Bilateral adaptive deep brain stimulation is effective in Parkinson's disease

Abstract

Introduction & objectivesAdaptive deep brain stimulation (aDBS) uses feedback from brain signals to guide stimulation. A recent acute trial of unilateral aDBS showed that aDBS can lead to substantial improvements in contralateral hemibody Unified Parkinson’s Disease Rating Scale (UPDRS) motor scores and may be superior to conventional continuous DBS in Parkinson’s disease (PD). We test whether potential benefits are retained with bilateral aDBS and in the face of concurrent medication.MethodsWe applied bilateral aDBS in 4 patients with PD undergoing DBS of the subthalamic nucleus. aDBS was delivered bilaterally with independent triggering of stimulation according to the amplitude of β activity at the corresponding electrode. Mean stimulation voltage was 3.0±0.1 volts. Motor assessments consisted of double-blinded video-taped motor UPDRS scores that included both limb and axial features.ResultsUPDRS scores were 43% (p=0.04; Cohen’s d=1.62) better with aDBS than without stimulation. Motor improvement with aDBS occurred despite an average time on stimulation (ToS) of only 45%. Levodopa was well tolerated during aDBS and led to further reductions in ToS.ConclusionBilateral aDBS can improve both axial and limb symptoms and can track the need for stimulation across drug states.

Robust stabilization of delayed neural fields with partial measurement and actuation

“…The source code, written in Python (Numpy,Scipy, Matplotlib), is freely distributed under the GPL License and can be found on-line at Github 3 . Figure 1 shows that the model reproduces sustained β-band oscillations in the absence of stimulation, as observed in the STN and GPe of parkinsonian patients (Little et al, 2016). At time t = 0.5 s the proportional feedback (4) is applied with gain k = 2.…”

“…As reported in the survey paper (Carron et al, 2013), several attempts have been made in that direction. These include adaptive and on-demand stimulation (Rosin et al, 2011;Graupe et al, 2010;Santaniello et al, 2011;Little et al, 2016;Marceglia et al, 2007), delayed and multi-site stimulation (Lysyansky et al, 2011;Batista et al, 2010;Pfister and Tass, 2010;Tass et al, 2012), optimal control strategies (Feng et al, 2007), and activity regulation (Haidar et al, 2016;Wagenaar et al, 2005;Grant and Lowery, 2013).…”

Suppression of spontaneous oscillations in high-frequency stimulated neuron models

“…This is to stimulate only when necessary and/or to adapt the strength of stimulation to the amount of abnormal neuronal synchrony. Initially introduced in computational studies with different types of specifically designed desynchronizing stimuli [61][62][63], demand-controlled DBS was experimentally tested by means of conventional high-frequency stimulation and denoted as adaptive DBS (aDBS) [64][65][66][67]. An alternative approach to significantly reduce stimulation current originated from computational studies on desynchronizing stimulation techniques [61][62][63]68] by incorporating spike timing-dependent plasticity (STDP) [69,70].…”

Communication changes in Parkinson’s disease

“…Pulse width and frequency can also influence speech outcomes 47 48. Little et al 49 found adaptive DBS less detrimental to speech and maybe even capable of benefits.…”