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.

scholarly journals Local vs. volume conductance activity of field potentials in the human subthalamic nucleus

2017 ◽  
Vol 117 (6) ◽  
pp. 2140-2151 ◽  
Author(s):  
Odeya Marmor ◽  
Dan Valsky ◽  
Mati Joshua ◽  
Atira S Bick ◽  
David Arkadir ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Subthalamic Nucleus ◽  
Neuronal Activity ◽  
Brain Stimulation ◽  
Closed Loop ◽  
Field Potential ◽  
Cortical Activity ◽  
Field Potentials ◽  
Brain Functions ◽  
Deep Brain

Subthalamic nucleus field potentials have attracted growing research and clinical interest over the last few decades. However, it is unclear whether subthalamic field potentials represent locally generated neuronal subthreshold activity or volume conductance of the organized neuronal activity generated in the cortex. This study aimed at understanding of the physiological origin of subthalamic field potentials and determining the most accurate method for recording them. We compared different methods of recordings in the human subthalamic nucleus: spikes (300–9,000 Hz) and field potentials (3–100 Hz) recorded by monopolar micro- and macroelectrodes, as well as by differential-bipolar macroelectrodes. The recordings were done outside and inside the subthalamic nucleus during electrophysiological navigation for deep brain stimulation procedures (150 electrode trajectories) in 41 Parkinson’s disease patients. We modeled the signal and estimated the contribution of nearby/independent vs. remote/common activity in each recording configuration and area. Monopolar micro- and macroelectrode recordings detect field potentials that are considerably affected by common (probably cortical) activity. However, bipolar macroelectrode recordings inside the subthalamic nucleus can detect locally generated potentials. These results are confirmed by high correspondence between the model predictions and actual correlation of neuronal activity recorded by electrode pairs. Differential bipolar macroelectrode subthalamic field potentials can overcome volume conductance effects and reflect locally generated neuronal activity. Bipolar macroelectrode local field potential recordings might be used as a biological marker of normal and pathological brain functions for future electrophysiological studies and navigation systems as well as for closed-loop deep brain stimulation paradigms. NEW & NOTEWORTHY Our results integrate a new method for human subthalamic recordings with a development of an advanced mathematical model. We found that while monopolar microelectrode and macroelectrode recordings detect field potentials that are considerably affected by common (probably cortical) activity, bipolar macroelectrode recordings inside the subthalamic nucleus (STN) detect locally generated potentials that are significantly different than those recorded outside the STN. Differential bipolar subthalamic field potentials can be used in navigation and closed-loop deep brain stimulation paradigms.

scholarly journals Advances in neurochemical measurements: A review of biomarkers and devices for the development of closed-loop deep brain stimulation systems

2020 ◽  
Vol 39 (1) ◽  
pp. 188-199
Author(s):  
Juan M. Rojas Cabrera ◽  
J. Blair Price ◽  
Aaron E. Rusheen ◽  
Abhinav Goyal ◽  
Danielle Jondal ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Closed Loop ◽  
Field Potential ◽  
Disease Diagnosis ◽  
Neuronal Firing ◽  
Electrochemical Sensing ◽  
Treatment Modalities ◽  
Compulsive Disorder ◽  
Deep Brain

Abstract Neurochemical recording techniques have expanded our understanding of the pathophysiology of neurological disorders, as well as the mechanisms of action of treatment modalities like deep brain stimulation (DBS). DBS is used to treat diseases such as Parkinson’s disease, Tourette syndrome, and obsessive-compulsive disorder, among others. Although DBS is effective at alleviating symptoms related to these diseases and improving the quality of life of these patients, the mechanism of action of DBS is currently not fully understood. A leading hypothesis is that DBS modulates the electrical field potential by modifying neuronal firing frequencies to non-pathological rates thus providing therapeutic relief. To address this gap in knowledge, recent advances in electrochemical sensing techniques have given insight into the importance of neurotransmitters, such as dopamine, serotonin, glutamate, and adenosine, in disease pathophysiology. These studies have also highlighted their potential use in tandem with electrophysiology to serve as biomarkers in disease diagnosis and progression monitoring, as well as characterize response to treatment. Here, we provide an overview of disease-relevant neurotransmitters and their roles and implications as biomarkers, as well as innovations to the biosensors used to record these biomarkers. Furthermore, we discuss currently available neurochemical and electrophysiological recording devices, and discuss their viability to be implemented into the development of a closed-loop DBS system.

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.

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 Case Report: Chronic Adaptive Deep Brain Stimulation Personalizing Therapy Based on Parkinsonian State

2021 ◽  
Vol 15 ◽  
Author(s):  
Asuka Nakajima ◽  
Yasushi Shimo ◽  
Atsuhito Fuse ◽  
Joji Tokugawa ◽  
Makoto Hishii ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Field Potential ◽  
Neural Oscillations ◽  
Target Structure ◽  
New Device ◽  
Stimulation Method ◽  
Local Field Potential Lfp ◽  
Beta Oscillation ◽  
Deep Brain

We describe the case of a 51-year-old man with Parkinson's disease (PD) presenting with motor fluctuations, who received bilateral subthalamic deep brain stimulation (DBS) with an adaptive DBS (aDBS) device, Percept™ PC (Medtronic, Inc. , Minneapolis, MN). This device can deliver electrical stimulations based on fluctuations of neural oscillations of the local field potential (LFP) at the target structure. We observed that the LFP fluctuations were less evident inside the hospital than outside, while the stimulation successfully adapted to beta oscillation fluctuations during the aDBS phase without any stimulation-induced side effects. Thus, this new device facilitates condition-dependent stimulation; this new stimulation method is feasible and provides new insights into the pathophysiological mechanisms of PD.

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 Adaptive Parameter Modulation of Deep Brain Stimulation in a Computational Model of Basal Ganglia-thalamic Network

2021 ◽  
Author(s):  
Yulin Zhu ◽  
Jiang Wang ◽  
Siyuan Chang ◽  
Huiyan Li ◽  
Bin Deng ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Basal Ganglia ◽  
Brain Stimulation ◽  
Closed Loop ◽  
Dynamic Change ◽  
External Disturbance ◽  
Field Potential ◽  
Least Square ◽  
Feedback Signal ◽  
Deep Brain

Abstract Deep brain stimulation (DBS) has proven to be an effective treatment for Parkinson’s disease (PD). Adaptive control strategies offer the potential to improve efficacy, limit side effects and save battery consumption via reducing the total amount of stimulation delivered. However, the mechanisms underlying the beneficial effects of DBS for PD remain poorly understood and are still under debate, which has hindered the development of closed-loop DBS. And during the chronically implanted phase, adaptive DBS needs to be further improved to maintain its advantages. In the design of new adaptive DBS, more insights into inaccuracies when establishing mathematical basal ganglia model, unknown external disturbance signal and dynamics of focal area should be considered. A controlled auto-regressive moving average is used as the representative description of stimulus-response relationship based on recursive extended least square method, where stimulation signal is applied to subthalamic nucleus (STN) and the feedback signal is selected as local field potential signal from globus pallidus (GPi). The generalized minimum variance algorithm is used for online update of stimulation frequency and amplitude in a closed-loop manner. Simulation results illustrated the efficiency of the proposed closed-loop stimulation methods in disrupting the aberrant beta band oscillation and restore normal firing pattern when compared with the PD state. Robustness of the adaptive algorithm was further verified through dynamic change of illness state.

Deep Brain Stimulation for Intractable OCD

2017 ◽  
Author(s):  
Wayne K. Goodman ◽  
Nigel Kennedy ◽  
Kyle Lapidus ◽  
Brian H. Kopell
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Closed Loop ◽  
Behavioral Therapy ◽  
Adequate Treatment ◽  
Predictors Of Response ◽  
The Us ◽  
Ablative Procedures ◽  
The Brain ◽  
Deep Brain

This chapter discusses the use of deep brain stimulation (DBS) for intractable OCD. In contrast to ablative procedures, DBS has the advantages of being reversible (explantable) and adjustable. In 2010, the FDA approved a Humanitarian Device Exemption (HDE) for ventral capsule/ventral striatum DBS in intractable OCD, based upon the device’s safety and its probable benefit, for up to 4,000 people a year in the US. DBS is only suitable for adult patients who remain severely ill despite multiple medication trials and adequate treatment with cognitive behavioral therapy. Further research is needed to further test the efficacy of DBS in OCD, compare targets, identify predictors of response, and optimize programming. Future DBS systems may take advantage of closed loop technology in which feedback from the brain is used to adjust stimulation automatically according to the patient’s changing needs.

Brain shift: an error factor during implantation of deep brain stimulation electrodes

2007 ◽  
Vol 107 (5) ◽  
pp. 989-997 ◽  
Author(s):  
Yasushi Miyagi ◽  
Fumio Shima ◽  
Tomio Sasaki
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Brain Shift ◽  
Mr Images ◽  
Implanted Electrodes ◽  
Error Factor ◽  
Bilateral Surgery ◽  
Second Procedure ◽  
The Brain ◽  
Deep Brain

Object The goal of this study was to focus on the tendency of brain shift during stereotactic neurosurgery and the shift's impact on the unilateral and bilateral implantation of electrodes for deep brain stimulation (DBS). Methods Eight unilateral and 10 bilateral DBS electrodes at 10 nuclei ventrales intermedii and 18 subthalamic nuclei were implanted in patients at Kaizuka Hospital with the aid of magnetic resonance (MR) imaging–guided and microelectrode-guided methods. Brain shift was assessed as changes in the 3D coordinates of the anterior and posterior commissures (AC and PC) with MR images before and immediately after the implantation surgery. The positions of the implanted electrodes, based on the midcommissural point and AC–PC line, were measured both on x-ray films (virtual position) during surgery and the postoperative MR images (actual position) obtained on the 7th day postoperatively. Results Contralateral and posterior shift of the AC and PC were the characteristics of unilateral and bilateral procedures, respectively. The authors suggest the following. 1) The first unilateral procedure elicits a unilateral air invasion, resulting in a contralateral brain shift. 2) During the second procedure in the bilateral surgery, the contralateral shift is reset to the midline and, at the same time, the anteroposterior support by the contralateral hemisphere against gravity is lost due to a bilateral air invasion, resulting in a significant posterior (caudal) shift. Conclusions To note the tendency of the brain to shift is very important for accurate implantation of a DBS electrode or high frequency thermocoagulation, as well as for the prediction of therapeutic and adverse effects of stereotactic surgery.

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