scholarly journals Predicting the effects of deep brain stimulation using a reduced coupled oscillator model

2018 ◽  
Author(s):  
Gihan Weerasinghe ◽  
Benoit Duchet ◽  
Hayriye Cagnan ◽  
Peter Brown ◽  
Christian Bick ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Essential Tremor ◽  
Brain Stimulation ◽  
Neurological Disorders ◽  
Closed Loop ◽  
Kuramoto Model ◽  
Brain Oscillations ◽  
Hybrid Strategy ◽  
The Brain ◽  
Deep Brain

AbstractDeep brain stimulation (DBS) is known to be an effective treatment for a variety of neurological disorders, including Parkinson’s disease and essential tremor (ET). At present, it involves administering a train of pulses with constant frequency via electrodes implanted into the brain. New ‘closed-loop’ approaches involve delivering stimulation according to the ongoing symptoms or brain activity and have the potential to provide improvements in terms of efficiency, efficacy and reduction of side effects. The success of closed-loop DBS depends on being able to devise a stimulation strategy that minimizes oscillations in neural activity associated with symptoms of motor disorders. A useful stepping stone towards this is to construct a mathematical model, which can describe how the brain oscillations should change when stimulation is applied at a particular state of the system. Our work focuses on the use of coupled oscillators to represent neurons in areas generating pathological oscillations. Using a reduced form of the Kuramoto model, we analyse how a patient should respond to stimulation when neural oscillations have a given phase and amplitude. We predict that, provided certain conditions are satisfied, the best stimulation strategy should be phase specific but also that stimulation should have a greater effect if applied when the amplitude of brain oscillations is lower. We compare this surprising prediction with data obtained from ET patients. In light of our predictions, we also propose a new hybrid strategy which effectively combines two of the strategies found in the literature, namely phase-locked and adaptive DBS.Author summaryDeep brain stimulation (DBS) involves delivering electrical impulses to target sites within the brain and is a proven therapy for a variety of neurological disorders. Closed loop DBS is a promising new approach where stimulation is applied according to the state of a patient. Crucial to the success of this approach is being able to predict how a patient should respond to stimulation. Our work focusses on DBS as applied to patients with essential tremor (ET). On the basis of a theoretical model, which describes neurons as oscillators that respond to stimulation and have a certain tendency to synchronize, we provide predictions for how a patient should respond when stimulation is applied at a particular phase and amplitude of the ongoing tremor oscillations. Previous experimental studies of closed loop DBS provided stimulation either on the basis of ongoing phase or amplitude of pathological oscillations. Our study suggests how both of these measurements can be used to control stimulation. As part of this work, we also look for evidence for our theories in experimental data and find our predictions to be satisfied in one patient. The insights obtained from this work should lead to a better understanding of how to optimise closed loop DBS strategies.

scholarly journals Chronic embedded cortico-thalamic closed-loop deep brain stimulation for the treatment of essential tremor

2020 ◽  
Vol 12 (572) ◽  
pp. eaay7680
Author(s):  
Enrico Opri ◽  
Stephanie Cernera ◽  
Rene Molina ◽  
Robert S. Eisinger ◽  
Jackson N. Cagle ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Essential Tremor ◽  
Brain Stimulation ◽  
Closed Loop ◽  
Motor Behavior ◽  
Open Loop ◽  
Therapeutic Window ◽  
Patient Specific ◽  
Stimulation Paradigm ◽  
Deep Brain

Deep brain stimulation (DBS) is an approved therapy for the treatment of medically refractory and severe movement disorders. However, most existing neurostimulators can only apply continuous stimulation [open-loop DBS (OL-DBS)], ignoring patient behavior and environmental factors, which consequently leads to an inefficient therapy, thus limiting the therapeutic window. Here, we established the feasibility of a self-adjusting therapeutic DBS [closed-loop DBS (CL-DBS)], fully embedded in a chronic investigational neurostimulator (Activa PC + S), for three patients affected by essential tremor (ET) enrolled in a longitudinal (6 months) within-subject crossover protocol (DBS OFF, OL-DBS, and CL-DBS). Most patients with ET experience involuntary limb tremor during goal-directed movements, but not during rest. Hence, the proposed CL-DBS paradigm explored the efficacy of modulating the stimulation amplitude based on patient-specific motor behavior, suppressing the pathological tremor on-demand based on a cortical electrode detecting upper limb motor activity. Here, we demonstrated how the proposed stimulation paradigm was able to achieve clinical efficacy and tremor suppression comparable with OL-DBS in a range of movements (cup reaching, proximal and distal posture, water pouring, and writing) while having a consistent reduction in energy delivery. The proposed paradigm is an important step toward a behaviorally modulated fully embedded DBS system, capable of delivering stimulation only when needed, and potentially mitigating pitfalls of OL-DBS, such as DBS-induced side effects and premature device replacement.

scholarly journals Chronic electrocorticography for sensing movement intention and closed-loop deep brain stimulation with wearable sensors in an essential tremor patient

2017 ◽  
Vol 127 (3) ◽  
pp. 580-587 ◽  
Author(s):  
Jeffrey A. Herron ◽  
Margaret C. Thompson ◽  
Timothy Brown ◽  
Howard J. Chizeck ◽  
Jeffrey G. Ojemann ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Essential Tremor ◽  
Brain Stimulation ◽  
Power Efficiency ◽  
Closed Loop ◽  
Wearable Sensors ◽  
Open Loop ◽  
Valuable Treatment ◽  
Closing The Loop ◽  
Deep Brain

Deep brain stimulation (DBS) has become a widespread and valuable treatment for patients with movement disorders such as essential tremor (ET). However, current DBS treatment constantly delivers stimulation in an open loop, which can be inefficient. Closing the loop with sensors to provide feedback may increase power efficiency and reduce side effects for patients. New implantable neuromodulation platforms, such as the Medtronic Activa PC+S DBS system, offer important data sources by providing chronic neural sensing capabilities and a means of investigating dynamic stimulation based on symptom measurements. The authors implanted in a single patient with ET an Activa PC+S system, a cortical strip of electrodes on the hand sensorimotor cortex, and therapeutic electrodes in the ventral intermediate nucleus of the thalamus. In this paper they describe the effectiveness of the platform when sensing cortical movement intentions while the patient actually performed and imagined performing movements. Additionally, they demonstrate dynamic closed-loop DBS based on several wearable sensor measurements of tremor intensity.

Hyperhidrosis due to deep brain stimulation in a patient with essential tremor

2007 ◽  
Vol 107 (5) ◽  
pp. 1036-1038 ◽  
Author(s):  
Alan Diamond ◽  
Christopher Kenney ◽  
Michael Almaguer ◽  
Joseph Jankovic
Keyword(s):  
Deep Brain Stimulation ◽  
Essential Tremor ◽  
Brain Stimulation ◽  
Side Effect ◽  
Rare Complication ◽  
Zona Incerta ◽  
Electrode Placement ◽  
Anterior Thalamus ◽  
The Brain ◽  
Deep Brain

✓The authors present a unique case of hyperhidrosis as a side effect of a misplaced deep brain stimulation (DBS) electrode near the ventrointermedius (Vim) nucleus in a patient with essential tremor. Magnetic resonance imaging of the brain showed electrode placement in the left anterior thalamus traversing the hypothalamus. High-frequency electrical stimulation possibly resulted in unilateral activation of the efferent sympathetic pathways in the zona incerta. Although a rare complication, hypothalamic dysfunction may occur as a stimulation-related side effect of Vim-DBS.

scholarly journals Optimal closed-loop deep brain stimulation using multiple independently controlled contacts

2021 ◽  
Vol 17 (8) ◽  
pp. e1009281
Author(s):  
Gihan Weerasinghe ◽  
Benoit Duchet ◽  
Christian Bick ◽  
Rafal Bogacz
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Closed Loop ◽  
Brain Activity ◽  
Neural Populations ◽  
Multiple Regions ◽  
Analytical Expressions ◽  
The Brain ◽  
Coordinated Reset ◽  
Deep Brain

Deep brain stimulation (DBS) is a well-established treatment option for a variety of neurological disorders, including Parkinson’s disease and essential tremor. The symptoms of these disorders are known to be associated with pathological synchronous neural activity in the basal ganglia and thalamus. It is hypothesised that DBS acts to desynchronise this activity, leading to an overall reduction in symptoms. Electrodes with multiple independently controllable contacts are a recent development in DBS technology which have the potential to target one or more pathological regions with greater precision, reducing side effects and potentially increasing both the efficacy and efficiency of the treatment. The increased complexity of these systems, however, motivates the need to understand the effects of DBS when applied to multiple regions or neural populations within the brain. On the basis of a theoretical model, our paper addresses the question of how to best apply DBS to multiple neural populations to maximally desynchronise brain activity. Central to this are analytical expressions, which we derive, that predict how the symptom severity should change when stimulation is applied. Using these expressions, we construct a closed-loop DBS strategy describing how stimulation should be delivered to individual contacts using the phases and amplitudes of feedback signals. We simulate our method and compare it against two others found in the literature: coordinated reset and phase-locked stimulation. We also investigate the conditions for which our strategy is expected to yield the most benefit.

Classifier-based closed-loop deep brain stimulation for essential tremor

2017 ◽  
Author(s):  
Brady C. Houston ◽  
Margaret C. Thompson ◽  
Jeffrey G. Ojemann ◽  
Andrew L. Ko ◽  
Howard J. Chizeck
Keyword(s):  
Deep Brain Stimulation ◽  
Essential Tremor ◽  
Brain Stimulation ◽  
Closed Loop ◽  
Deep Brain

scholarly journals Approaches to closed-loop deep brain stimulation for movement disorders

2018 ◽  
Vol 45 (2) ◽  
pp. E2 ◽  
Author(s):  
Chao-Hung Kuo ◽  
Gabrielle A. White-Dzuro ◽  
Andrew L. Ko
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Deep Brain Stimulation ◽  
Essential Tremor ◽  
Brain Stimulation ◽  
Movement Disorders ◽  
Closed Loop ◽  
Closed Loop Systems ◽  
Signal Sources ◽  
Deep Brain

OBJECTIVEDeep brain stimulation (DBS) is a safe and effective therapy for movement disorders, such as Parkinson’s disease (PD), essential tremor (ET), and dystonia. There is considerable interest in developing “closed-loop” DBS devices capable of modulating stimulation in response to sensor feedback. In this paper, the authors review related literature and present selected approaches to signal sources and approaches to feedback being considered for deployment in closed-loop systems.METHODSA literature search using the keywords “closed-loop DBS” and “adaptive DBS” was performed in the PubMed database. The search was conducted for all articles published up until March 2018. An in-depth review was not performed for publications not written in the English language, nonhuman studies, or topics other than Parkinson’s disease or essential tremor, specifically epilepsy and psychiatric conditions.RESULTSThe search returned 256 articles. A total of 71 articles were primary studies in humans, of which 50 focused on treatment of movement disorders. These articles were reviewed with the aim of providing an overview of the features of closed-loop systems, with particular attention paid to signal sources and biomarkers, general approaches to feedback control, and clinical data when available.CONCLUSIONSClosed-loop DBS seeks to employ biomarkers, derived from sensors such as electromyography, electrocorticography, and local field potentials, to provide real-time, patient-responsive therapy for movement disorders. Most studies appear to focus on the treatment of Parkinson’s disease. Several approaches hold promise, but additional studies are required to determine which approaches are feasible, efficacious, and efficient.

scholarly journals Closed‐Loop Deep Brain Stimulation for Essential Tremor Based on Thalamic Local Field Potentials

2021 ◽  
Vol 36 (4) ◽  
pp. 863-873
Author(s):  
Shenghong He ◽  
Fahd Baig ◽  
Abteen Mostofi ◽  
Alek Pogosyan ◽  
Jean Debarros ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Essential Tremor ◽  
Local Field ◽  
Brain Stimulation ◽  
Closed Loop ◽  
Local Field Potentials ◽  
Field Potentials ◽  
Deep Brain

scholarly journals Phase-Dependent Deep Brain Stimulation: A Review

2021 ◽  
Vol 11 (4) ◽  
pp. 414
Author(s):  
Lekshmy Sudha Kumari ◽  
Abbas Z. Kouzani
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Closed Loop ◽  
Field Potential ◽  
Neural Oscillations ◽  
Oscillation Phase ◽  
Frequency Bands ◽  
Brain Functions ◽  
The Brain ◽  
Deep Brain

Neural oscillations are repetitive patterns of neural activity in the central nervous systems. Oscillations of the neurons in different frequency bands are evident in electroencephalograms and local field potential measurements. These oscillations are understood to be one of the key mechanisms for carrying out normal functioning of the brain. Abnormality in any of these frequency bands of oscillations can lead to impairments in different cognitive and memory functions leading to different pathological conditions of the nervous system. However, the exact role of these neural oscillations in establishing various brain functions and the brain pathologies are still under investigation. Closed loop deep brain stimulation paradigms with neural oscillations as biomarkers could be used as a mechanism to understand the function of these oscillations. For making use of the neural oscillations as biomarkers to manipulate the frequency band of the oscillation, phase of the oscillation, and stimulation signal are of importance. This paper reviews recent trends in deep brain stimulation systems and their non-invasive counterparts, in the use of phase specific stimulation to manipulate individual neural oscillations. In particular, the paper reviews the methods adopted in different brain stimulation systems and devices for stimulating at a definite phase to further optimize closed loop brain stimulation strategies.

Sign in / Sign up

Export Citation Format

Share Document