scholarly journals Sleep-Aware Adaptive Deep Brain Stimulation Control: Chronic Use at Home With Dual Independent Linear Discriminate Detectors

2021 ◽  
Vol 15 ◽  
Author(s):  
Ro’ee Gilron ◽  
Simon Little ◽  
Robert Wilt ◽  
Randy Perrone ◽  
Juan Anso ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
New Technology ◽  
Algorithm Design ◽  
Sleep Mode ◽  
Dual Algorithm ◽  
Sleep State ◽  
Experimental Trials ◽  
Stimulation Control ◽  
Deep Brain

Adaptive deep brain stimulation (aDBS) is a promising new technology with increasing use in experimental trials to treat a diverse array of indications such as movement disorders (Parkinson’s disease, essential tremor), psychiatric disorders (depression, OCD), chronic pain and epilepsy. In many aDBS trials, a neural biomarker of interest is compared with a predefined threshold and stimulation amplitude is adjusted accordingly. Across indications and implant locations, potential biomarkers are greatly influenced by sleep. Successful chronic embedded adaptive detectors must incorporate a strategy to account for sleep, to avoid unwanted or unexpected algorithm behavior. Here, we show a dual algorithm design with two independent detectors, one used to track sleep state (wake/sleep) and the other used to track parkinsonian motor state (medication-induced fluctuations). Across six hemispheres (four patients) and 47 days, our detector successfully transitioned to sleep mode while patients were sleeping, and resumed motor state tracking when patients were awake. Designing “sleep aware” aDBS algorithms may prove crucial for deployment of clinically effective fully embedded aDBS algorithms.

scholarly journals Patient, Caregiver, and Decliner Perspectives on Whether to Enroll in Adaptive Deep Brain Stimulation Research

2021 ◽  
Vol 15 ◽  
Author(s):  
Simon Outram ◽  
Katrina A. Muñoz ◽  
Kristin Kostick-Quenet ◽  
Clarissa E. Sanchez ◽  
Lavina Kalwani ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Study Design ◽  
Brain Stimulation ◽  
Research Study ◽  
New Technology ◽  
Innovative Technology ◽  
Theoretical Perspectives ◽  
Potential Risks ◽  
Deep Brain

This research study provides patient and caregiver perspectives as to whether or not to undergo adaptive deep brain stimulation (aDBS) research. A total of 51 interviews were conducted in a multi-site study including patients undergoing aDBS and their respective caregivers along with persons declining aDBS. Reasons highlighted for undergoing aDBS included hopes for symptom alleviation, declining quality of life, desirability of being in research, and altruism. The primary reasons for not undergoing aDBS issues were practical rather than specific to aDBS technology, although some persons highlighted a desire to not be the first to trial the new technology. These themes are discussed in the context of “push” factors wherein any form of surgical intervention is preferable to none and “pull” factors wherein opportunities to contribute to science combine with hopes and/or expectations for the alleviation of symptoms. We highlight the significance of study design in decision making. aDBS is an innovative technology and not a completely new technology. Many participants expressed value in being part of research as an important consideration. We suggest that there are important implications when comparing patient perspectives vs. theoretical perspectives on the choice for or against aDBS. Additionally, it will be important how we communicate with patients especially in reference to the complexity of study design. Ultimately, this study reveals that there are benefits and potential risks when choosing a research study that involves implantation of a medical device.

scholarly journals 1120 Clinical Applications of Local Field Potentials in Deep Brain Stimulation

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
K Khan
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Deep Brain Stimulation ◽  
Local Field ◽  
Brain Stimulation ◽  
New Technology ◽  
Local Field Potentials ◽  
Field Potentials ◽  
Deep Brain

Abstract Aim Local field potentials (LFP) are gathered when deep brain stimulation (DBS) electrodes are inserted into subcortical structures; however, the clinical application of these findings are unclear. Method A literature search was conducted using PRISMA guidelines, 231 papers were analysed for the literature review. Results The lack of dopamine in Parkinson’s disease (PD), is thought to increase the sensitivity of the basal ganglia-thalamo-cortical network to rhythmic oscillatory inputs causing pathological oscillations. Beta band frequency oscillations have been strongly linked to bradykinesia and rigidity in Parkinson’s disease patients. Whereas gamma oscillations were found to be prokinetic and possibly related to normal physiology. There has been varying views on LFP findings and tremor pathology, recent research has suggested a link between the ratio of slow and fast oscillations increasing resulting in a tremor. Studies found contradicting results with pathological oscillations, reasons for the variation include the time of the LFP recordings and the placement of the electrodes. The use of LFP presents a promising new technology namely adaptive deep brain stimulation (aDBS). aDBS has not been tested long-term in human patients, the safety and effectiveness long-term is unknown. Conclusions aDBS provide an exciting new technology however, the current evidence base provides a proof-of- principle, there are still many issues which need to be addressed before this can become an established treatment. With technological advances aDBS could revolutionise PD treatment and if perfected could potentially abolish patient’s symptoms completely.

scholarly journals Changes in Patients’ Desired Control of Their Deep Brain Stimulation and Subjective Global Control Over the Course of Deep Brain Stimulation

2021 ◽  
Vol 15 ◽  
Author(s):  
Amanda R. Merner ◽  
Thomas Frazier ◽  
Paul J. Ford ◽  
Scott E. Cooper ◽  
Andre Machado ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Qualitative Data ◽  
Prospective Longitudinal Study ◽  
Global Control ◽  
Post Surgery ◽  
Prospective Longitudinal ◽  
Stimulation Control ◽  
Over Time ◽  
Deep Brain

Objective: To examine changes in patients’ desired control of the deep brain stimulator (DBS) and perception of global life control throughout DBS.Methods: A consecutive cohort of 52 patients with Parkinson’s disease (PD) was recruited to participate in a prospective longitudinal study over three assessment points (pre-surgery, post-surgery months 3 and 6). Semi-structured interviews assessing participants’ desire for stimulation control and perception of global control were conducted at all three points. Qualitative data were coded using content analysis. Visual analog scales were embedded in the interviews to quantify participants’ perceptions of control over time.Results: Participants reported significant increases in their perception of global control over time and significant declines in their desired control of the stimulation. These changes were unrelated to improvements in motor symptoms. Improvements in global control were negatively correlated with a decline in desired stimulation control. Qualitative data indicate that participants have changed, nuanced levels of desired control over their stimulators. Increased global life control following DBS may be attributed to increased control over PD symptoms, increased ability to engage in valued activities, and increased overall self-regulation, while other domains related to global control remained unaffected by DBS.Conclusions: There are few empirical data documenting patients’ desire for stimulation control throughout neuromodulation and how stimulation control is related to other aspects of control despite the growing application of neuromodulation devices to treat a variety of disorders. Our data highlight distinctions in different types of control and have implications for the development of patient-controlled neurostimulation devices.

Nicht-medikamentöse Optionen zur Behandlung pharmakoresistenter Epilepsien

2018 ◽  
Vol 75 (7) ◽  
pp. 448-454
Author(s):  
Thomas Grunwald ◽  
Judith Kröll
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Tiefe Hirnstimulation ◽  
Ketogene Diät ◽  
Deep Brain

Zusammenfassung. Wenn mit den ersten beiden anfallspräventiven Medikamenten keine Anfallsfreiheit erzielt werden konnte, so ist die Wahrscheinlichkeit, dies mit anderen Medikamenten zu erreichen, nur noch ca. 10 %. Es sollte dann geprüft werden, warum eine Pharmakoresistenz besteht und ob ein epilepsiechirurgischer Eingriff zur Anfallsfreiheit führen kann. Ist eine solche Operation nicht möglich, so können palliative Verfahren wie die Vagus-Nerv-Stimulation (VNS) und die tiefe Hirnstimulation (Deep Brain Stimulation) in eine bessere Anfallskontrolle ermöglichen. Insbesondere bei schweren kindlichen Epilepsien stellt auch die ketogene Diät eine zu erwägende Option dar.

Sign in / Sign up

Export Citation Format

Share Document