Adaptive deep brain stimulation for Parkinson's disease demonstrates reduced speech side effects compared to conventional stimulation in the acute setting

Little, Simon; Tripoliti, Elina; Beudel, Martijn; Pogosyan, Alek; Cagnan, Hayriye; Herz, Damian M.; Bestmann, Sven; Aziz, Tipu Z.; Cheeran, Binith; Zrinzo, Ludvic; Hariz, Marwan; Hyam, Jonathan A.; Limousin, Patricia; Foltynie, Tom; Brown, Peter

doi:10.1136/jnnp-2016-313518

Cited by 203 publications

(182 citation statements)

References 5 publications

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“…However, there are several reasons why adaptive DBS could improve this therapy. Reduction in stimulation current without loss of therapeutic benefit has the potential to reduce stimulation-induced adverse effects 19 , as well as prolong battery life or allow greater miniaturization of the relatively large pulse generators now in use 20 . Further, some of the PD patients most in need of DBS are also among the most difficult to successfully program: those who alternate between extreme states of dyskinesia and bradykinesia with little in-between time (“brittle fluctuators”) 21,22 .…”

Section: Discussionmentioning

confidence: 99%

Adaptive deep brain stimulation for Parkinson’s disease using motor cortex sensing

et al. 2018

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Objective Contemporary deep brain stimulation for Parkinson’s disease is delivered continuously, and adjustments based on patient’s changing symptoms must be made manually by a trained clinician. Patients may be subjected to energy intensive settings at times when they are not needed, possibly resulting in stimulation-induced adverse effects, such as dyskinesia. One solution is “adaptive” DBS, in which stimulation is modified in real time based on neural signals that co-vary with the severity of motor signs or of stimulation-induced adverse effects. Here we show the feasibility of adaptive DBS using a fully implanted neural prosthesis. Approach We demonstrate adaptive deep brain stimulation in two patients with Parkinson’s disease using a fully implanted neural prosthesis that is enabled to utilize brain sensing to control stimulation amplitude (Activa PC+S). We used a cortical narrowband gamma (60-90 Hz) oscillation related to dyskinesia to decrease stimulation voltage when gamma oscillatory activity is high (indicating dyskinesia) and increase stimulation voltage when it is low. Main Results We demonstrate the feasibility of “adaptive deep brain stimulation” in two patients with Parkinson’s disease. In short term in-clinic testing, energy savings were substantial (38-45%), and therapeutic efficacy was maintained. Significance This is the first demonstration of adaptive DBS in Parkinson’s disease using a fully implanted device and neural sensing. Our approach is distinct from other strategies utilizing basal ganglia signals for feedback control.

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Section: Discussionmentioning

confidence: 99%

Adaptive deep brain stimulation for Parkinson’s disease using motor cortex sensing

et al. 2018

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“…Dyskinesias may, for example, be problematic when stimulation is combined with dopaminergic medication following surgery, but this will be less so once the stun effect abates and once medication has been titrated over time 37. The speech impairment that was shown with acute cDBS, and was absent with aDBS, might also disappear with optimisation of cDBS stimulation site and parameters over time 28. In reality, side effects (and efficacy) should be assessed during chronic treatment in the patient’s everyday environment, with the clinical team afforded the opportunity to optimize both DBS therapy and medication.…”

Section: Limitations and Roadblocksmentioning

confidence: 99%

“…These may be mechanistically or causally related to the symptoms or serve as faithful markers of the primary circuit dysfunction. In the former case, stimulation can be specifically patterned to maximally disrupt the underlying causal circuit dynamics, as for example, in the case of phase-responsive forms of stimulation being pioneered for the treatment of tremor 28. In the latter case, the DBS intervention is necessarily more generic, and its delivery is controlled by the inferred state of the unmeasured or unknown primary circuit dysfunction.…”

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confidence: 99%

Adaptive Deep Brain Stimulation for Movement Disorders: The Long Road to Clinical Therapy

et al. 2017

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Continuous high-frequency DBS is an established treatment for essential tremor and Parkinson’s disease. Current developments focus on trying to widen the therapeutic window of DBS. Adaptive DBS (aDBS), where stimulation is dynamically controlled by feedback from biomarkers of pathological brain circuit activity, is one such development. Relevant biomarkers may be central, such as local field potential activity, or peripheral, such as inertial tremor data. Moreover, stimulation may be directed by the amplitude or the phase (timing) of the biomarker signal. In this review, we evaluate existing aDBS studies as proof-of-principle, discuss their limitations, most of which stem from their acute nature, and propose what is needed to take aDBS into a chronic setting.

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“…A number of proof‐of‐concept studies using beta‐LFPs to modify aDBS have shown motor improvement, less speech impairment, and less levodopa‐induced dyskinesia compared to cDBS, which suggests that this is a more efficient and effective method of stimulation. Moreover, a recent study demonstrated the feasibility and beneficial effects on motor symptoms of aDBS over the course of 8 hours in akinetic‐rigid PD patients .…”

Section: Adbs Based On Electrophysiological Recordingsmentioning

confidence: 99%

An update on adaptive deep brain stimulation in Parkinson's disease

et al. 2018

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Advancing conventional open‐loop DBS as a therapy for PD is crucial for overcoming important issues such as the delicate balance between beneficial and adverse effects and limited battery longevity that are currently associated with treatment. Closed‐loop or adaptive DBS aims to overcome these limitations by real‐time adjustment of stimulation parameters based on continuous feedback input signals that are representative of the patient's clinical state. The focus of this update is to discuss the most recent developments regarding potential input signals and possible stimulation parameter modulation for adaptive DBS in PD. Potential input signals for adaptive DBS include basal ganglia local field potentials, cortical recordings (electrocorticography), wearable sensors, and eHealth and mHealth devices. Furthermore, adaptive DBS can be applied with different approaches of stimulation parameter modulation, the feasibility of which can be adapted depending on specific PD phenotypes. Implementation of technological developments like machine learning show potential in the design of such approaches; however, energy consumption deserves further attention. Furthermore, we discuss future considerations regarding the clinical implementation of adaptive DBS in PD. © 2018 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.

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Adaptive deep brain stimulation for Parkinson's disease demonstrates reduced speech side effects compared to conventional stimulation in the acute setting

Cited by 203 publications

References 5 publications

Adaptive deep brain stimulation for Parkinson’s disease using motor cortex sensing

Adaptive deep brain stimulation for Parkinson’s disease using motor cortex sensing

Adaptive Deep Brain Stimulation for Movement Disorders: The Long Road to Clinical Therapy

An update on adaptive deep brain stimulation in Parkinson's disease

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