Short pauses in thalamic deep brain stimulation promote tremor and neuronal bursting

Swan, Brandon D.; Brocker, David T.; Hilliard, Justin D.; Tatter, Stephen B.; Gross, Robert E.; Turner, Dennis A.; Grill, Warren M.

doi:10.1016/j.clinph.2015.07.034

Cited by 26 publications

(27 citation statements)

References 42 publications

(59 reference statements)

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“…Recently, it has been discussed whether uniform regular stimulation or patterned stimulation such as repeated bursts of high frequency stimulation is most effective [62]. We applied bursting stimulation patterns in this model but found it to be less effective at suppressing the pathological oscillation in this model in agreement with previous work [63]. …”

Section: Discussionsupporting

confidence: 83%

A Network Model of Local Field Potential Activity in Essential Tremor and the Impact of Deep Brain Stimulation

et al. 2017

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Essential tremor (ET), a movement disorder characterised by an uncontrollable shaking of the affected body part, is often professed to be the most common movement disorder, affecting up to one percent of adults over 40 years of age. The precise cause of ET is unknown, however pathological oscillations of a network of a number of brain regions are implicated in leading to the disorder. Deep brain stimulation (DBS) is a clinical therapy used to alleviate the symptoms of a number of movement disorders. DBS involves the surgical implantation of electrodes into specific nuclei in the brain. For ET the targeted region is the ventralis intermedius (Vim) nucleus of the thalamus. Though DBS is effective for treating ET, the mechanism through which the therapeutic effect is obtained is not understood. To elucidate the mechanism underlying the pathological network activity and the effect of DBS on such activity, we take a computational modelling approach combined with electrophysiological data. The pathological brain activity was recorded intra-operatively via implanted DBS electrodes, whilst simultaneously recording muscle activity of the affected limbs. We modelled the network hypothesised to underlie ET using the Wilson-Cowan approach. The modelled network exhibited oscillatory behaviour within the tremor frequency range, as did our electrophysiological data. By applying a DBS-like input we suppressed these oscillations. This study shows that the dynamics of the ET network support oscillations at the tremor frequency and the application of a DBS-like input disrupts this activity, which could be one mechanism underlying the therapeutic benefit.

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Section: Discussionsupporting

confidence: 83%

A Network Model of Local Field Potential Activity in Essential Tremor and the Impact of Deep Brain Stimulation

et al. 2017

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“…However, the nature of the intraoperative testing environment precluded assessment of the effect of stimulation pattern of the side effects produced by DBS. Intermittent DBS may be an alternative approach to reduce stimulation energy, but intermittent thalamic stimulation in patients with essential tremor (42, 43) and intermittent STN DBS in patients with PD (19) were less effective than constant stimulation.…”

Section: Discussionmentioning

confidence: 99%

Optimized temporal pattern of brain stimulation designed by computational evolution

et al. 2017

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Brain stimulation is a promising therapy for several neurological disorders, including Parkinson’s disease. Stimulation parameters are selected empirically and are limited to the frequency and intensity of stimulation. We used the temporal pattern of stimulation as a novel parameter of deep brain stimulation to ameliorate symptoms in a parkinsonian animal model and in humans with Parkinson’s disease. We used model-based computational evolution to optimize the stimulation pattern. The optimized pattern produced symptom relief comparable to that from standard high-frequency stimulation (a constant rate of 130 or 185 Hz) and outperformed frequency-matched standard stimulation in the parkinsonian rat and in patients. Both optimized and standard stimulation suppressed abnormal oscillatory activity in the basal ganglia of rats and humans. The results illustrate the utility of model-based computational evolution to design temporal pattern of stimulation to increase the efficiency of brain stimulation in Parkinson’s disease, thereby requiring substantially less energy than traditional brain stimulation.

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“…This result may have been caused by sufficiently long gaps in the stimulation train. These gaps could facilitate pathological activity and lead to undesired propagation through a region [19]. …”

Section: Novel Temporal Patterns Of Stimulation As a Therapeutic Innomentioning

confidence: 99%

Reengineering deep brain stimulation for movement disorders: Emerging technologies

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2017

Current Opinion in Biomedical Engineering

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Deep brain stimulation (DBS) is a neurosurgical technique, which consists of continuous delivery of an electrical pulse through chronically implanted electrodes connected to a neurostimulator, programmable in amplitude, pulse width, frequency, and stimulation channel. DBS is a promising treatment option for addressing severe and drug-resistant movement disorders. The success of DBS therapy is a combination of surgical implantation techniques, device technology, and clinical programming strategies. Changes in device settings require highly trained and experienced clinicians to achieve maximal therapeutic benefit for each targeted symptom, and optimization of stimulation parameters can take many visits. Thus, the development of innovative DBS technologies that can optimize the clinical implementation of DBS will lead to wider scale utilization. This review aims to present engineering approaches that have the potential to improve clinical outcomes of DBS, focusing on the development novel temporal patterns, innovative electrode designs, computational models to guide stimulation, closed-loop DBS, and remote programming.

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Short pauses in thalamic deep brain stimulation promote tremor and neuronal bursting

Cited by 26 publications

References 42 publications

A Network Model of Local Field Potential Activity in Essential Tremor and the Impact of Deep Brain Stimulation

A Network Model of Local Field Potential Activity in Essential Tremor and the Impact of Deep Brain Stimulation

Optimized temporal pattern of brain stimulation designed by computational evolution

Reengineering deep brain stimulation for movement disorders: Emerging technologies

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