sleep. We aimed investigate oscillatory pattern pallidum during sleep explore whether pallidal activities can be utilized differentiate stages, which could pave way sleep-aware adaptive DBS.We directly recorded over 500 h local field potentials from 39 subjects with (20 dystonia, 8 Huntington's disease, 11 Parkinson's disease). spectrum cortical-pallidal coherence were computed compared across stages. Machine learning approaches build decoders different diseases classify stages through features. Decoding accuracy was further associated spatial localization pallidum.Pallidal power spectra significantly modulated by sleep-stage transitions three disorders. Differences sleep-related between identified non-rapid eye (NREM) REM models using features decode sleep-wake states 90% accuracy. accuracies higher recording sites within internus-pallidum than external-pallidum, precited structural (P < 0.0001) functional whole-brain neuroimaging connectomics.Our findings revealed strong dependent distinctions oscillations sufficient stage decoding. These data may facilitate development DBS systems targeting problems that have broad translational prospects.

Язык: Английский

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At home adaptive dual target deep brain stimulation in Parkinson’s disease with proportional control

Brain, Год журнала: 2023, Номер 147(3), С. 911 - 922

Опубликована: Дек. 20, 2023

Abstract Continuous deep brain stimulation (cDBS) of the subthalamic nucleus (STN) or globus pallidus is an effective treatment for motor symptoms Parkinson’s disease. The relative benefit one region over other great interest but cannot usually be compared in same patient. Simultaneous DBS both regions may synergistically increase therapeutic benefit. limited by a lack responsiveness to dynamic, fluctuating intrinsic Adaptive (aDBS) adjusts response biomarkers improve efficacy, side effects, and efficiency. We combined bilateral STN (dual target DBS) prospective within-participant, clinical trial six patients with disease (n = 6, 55–65 years, n 2 females). Dual cDBS was tested symptom control annually measured rating scales, on time without dyskinesia, medication reduction. Random amplitude experiments probed system dynamics estimate parameters aDBS. then implemented proportional-plus-integral aDBS using novel distributed (off-implant) architecture. In home setting, we collected tremor dyskinesia scores as well individualized β amplitudes. reduced Unified Disease Rating Scale (UPDRS) greater degree than either alone (P &lt; 0.05, linear mixed model) cohort. β-oscillations correlated speed hand grasp movements five participants Pearson correlation). provided insight into temporal windowing avoid artefacts demonstrated correlation between amplitude. Proportional plus integral average power, while preserving UPDRS III clinic 0.28, Wilcoxon signed rank), during blinded testing at 3, P &gt; ranked sum). power reductions were slight significant. offer improvement alone. When proportional aDBS, reduced, increased dual DBS.

Язык: Английский

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Chronic intracranial recordings in the globus pallidus reveal circadian rhythms in Parkinson’s disease

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

Опубликована: Май 30, 2024

Abstract Circadian rhythms have been shown in the subthalamic nucleus (STN) Parkinson’s disease (PD), but only a few studies focused on globus pallidus internus (GPi). This retrospective study investigates GPi circadian large cohort of subjects with PD (130 recordings from 93 subjects) activity chronically recorded their home environment. We found significant change between daytime and nighttime most (82.4%), reduction at 56.2% an increase 26.2%. higher frequency bands ( > 20 Hz) was more likely to decrease night patients taking extended-release levodopa medication. Our results suggest that fluctuations vary across individuals increased power might be due reemergence pathological neural activity. These findings should considered ensure successful implementation adaptive neurostimulation paradigms real-world.

Язык: Английский

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Diving into the subcortex: The potential of chronic subcortical sensing for unravelling basal ganglia function and optimization of deep brain stimulation

NeuroImage, Год журнала: 2022, Номер 254, С. 119147 - 119147

Опубликована: Март 27, 2022

Subcortical structures are a relative neurophysiological 'terra incognita' owing to their location within the skull. While perioperative subcortical sensing has been performed for more than 20 years, neurophysiology of basal ganglia in home setting remained almost unexplored. However, with recent advent implantable pulse generators (IPG) that able record neural activity, opportunity chronically local field potentials (LFPs) directly from electrodes implanted deep brain stimulation opens up. This allows breakthrough chronic into fundamental research and clinical practice. In this review an extensive overview current state is provided. The widespread potential investigational use discussed. Finally, status future perspectives most promising application -i.e., adaptive (aDBS)- discussed context movement disorders. development aDBS based on both cortical dramatically change practice life patients several barriers still stand way implementation. Advancements regarding IPG lead technology, physiomarkers, algorithms as well harnessing artificial intelligence, multimodality naturalistic needed bring

Язык: Английский

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Sleep and circadian rhythms in α‐synucleinopathies—Perspectives for disease modification

Acta Physiologica, Год журнала: 2023, Номер 238(1)

Опубликована: Март 23, 2023

Abstract The global north is facing an unprecedented rise in the prevalence of neurodegenerative diseases. increasing incidence Parkinson's disease being referred to as a pandemic. reason for enormous increase only partly understood. Lifestyle factors are known play role, but they alone cannot account surge. One factor that—although recognized important—has not been explored detail so far influence circadian rhythms. Sleep and rhythm disruption key neurodegeneration, their occurrence during early stages suggests causal role pathogenesis. Isolated rapid eye movement (REM) sleep behavior disorder (iRBD) has identified prodromal state α‐synucleinopathies, such disease, Lewy body dementia, multiple system atrophy offering window insights into development these Even though REM most pronounced, driven modulated by timing system, specific abnormalities have described iRBD. Novel experimental clinical approaches exploiting molecular circuitry underlying timekeeping hold promise disentangle some pathophysiologic mechanisms α‐synucleinopathies. In this review, we summarize current knowledge on disruptions α‐synucleinopathies with emphasis aspects therapeutic potentials. These might contribute our understanding pathogenesis diseases may allow interventions addressing disturbed at stage disease.

Язык: Английский

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Advances in Deep Brain Stimulation: From Mechanisms to Applications

Journal of Neuroscience, Год журнала: 2023, Номер 43(45), С. 7575 - 7586

Опубликована: Ноя. 8, 2023

Deep brain stimulation (DBS) is an effective therapy for various neurologic and neuropsychiatric disorders, involving chronic implantation of electrodes into target regions electrical delivery. Despite its safety efficacy, DBS remains underutilized therapy. Advances in the field DBS, including technology, mechanistic understanding, applications have potential to expand access use while also improving clinical outcomes. Developments such as MRI compatibility bidirectional systems capable sensing neural activity providing therapeutic stimulation, enabled advances our understanding mechanisms application. In this review, we summarize recent work exploring modulation networks. We cover current focusing on improved programming development novel paradigms that go beyond standards many which are by sensing-enabled DBS.

Язык: Английский

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Contribution of basal ganglia activity to REM sleep disorder in Parkinson’s disease

Journal of Neurology Neurosurgery & Psychiatry, Год журнала: 2024, Номер unknown, С. jnnp - 332014

Опубликована: Апрель 19, 2024

Rapid eye movement (REM) sleep behaviour disorder (RBD) is one of the most common problems and represents a key prodromal marker in Parkinson's disease (PD). It remains unclear whether how basal ganglia nuclei, structures that are directly involved pathology PD, implicated occurrence RBD.

Язык: Английский

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