DBS Programming: An Evolving Approach for Patients with Parkinson’s Disease

Shukla, Aparna Wagle; Zeilman, Pam; Fernández, Hubert H.; Bajwa, Jawad A.; Mehanna, Raja

doi:10.1155/2017/8492619

Cited by 46 publications

(26 citation statements)

References 52 publications

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“…As for the second possibility, increasing repeatability of the tremor assessment during the DBS programming is a factor supporting automation of this time-consuming process. The tremors of PD respond quickly to the changes in stimulation settings [33]; therefore, their ratings provide information relevant for tuning the DBS parameters.…”

Section: Discussionmentioning

confidence: 99%

A Multimodal Approach to the Quantification of Kinetic Tremor in Parkinson’s Disease

Szumilas

Lewenstein

Ślubowska

et al. 2019

Sensors

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Parkinson's disease results in motor impairment that deteriorates patients' quality of life. One of the symptoms negatively interfering with daily activities is kinetic tremor which should be measured to monitor the outcome of therapy. A new instrumented method of quantification of the kinetic tremor is proposed, based on the analysis of circles drawn on a digitizing tablet by a patient. The aim of this approach is to obtain a tremor scoring equivalent to that performed by trained clinicians. Models are trained with the least absolute shrinkage and selection operator (LASSO) method to predict the tremor scores on the basis of the parameters computed from the patients' drawings. Signal parametrization is derived from both expert knowledge and the response of an artificial neural network to the raw data, thus the approach was named multimodal. The fitted models are eventually combined into model ensembles that provide aggregated scores of the kinetic tremor captured in the drawings. The method was verified with a set of clinical data acquired from 64 Parkinson's disease patients. Automated and objective quantification of the kinetic tremor with the presented approach yielded promising results, as the Pearson's correlations between the visual ratings of tremor and the model predictions ranged from 0.839 to 0.890 in the best-performing models.

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Section: Discussionmentioning

confidence: 99%

A Multimodal Approach to the Quantification of Kinetic Tremor in Parkinson’s Disease

Szumilas

Lewenstein

Ślubowska

et al. 2019

Sensors

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“…Until recently, DBS systems have been pre-dominantly voltage-controlled (VC), which inconsistently deliver charge due to impedance fluctuations at the contiguous border between the neural tissue and contact 23,24 . Charge delivery of VC devices may not match the programmed value, which renders frequent programming adjustments due to inadequate stimulation of the target 13 . This is particularly an issue for programming during the early post-operative period (first few weeks following surgical implantation) when impedance fluctuations are common.…”

Section: Advances In Dbs Technologymentioning

confidence: 99%

“…Namely, oedema as a result of surgical implantation increases the electrode impedance while stimulation decreases impedance 25 . Accordingly, tedious programming prompted the development of current-controlled (CC) systems with multiple independent current control 13,23 . CC devices adjust voltage to account for impedance fluctuations to ensure that charge distribution is consistent and that current amplitudes match the programmed value 13,23 .…”

Section: Advances In Dbs Technologymentioning

confidence: 99%

“…Electrode geometry is determined by the designation of the cathode and anode; unipolar configurations assign the contact(s) and IPG as the cathode and anode, respectively, and bipolar configurations assign one contact and a different contact as the cathode and anode, respectively 10 . Conventionally, single-contact unipolar configurations are programmed first; followed by, double contact unipolar then bipolar configurations upon failure of the previous configuration 13 . Unipolar stimulation is associated with a lower therapeutic threshold; thus, symptom alleviation occurs at lower amplitudes, which is beneficial for reducing power consumption 10 .…”

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confidence: 99%

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Assessing the effect of current steering on the total electrical energy delivered and ambulation in Parkinson’s disease

Hui

Murgai

Gilmore

et al. 2020

Sci Rep

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Vertical current steering (vCS) divides current between multiple contacts, which reduces radial spread to fine-tune the electric field shape and improves neuroanatomical targeting. vCS may improve the variable responsiveness of Parkinsonian gait to conventional deep brain stimulation. We hypothesized that vCS elicits greater improvement in ambulation in Parkinson's disease patients compared to conventional, single-contact stimulation. vCS was implemented with divisions of 70%/30% and 50%/50% and compared to single-contact stimulation with four therapeutic window amplitudes in current-controlled systems. Walking at a self-selected pace was evaluated in seven levodopa-responsive patients. Integrative measures of gait and stimulation parameters were assessed with the functional ambulation performance (FAP) score and total electrical energy delivered (TEED), respectively. A twotailed Wilcoxon matched-pairs signed rank test assessed the effect of each stimulation condition on FAP and TEED and compared regression slopes; further, a two-tailed Spearman test identified correlations. vCS significantly lowered the TEED (P < 0.0001); however, FAP scores were not different between conditions (P = 0.786). Compared to single-contact stimulation, vCS elicited higher FAP scores with lower TEED (P = 0.031). FAP and TEED were positively correlated in vCS (P = 2.000 × 10-5 , r = 0.397) and single-contact stimulation (P = 0.034, r = 0.205). Therefore, vCS and single-contact stimulation improved ambulation similarly but vCS reduced the TEED and side-effects at higher amplitudes. Parkinson's disease and deep brain stimulation Deep brain stimulation (DBS) consistently relieves appendicular symptoms in Parkinson's disease (PD) but its effect on Parkinsonian gait deficits remains more elusive and variable 1. Thus, in present clinical practice, PD patients with severe postural and gait instabilities or levodopa (L-DOPA) resistant postural and gait instabilities are often excluded from receiving DBS 2-4. DBS chronically transmits electrical pulses from a sub-dermally implanted impulse generator (IPG) in the upper chest to neural tissue through implanted electrodes to address disabling dyskinesia and motor fluctuations from long-term use of L-DOPA 5. The varying response of Parkinsonian gait deficits to DBS may be attributed to extensive physiological integration of various networks necessary for gait facilitation, the influence of bradykinesia and rigidity on Parkinsonian gait deficits, and the bias of upper limb symptom improvement during contact localization and selection 6,7. Gait deficits attributed to rigidity and bradykinesia such as reduced step length and gait velocity tend to respond to L-DOPA and subthalamic nucleus (STN)-DBS. However, L-DOPA responsive gait deficits still exhibit a more variable responsiveness to STN-DBS as compared to appendicular symptoms such as tremor and rigidity. For instance, stimulation spread into the zona incerta and/or fields of forel from STN targeted electrodes has been reported to induce gait akine...

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“…In contrast to conventional DBS, the promise of aDBS systems is that they will identify neural activity associated with symptoms and adjust stimulation delivery in real time to alter neural activity and manage symptoms accordingly (Arlotti et al, 2016;Shute et al, 2016). The goal of aDBS systems is to deliver stimulation only when pathological brain activity is detected in order to prevent overtreatment, decrease side effects (e.g., hypomania), and battery depletion, which requires surgical replacement (Hosain et al, 2014;Beudel and Brown, 2016;Shukla et al, 2017). In addition to these safety advantages, aDBS may lead to better outcomes for patients because it adjusts automatically, thus avoiding the delay between suboptimal symptom management and adjustment of stimulation in a clinical encounter (Klein, 2020, p.336).…”

Section: Introductionmentioning

confidence: 99%

Researcher Perspectives on Ethical Considerations in Adaptive Deep Brain Stimulation Trials

Muñoz

Kostick

Sanchez

et al. 2020

Front. Hum. Neurosci.

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DBS Programming: An Evolving Approach for Patients with Parkinson’s Disease

Cited by 46 publications

References 52 publications

A Multimodal Approach to the Quantification of Kinetic Tremor in Parkinson’s Disease

A Multimodal Approach to the Quantification of Kinetic Tremor in Parkinson’s Disease

Assessing the effect of current steering on the total electrical energy delivered and ambulation in Parkinson’s disease

Researcher Perspectives on Ethical Considerations in Adaptive Deep Brain Stimulation Trials

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