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Sand D, Rappel P, Marmor O, Bick AS, Arkadir D, Lu BL, Bergman H, Israel Z, Eitan R. Machine learning-based personalized subthalamic biomarkers predict ON-OFF levodopa states in Parkinson patients. J Neural Eng 2021; 18. [PMID: 33906182 DOI: 10.1088/1741-2552/abfc1d] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 04/27/2021] [Indexed: 01/20/2023]
Abstract
Objective.Adaptive deep brain stimulation (aDBS) based on subthalamic nucleus (STN) electrophysiology has recently been proposed to improve clinical outcomes of DBS for Parkinson's disease (PD) patients. Many current models for aDBS are based on one or two electrophysiological features of STN activity, such as beta or gamma activity. Although these models have shown interesting results, we hypothesized that an aDBS model that includes many STN activity parameters will yield better clinical results. The objective of this study was to investigate the most appropriate STN neurophysiological biomarkers, detectable over long periods of time, that can predict OFF and ON levodopa states in PD patients.Approach.Long-term local field potentials (LFPs) were recorded from eight STNs (four PD patients) during 92 recording sessions (44 OFF and 48 ON levodopa states), over a period of 3-12 months. Electrophysiological analysis included the power of frequency bands, band power ratio and burst features. A total of 140 engineered features was extracted for 20 040 epochs (each epoch lasting 5 s). Based on these engineered features, machine learning (ML) models classified LFPs as OFF vs ON levodopa states.Main results.Beta and gamma band activity alone poorly predicts OFF vs ON levodopa states, with an accuracy of 0.66 and 0.64, respectively. Group ML analysis slightly improved prediction rates, but personalized ML analysis, based on individualized engineered electrophysiological features, were markedly better, predicting OFF vs ON levodopa states with an accuracy of 0.8 for support vector machine learning models.Significance.We showed that individual patients have unique sets of STN neurophysiological biomarkers that can be detected over long periods of time. ML models revealed that personally classified engineered features most accurately predict OFF vs ON levodopa states. Future development of aDBS for PD patients might include personalized ML algorithms.
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Affiliation(s)
- Daniel Sand
- Department of Medical Neurobiology (Physiology), Institute of Medical Research-Israel-Canada, The Hebrew University-Hadassah Medical School, Jerusalem, Israel.,The Edmond and Lily Safra Center for Brain Research, The Hebrew University, Jerusalem, Israel
| | - Pnina Rappel
- Department of Medical Neurobiology (Physiology), Institute of Medical Research-Israel-Canada, The Hebrew University-Hadassah Medical School, Jerusalem, Israel.,The Edmond and Lily Safra Center for Brain Research, The Hebrew University, Jerusalem, Israel
| | - Odeya Marmor
- Department of Medical Neurobiology (Physiology), Institute of Medical Research-Israel-Canada, The Hebrew University-Hadassah Medical School, Jerusalem, Israel.,The Edmond and Lily Safra Center for Brain Research, The Hebrew University, Jerusalem, Israel
| | - Atira S Bick
- Department of Medical Neurobiology (Physiology), Institute of Medical Research-Israel-Canada, The Hebrew University-Hadassah Medical School, Jerusalem, Israel.,The Brain Division, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - David Arkadir
- The Brain Division, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Bao-Liang Lu
- Center for Brain-like Computing and Machine Intelligence, Department of Computer Science and Engineering, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Hagai Bergman
- Department of Medical Neurobiology (Physiology), Institute of Medical Research-Israel-Canada, The Hebrew University-Hadassah Medical School, Jerusalem, Israel.,The Edmond and Lily Safra Center for Brain Research, The Hebrew University, Jerusalem, Israel.,Functional Neurosurgery Unit, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Zvi Israel
- The Brain Division, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.,Functional Neurosurgery Unit, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Renana Eitan
- Department of Medical Neurobiology (Physiology), Institute of Medical Research-Israel-Canada, The Hebrew University-Hadassah Medical School, Jerusalem, Israel.,The Brain Division, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.,Jerusalem Mental Health Center, Hebrew University-Hadassah Medical School, Jerusalem, Israel.,Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America
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Fins JJ, Wright MS, Kraft C, Rogers A, Romani MB, Godwin S, Ulrich MR. Whither the "Improvement Standard"? Coverage for Severe Brain Injury after Jimmo v. Sebelius. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2016; 44:182-193. [PMID: 27256134 DOI: 10.1177/1073110516644209] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
As improvements in neuroscience have enabled a better understanding of disorders of consciousness as well as methods to treat them, a hurdle that has become all too prevalent is the denial of coverage for treatment and rehabilitation services. In 2011, a settlement emerged from a Vermont District Court case, Jimmo v. Sebelius, which was brought to stop the use of an "improvement standard" that required tangible progress over an identifiable period of time for Medicare coverage of services. While the use of this standard can have deleterious effects on those with many chronic conditions, it is especially burdensome for those in the minimally conscious state (MCS), where improvements are unpredictable and often not manifested through repeatable overt behaviors. Though the focus of this paper is on the challenges of brain injury and the minimally conscious state, which an estimated 100,000 to 200,000 individuals suffer from in the United States, the post-Jimmo arguments presented can and should have a broad impact as envisioned by the plaintiffs who brought the case on behalf of multiple advocacy groups representing patients with a range of chronic care conditions.
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Affiliation(s)
- Joseph J Fins
- Joseph J. Fins, M.D., M.A.C.P., is The E. William Davis, Jr. M.D. Professor of Medical Ethics and Chief of the Division of Medical Ethics at Weill Cornell Medical College where he is a Tenured Professor of Medicine, Professor of Medical Ethics in Neurology, Professor of Health Care Policy and Research, and Professor of Medicine in Psychiatry. He Co-Directs, the Consortium for the Advanced Study of Brain Injury (CASBI) at Weill Cornell and Rockefeller University, is a Senior Research Scholar in Law at the Yale Law School, an elected Member of the Institute of Medicine of the National Academy of Sciences, a Fellow of the American Academy of Arts and Sciences and an Academico de Honor (Honored Academic) of the Real Academia Nacional de Medicina de Espana (the Royal Academy of Medicine of Spain). He received his B.A. with Honors from Wesleyan University (Middletown, CT) and M.D. from Cornell University (New York, NY). Megan S. Wright, Ph.D., is a J.D. candidate (2016) at Yale Law School (New Haven, CT). She earned a Ph.D. in Sociology from the University of Arizona (Tucson, Arizona). Claudia Kraft is a third-year law student at Yale Law School (New Haven, CT). She received a B.A. in Human Biology from the University of Virginia (Charlottesville, VA). Alix Rogers, M.Phil., is concurrently pursuing a J.D. at Yale Law School (New Haven, CT), and a Ph.D. in the History and Philosophy of Science at the University of Cambridge (Cambridge, United Kingdom). She holds a M.Phil from the University of Cambridge (Cambridge, United Kingdom), and a B.A. from the University of Pennsylvania (Philadelphia, PA). Marina Romani is a J.D Candidate (2016) at Yale Law School (New Haven, CT). She received a B.S. in Biology from Dartmouth College (Hanover, NH). Samantha Godwin, J.D., is a Ph.D candidate and Gates Cambridge Scholar at Cambridge University and an LL.M student at Yale Law School. She received her B.A. and MA from University College London department of philosophy and her J.D. from
| | - Megan S Wright
- Joseph J. Fins, M.D., M.A.C.P., is The E. William Davis, Jr. M.D. Professor of Medical Ethics and Chief of the Division of Medical Ethics at Weill Cornell Medical College where he is a Tenured Professor of Medicine, Professor of Medical Ethics in Neurology, Professor of Health Care Policy and Research, and Professor of Medicine in Psychiatry. He Co-Directs, the Consortium for the Advanced Study of Brain Injury (CASBI) at Weill Cornell and Rockefeller University, is a Senior Research Scholar in Law at the Yale Law School, an elected Member of the Institute of Medicine of the National Academy of Sciences, a Fellow of the American Academy of Arts and Sciences and an Academico de Honor (Honored Academic) of the Real Academia Nacional de Medicina de Espana (the Royal Academy of Medicine of Spain). He received his B.A. with Honors from Wesleyan University (Middletown, CT) and M.D. from Cornell University (New York, NY). Megan S. Wright, Ph.D., is a J.D. candidate (2016) at Yale Law School (New Haven, CT). She earned a Ph.D. in Sociology from the University of Arizona (Tucson, Arizona). Claudia Kraft is a third-year law student at Yale Law School (New Haven, CT). She received a B.A. in Human Biology from the University of Virginia (Charlottesville, VA). Alix Rogers, M.Phil., is concurrently pursuing a J.D. at Yale Law School (New Haven, CT), and a Ph.D. in the History and Philosophy of Science at the University of Cambridge (Cambridge, United Kingdom). She holds a M.Phil from the University of Cambridge (Cambridge, United Kingdom), and a B.A. from the University of Pennsylvania (Philadelphia, PA). Marina Romani is a J.D Candidate (2016) at Yale Law School (New Haven, CT). She received a B.S. in Biology from Dartmouth College (Hanover, NH). Samantha Godwin, J.D., is a Ph.D candidate and Gates Cambridge Scholar at Cambridge University and an LL.M student at Yale Law School. She received her B.A. and MA from University College London department of philosophy and her J.D. from
| | - Claudia Kraft
- Joseph J. Fins, M.D., M.A.C.P., is The E. William Davis, Jr. M.D. Professor of Medical Ethics and Chief of the Division of Medical Ethics at Weill Cornell Medical College where he is a Tenured Professor of Medicine, Professor of Medical Ethics in Neurology, Professor of Health Care Policy and Research, and Professor of Medicine in Psychiatry. He Co-Directs, the Consortium for the Advanced Study of Brain Injury (CASBI) at Weill Cornell and Rockefeller University, is a Senior Research Scholar in Law at the Yale Law School, an elected Member of the Institute of Medicine of the National Academy of Sciences, a Fellow of the American Academy of Arts and Sciences and an Academico de Honor (Honored Academic) of the Real Academia Nacional de Medicina de Espana (the Royal Academy of Medicine of Spain). He received his B.A. with Honors from Wesleyan University (Middletown, CT) and M.D. from Cornell University (New York, NY). Megan S. Wright, Ph.D., is a J.D. candidate (2016) at Yale Law School (New Haven, CT). She earned a Ph.D. in Sociology from the University of Arizona (Tucson, Arizona). Claudia Kraft is a third-year law student at Yale Law School (New Haven, CT). She received a B.A. in Human Biology from the University of Virginia (Charlottesville, VA). Alix Rogers, M.Phil., is concurrently pursuing a J.D. at Yale Law School (New Haven, CT), and a Ph.D. in the History and Philosophy of Science at the University of Cambridge (Cambridge, United Kingdom). She holds a M.Phil from the University of Cambridge (Cambridge, United Kingdom), and a B.A. from the University of Pennsylvania (Philadelphia, PA). Marina Romani is a J.D Candidate (2016) at Yale Law School (New Haven, CT). She received a B.S. in Biology from Dartmouth College (Hanover, NH). Samantha Godwin, J.D., is a Ph.D candidate and Gates Cambridge Scholar at Cambridge University and an LL.M student at Yale Law School. She received her B.A. and MA from University College London department of philosophy and her J.D. from
| | - Alix Rogers
- Joseph J. Fins, M.D., M.A.C.P., is The E. William Davis, Jr. M.D. Professor of Medical Ethics and Chief of the Division of Medical Ethics at Weill Cornell Medical College where he is a Tenured Professor of Medicine, Professor of Medical Ethics in Neurology, Professor of Health Care Policy and Research, and Professor of Medicine in Psychiatry. He Co-Directs, the Consortium for the Advanced Study of Brain Injury (CASBI) at Weill Cornell and Rockefeller University, is a Senior Research Scholar in Law at the Yale Law School, an elected Member of the Institute of Medicine of the National Academy of Sciences, a Fellow of the American Academy of Arts and Sciences and an Academico de Honor (Honored Academic) of the Real Academia Nacional de Medicina de Espana (the Royal Academy of Medicine of Spain). He received his B.A. with Honors from Wesleyan University (Middletown, CT) and M.D. from Cornell University (New York, NY). Megan S. Wright, Ph.D., is a J.D. candidate (2016) at Yale Law School (New Haven, CT). She earned a Ph.D. in Sociology from the University of Arizona (Tucson, Arizona). Claudia Kraft is a third-year law student at Yale Law School (New Haven, CT). She received a B.A. in Human Biology from the University of Virginia (Charlottesville, VA). Alix Rogers, M.Phil., is concurrently pursuing a J.D. at Yale Law School (New Haven, CT), and a Ph.D. in the History and Philosophy of Science at the University of Cambridge (Cambridge, United Kingdom). She holds a M.Phil from the University of Cambridge (Cambridge, United Kingdom), and a B.A. from the University of Pennsylvania (Philadelphia, PA). Marina Romani is a J.D Candidate (2016) at Yale Law School (New Haven, CT). She received a B.S. in Biology from Dartmouth College (Hanover, NH). Samantha Godwin, J.D., is a Ph.D candidate and Gates Cambridge Scholar at Cambridge University and an LL.M student at Yale Law School. She received her B.A. and MA from University College London department of philosophy and her J.D. from
| | - Marina B Romani
- Joseph J. Fins, M.D., M.A.C.P., is The E. William Davis, Jr. M.D. Professor of Medical Ethics and Chief of the Division of Medical Ethics at Weill Cornell Medical College where he is a Tenured Professor of Medicine, Professor of Medical Ethics in Neurology, Professor of Health Care Policy and Research, and Professor of Medicine in Psychiatry. He Co-Directs, the Consortium for the Advanced Study of Brain Injury (CASBI) at Weill Cornell and Rockefeller University, is a Senior Research Scholar in Law at the Yale Law School, an elected Member of the Institute of Medicine of the National Academy of Sciences, a Fellow of the American Academy of Arts and Sciences and an Academico de Honor (Honored Academic) of the Real Academia Nacional de Medicina de Espana (the Royal Academy of Medicine of Spain). He received his B.A. with Honors from Wesleyan University (Middletown, CT) and M.D. from Cornell University (New York, NY). Megan S. Wright, Ph.D., is a J.D. candidate (2016) at Yale Law School (New Haven, CT). She earned a Ph.D. in Sociology from the University of Arizona (Tucson, Arizona). Claudia Kraft is a third-year law student at Yale Law School (New Haven, CT). She received a B.A. in Human Biology from the University of Virginia (Charlottesville, VA). Alix Rogers, M.Phil., is concurrently pursuing a J.D. at Yale Law School (New Haven, CT), and a Ph.D. in the History and Philosophy of Science at the University of Cambridge (Cambridge, United Kingdom). She holds a M.Phil from the University of Cambridge (Cambridge, United Kingdom), and a B.A. from the University of Pennsylvania (Philadelphia, PA). Marina Romani is a J.D Candidate (2016) at Yale Law School (New Haven, CT). She received a B.S. in Biology from Dartmouth College (Hanover, NH). Samantha Godwin, J.D., is a Ph.D candidate and Gates Cambridge Scholar at Cambridge University and an LL.M student at Yale Law School. She received her B.A. and MA from University College London department of philosophy and her J.D. from
| | - Samantha Godwin
- Joseph J. Fins, M.D., M.A.C.P., is The E. William Davis, Jr. M.D. Professor of Medical Ethics and Chief of the Division of Medical Ethics at Weill Cornell Medical College where he is a Tenured Professor of Medicine, Professor of Medical Ethics in Neurology, Professor of Health Care Policy and Research, and Professor of Medicine in Psychiatry. He Co-Directs, the Consortium for the Advanced Study of Brain Injury (CASBI) at Weill Cornell and Rockefeller University, is a Senior Research Scholar in Law at the Yale Law School, an elected Member of the Institute of Medicine of the National Academy of Sciences, a Fellow of the American Academy of Arts and Sciences and an Academico de Honor (Honored Academic) of the Real Academia Nacional de Medicina de Espana (the Royal Academy of Medicine of Spain). He received his B.A. with Honors from Wesleyan University (Middletown, CT) and M.D. from Cornell University (New York, NY). Megan S. Wright, Ph.D., is a J.D. candidate (2016) at Yale Law School (New Haven, CT). She earned a Ph.D. in Sociology from the University of Arizona (Tucson, Arizona). Claudia Kraft is a third-year law student at Yale Law School (New Haven, CT). She received a B.A. in Human Biology from the University of Virginia (Charlottesville, VA). Alix Rogers, M.Phil., is concurrently pursuing a J.D. at Yale Law School (New Haven, CT), and a Ph.D. in the History and Philosophy of Science at the University of Cambridge (Cambridge, United Kingdom). She holds a M.Phil from the University of Cambridge (Cambridge, United Kingdom), and a B.A. from the University of Pennsylvania (Philadelphia, PA). Marina Romani is a J.D Candidate (2016) at Yale Law School (New Haven, CT). She received a B.S. in Biology from Dartmouth College (Hanover, NH). Samantha Godwin, J.D., is a Ph.D candidate and Gates Cambridge Scholar at Cambridge University and an LL.M student at Yale Law School. She received her B.A. and MA from University College London department of philosophy and her J.D. from
| | - Michael R Ulrich
- Joseph J. Fins, M.D., M.A.C.P., is The E. William Davis, Jr. M.D. Professor of Medical Ethics and Chief of the Division of Medical Ethics at Weill Cornell Medical College where he is a Tenured Professor of Medicine, Professor of Medical Ethics in Neurology, Professor of Health Care Policy and Research, and Professor of Medicine in Psychiatry. He Co-Directs, the Consortium for the Advanced Study of Brain Injury (CASBI) at Weill Cornell and Rockefeller University, is a Senior Research Scholar in Law at the Yale Law School, an elected Member of the Institute of Medicine of the National Academy of Sciences, a Fellow of the American Academy of Arts and Sciences and an Academico de Honor (Honored Academic) of the Real Academia Nacional de Medicina de Espana (the Royal Academy of Medicine of Spain). He received his B.A. with Honors from Wesleyan University (Middletown, CT) and M.D. from Cornell University (New York, NY). Megan S. Wright, Ph.D., is a J.D. candidate (2016) at Yale Law School (New Haven, CT). She earned a Ph.D. in Sociology from the University of Arizona (Tucson, Arizona). Claudia Kraft is a third-year law student at Yale Law School (New Haven, CT). She received a B.A. in Human Biology from the University of Virginia (Charlottesville, VA). Alix Rogers, M.Phil., is concurrently pursuing a J.D. at Yale Law School (New Haven, CT), and a Ph.D. in the History and Philosophy of Science at the University of Cambridge (Cambridge, United Kingdom). She holds a M.Phil from the University of Cambridge (Cambridge, United Kingdom), and a B.A. from the University of Pennsylvania (Philadelphia, PA). Marina Romani is a J.D Candidate (2016) at Yale Law School (New Haven, CT). She received a B.S. in Biology from Dartmouth College (Hanover, NH). Samantha Godwin, J.D., is a Ph.D candidate and Gates Cambridge Scholar at Cambridge University and an LL.M student at Yale Law School. She received her B.A. and MA from University College London department of philosophy and her J.D. from
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