scholarly journals Practical Closed-Loop Strategies for Deep Brain Stimulation: Lessons From Chronic Pain

2021 ◽  
Vol 15 ◽  
Author(s):  
Jordan Prosky ◽  
Jackson Cagle ◽  
Kristin K. Sellers ◽  
Ro’ee Gilron ◽  
Cora de Hemptinne ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Closed Loop ◽  
Open Loop ◽  
Neural Signals ◽  
Variable Success ◽  
Control Stimulation ◽  
Tonic Stimulation ◽  
Deep Brain

Deep brain stimulation (DBS) is a plausible therapy for various neuropsychiatric disorders, though continuous tonic stimulation without regard to underlying physiology (open-loop) has had variable success. Recently available DBS devices can sense neural signals which, in turn, can be used to control stimulation in a closed-loop mode. Closed-loop DBS strategies may mitigate many drawbacks of open-loop stimulation and provide more personalized therapy. These devices contain many adjustable parameters that control how the closed-loop system operates, which need to be optimized using a combination of empirically and clinically informed decision making. We offer a practical guide for the implementation of a closed-loop DBS system, using examples from patients with chronic pain. Focusing on two research devices from Medtronic, the Activa PC+S and Summit RC+S, we provide pragmatic details on implementing closed- loop programming from a clinician’s perspective. Specifically, by combining our understanding of chronic pain with data-driven heuristics, we describe how to tune key parameters to handle feature selection, state thresholding, and stimulation artifacts. Finally, we discuss logistical and practical considerations that clinicians must be aware of when programming closed-loop devices.

scholarly journals Closed-Loop Deep Brain Stimulation for Refractory Chronic Pain

2018 ◽  
Vol 12 ◽  
Author(s):  
Prasad Shirvalkar ◽  
Tess L. Veuthey ◽  
Heather E. Dawes ◽  
Edward F. Chang
Keyword(s):  
Chronic Pain ◽  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Closed Loop ◽  
Deep Brain

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.

scholarly journals Neural Closed Loop Deep Brain Stimulation for Freezing of Gait

2019 ◽  
Author(s):  
Matthew N. Petrucci ◽  
Raumin S. Neuville ◽  
M. Furqan Afzal ◽  
Anca Velisar ◽  
Chioma M. Anidi ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Closed Loop ◽  
Freezing Of Gait ◽  
Control Variable ◽  
Field Potential ◽  
Preliminary Evidence ◽  
Open Loop ◽  
Percent Time ◽  
Deep Brain

AbstractFreezing of gait (FOG), a devastating symptom of Parkinson’s disease (PD), can be refractory to current treatments such as medication and open-loop deep brain stimulation (olDBS). Recent evidence suggests that closed-loop DBS (clDBS), using beta local field potential power from the subthalamic nucleus (STN) as the control variable, can improve tremor and bradykinesia; however, no study has investigated the use of clDBS for the treatment of FOG. In this study, we provide preliminary evidence that clDBS was superior to olDBS in reducing percent time freezing and in reducing freezing behavior (gait arrhythmicity) in a person with PD and FOG. These findings warrant further investigation into the use of clDBS to treat FOG while also minimizing the total energy delivered to maintain a therapeutic effect.

scholarly journals The continued relevance of Deep Brain Stimulation for chronic pain

2021 ◽  
Vol 6 (1) ◽  
pp. 009-014
Author(s):  
Farrell Sarah Marie ◽  
Aziz Tipu
Keyword(s):  
Spinal Cord ◽  
Chronic Pain ◽  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Spinal Cord Stimulation ◽  
Success Rates ◽  
Off Label ◽  
The Past ◽  
Variable Success ◽  
Deep Brain

For the millions of patients experiencing chronic pain despite pharmacotherapy, deep brain stimulation (DBS) provides a beacon of hope. Over the past decade the field has shifted away from DBS towards other forms of neuromodulation, particularly spinal cord stimulation (SCS). DBS for pain is still performed, albeit off-label in US and UK, and experiences variable success rates. SCS is an extremely useful tool for the modulation of pain but is limited in its application to specific pain aetiologies. We advocate use of DBS for pain, for patients for whom pharmacology has failed and for whom spinal cord stimulation is inadequate. DBS for chronic pain is at risk of premature neglect. Here we outline how this has come to pass, and in the process argue for the untapped potential for this procedure.

scholarly journals Directions of Deep Brain Stimulation for Epilepsy and Parkinson’s Disease

2021 ◽  
Vol 15 ◽  
Author(s):  
Ying-Chang Wu ◽  
Ying-Siou Liao ◽  
Wen-Hsiu Yeh ◽  
Sheng-Fu Liang ◽  
Fu-Zen Shaw
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Closed Loop ◽  
System Development ◽  
Open Loop ◽  
Research System ◽  
Search Results ◽  
Electrode Recording ◽  
Future Direction ◽  
Deep Brain

BackgroundDeep brain stimulation (DBS) is an effective treatment for movement disorders and neurological/psychiatric disorders. DBS has been approved for the control of Parkinson disease (PD) and epilepsy.ObjectivesA systematic review and possible future direction of DBS system studies is performed in the open loop and closed-loop configuration on PD and epilepsy.MethodsWe searched Google Scholar database for DBS system and development. DBS search results were categorized into clinical device and research system from the open-loop and closed-loop perspectives.ResultsWe performed literature review for DBS on PD and epilepsy in terms of system development by the open loop and closed-loop configuration. This study described development and trends for DBS in terms of electrode, recording, stimulation, and signal processing. The closed-loop DBS system raised a more attention in recent researches.ConclusionWe overviewed development and progress of DBS. Our results suggest that the closed-loop DBS is important for PD and epilepsy.

scholarly journals Deep Brain Stimulation of the Posterior Insula in Chronic Pain: A Theoretical Framework

2021 ◽  
Vol 11 (5) ◽  
pp. 639
Author(s):  
David Bergeron ◽  
Sami Obaid ◽  
Marie-Pierre Fournier-Gosselin ◽  
Alain Bouthillier ◽  
Dang Khoa Nguyen
Keyword(s):  
Chronic Pain ◽  
Electrical Stimulation ◽  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
High Frequency ◽  
Brain Lesion ◽  
Low Frequency ◽  
Posterior Insula ◽  
Deep Brain ◽  
Stimulation Of

Introduction: To date, clinical trials of deep brain stimulation (DBS) for refractory chronic pain have yielded unsatisfying results. Recent evidence suggests that the posterior insula may represent a promising DBS target for this indication. Methods: We present a narrative review highlighting the theoretical basis of posterior insula DBS in patients with chronic pain. Results: Neuroanatomical studies identified the posterior insula as an important cortical relay center for pain and interoception. Intracranial neuronal recordings showed that the earliest response to painful laser stimulation occurs in the posterior insula. The posterior insula is one of the only regions in the brain whose low-frequency electrical stimulation can elicit painful sensations. Most chronic pain syndromes, such as fibromyalgia, had abnormal functional connectivity of the posterior insula on functional imaging. Finally, preliminary results indicated that high-frequency electrical stimulation of the posterior insula can acutely increase pain thresholds. Conclusion: In light of the converging evidence from neuroanatomical, brain lesion, neuroimaging, and intracranial recording and stimulation as well as non-invasive stimulation studies, it appears that the insula is a critical hub for central integration and processing of painful stimuli, whose high-frequency electrical stimulation has the potential to relieve patients from the sensory and affective burden of chronic pain.

Closed-loop programming using external responses for deep brain stimulation in Parkinson's disease

2021 ◽  
Vol 84 ◽  
pp. 47-51
Author(s):  
Fuyuko Sasaki ◽  
Genko Oyama ◽  
Satoko Sekimoto ◽  
Maierdanjiang Nuermaimaiti ◽  
Hirokazu Iwamuro ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Closed Loop ◽  
Deep Brain
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