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Review
. 2018 Dec;33(12):1834-1843.
doi: 10.1002/mds.115. Epub 2018 Oct 24.

An Update on Adaptive Deep Brain Stimulation in Parkinson's Disease

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Free PMC article
Review

An Update on Adaptive Deep Brain Stimulation in Parkinson's Disease

Jeroen G V Habets et al. Mov Disord. .
Free PMC article

Abstract

Advancing conventional open-loop DBS as a therapy for PD is crucial for overcoming important issues such as the delicate balance between beneficial and adverse effects and limited battery longevity that are currently associated with treatment. Closed-loop or adaptive DBS aims to overcome these limitations by real-time adjustment of stimulation parameters based on continuous feedback input signals that are representative of the patient's clinical state. The focus of this update is to discuss the most recent developments regarding potential input signals and possible stimulation parameter modulation for adaptive DBS in PD. Potential input signals for adaptive DBS include basal ganglia local field potentials, cortical recordings (electrocorticography), wearable sensors, and eHealth and mHealth devices. Furthermore, adaptive DBS can be applied with different approaches of stimulation parameter modulation, the feasibility of which can be adapted depending on specific PD phenotypes. Implementation of technological developments like machine learning show potential in the design of such approaches; however, energy consumption deserves further attention. Furthermore, we discuss future considerations regarding the clinical implementation of adaptive DBS in PD. © 2018 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.

Keywords: Parkinson's disease; adaptive; closed-loop; deep brain stimulation; stimulation paradigms.

Figures

Figure 1
Figure 1
Yearly number of publications on aDBS in PD, searched on PubMed on 5‐3‐2018, using search command: [(parkinson*) AND (adaptive OR (closed loop) OR (closed‐loop) OR responsive) AND (dbs OR stimulation)].
Figure 2
Figure 2
Schematic overview of the most used possible input signal origins for aDBS in PD. Sensors can also be worn on different locations, for example, the chest, legs, or fingers.
Figure 3
Figure 3
Overview of published evidence of the feasibility of different input signals regarding different parkinsonian symptoms for aDBS in PD. All input signals are scored on three categories per symptom. For each category 0, 0.5, or 1 bullet is given and the sum of them is visualized. The first line indicates the amount of publications: not possible yet (0), first reports (0.5), and repeated reports (1). The second line indicates the quality of reported evidence: no evidence (0), small evidence (0.5), and reproduced evidence (1). The third line indicates the amount of consensus on the use of an input signal for a symptom: no consensus (0), on debate (0.5), and starting consensus (1).
Figure 4
Figure 4
Schematic overview of different amplitude modulation paradigms used in aDBS in PD. (A) ON/OFF paradigm, which stimulates with ramping onset when input signals exceed a certain threshold. (B) Gradual paradigm, which increases or decreases stimulation amplitude stepwise when input signal exceeds or does not exceed a certain threshold respectively. (C) Continuous paradigm, which modifies stimulation amplitude according to strength of input signal.

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References

    1. Janssen ML, Duits AA, Turaihi AH, et al. Subthalamic nucleus high‐frequency stimulation for advanced Parkinson's disease: motor and neuropsychological outcome after 10 years. Stereotact Funct Neurosurg 2014;92:381‐387. - PubMed
    1. Limousin P, Pollak P, Benazzouz A, et al. Effect of parkinsonian signs and symptoms of bilateral subthalamic nucleus stimulation. Lancet 1995;345:91‐95. - PubMed
    1. Tripoliti E, Zrinzo L, Martinez‐Torres I, et al. Effects of subthalamic stimulation on speech of consecutive patients with Parkinson disease. Neurology 2011;76:80‐86. - PMC - PubMed
    1. Deuschl G, Schade‐Brittinger C, Krack P, et al. A randomized trial of deep‐brain stimulation for Parkinson's disease. N Engl J Med 2006;355:896‐908. - PubMed
    1. Malekmohammadi M, Herron J, Velisar A, et al. Kinematic adaptive deep brain stimulation for resting tremor in Parkinson's disease. Mov Disord 2016;31:426‐428. - PubMed
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