AI Article Synopsis

  • Deep brain stimulation (DBS) is a treatment for severe movement disorders, but traditional methods (open-loop DBS) provide constant stimulation without adjusting to patient needs, leading to inefficiency.
  • The study tested a new approach called closed-loop DBS, which adjusts stimulation based on patients' movements, specifically for those with essential tremor, and compared its effects to open-loop DBS over six months.
  • Results showed that closed-loop DBS effectively suppressed tremors during various activities while using less energy, paving the way for a more responsive DBS system that could reduce side effects and the need for device replacement.

Article Abstract

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.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8182660PMC
http://dx.doi.org/10.1126/scitranslmed.aay7680DOI Listing

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