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Olaru M, Cernera S, Hahn A, Wozny TA, Anso J, de Hemptinne C, Little S, Neumann WJ, Abbasi-Asl R, Starr PA. Motor network gamma oscillations in chronic home recordings predict dyskinesia in Parkinson's disease. Brain 2024; 147:2038-2052. [PMID: 38195196 PMCID: PMC11146421 DOI: 10.1093/brain/awae004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 12/17/2023] [Accepted: 12/21/2023] [Indexed: 01/11/2024] Open
Abstract
In Parkinson's disease, imbalances between 'antikinetic' and 'prokinetic' patterns of neuronal oscillatory activity are related to motor dysfunction. Invasive brain recordings from the motor network have suggested that medical or surgical therapy can promote a prokinetic state by inducing narrowband gamma rhythms (65-90 Hz). Excessive narrowband gamma in the motor cortex promotes dyskinesia in rodent models, but the relationship between narrowband gamma and dyskinesia in humans has not been well established. To assess this relationship, we used a sensing-enabled deep brain stimulator system, attached to both motor cortex and basal ganglia (subthalamic or pallidal) leads, paired with wearable devices that continuously tracked motor signs in the contralateral upper limbs. We recorded 984 h of multisite field potentials in 30 hemispheres of 16 subjects with Parkinson's disease (2/16 female, mean age 57 ± 12 years) while at home on usual antiparkinsonian medications. Recordings were done 2-4 weeks after implantation, prior to starting therapeutic stimulation. Narrowband gamma was detected in the precentral gyrus, subthalamic nucleus or both structures on at least one side of 92% of subjects with a clinical history of dyskinesia. Narrowband gamma was not detected in the globus pallidus. Narrowband gamma spectral power in both structures co-fluctuated similarly with contralateral wearable dyskinesia scores (mean correlation coefficient of ρ = 0.48 with a range of 0.12-0.82 for cortex, ρ = 0.53 with a range of 0.5-0.77 for subthalamic nucleus). Stratification analysis showed the correlations were not driven by outlier values, and narrowband gamma could distinguish 'on' periods with dyskinesia from 'on' periods without dyskinesia. Time lag comparisons confirmed that gamma oscillations herald dyskinesia onset without a time lag in either structure when using 2-min epochs. A linear model incorporating the three oscillatory bands (beta, theta/alpha and narrowband gamma) increased the predictive power of dyskinesia for several subject hemispheres. We further identified spectrally distinct oscillations in the low gamma range (40-60 Hz) in three subjects, but the relationship of low gamma oscillations to dyskinesia was variable. Our findings support the hypothesis that excessive oscillatory activity at 65-90 Hz in the motor network tracks with dyskinesia similarly across both structures, without a detectable time lag. This rhythm may serve as a promising control signal for closed-loop deep brain stimulation using either cortical or subthalamic detection.
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Affiliation(s)
- Maria Olaru
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA 94143, USA
- Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA 94158, USA
| | - Stephanie Cernera
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA 94143, USA
- Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA 94158, USA
| | - Amelia Hahn
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA 94143, USA
- Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA 94158, USA
| | - Thomas A Wozny
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA 94143, USA
- Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA 94158, USA
| | - Juan Anso
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA 94143, USA
- Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA 94158, USA
| | - Coralie de Hemptinne
- Department of Neurology, University of Florida Gainesville, Gainesville, FL 32611, USA
| | - Simon Little
- Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA 94158, USA
| | - Wolf-Julian Neumann
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin 10117, Germany
| | - Reza Abbasi-Asl
- Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA 94158, USA
- Department of Neurology, University of California San Francisco, San Francisco, CA 94143, USA
| | - Philip A Starr
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA 94143, USA
- Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA 94158, USA
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Lewis S, Radcliffe E, Ojemann S, Kramer DR, Hirt L, Case M, Holt-Becker AB, Raike R, Kern DS, Thompson JA. Pilot Study to Investigate the Use of In-Clinic Sensing to Identify Optimal Stimulation Parameters for Deep Brain Stimulation Therapy in Parkinson's Disease. Neuromodulation 2024; 27:509-519. [PMID: 36797194 DOI: 10.1016/j.neurom.2023.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 12/19/2022] [Accepted: 01/09/2023] [Indexed: 02/16/2023]
Abstract
BACKGROUND Deep brain stimulation (DBS) programming is time intensive. Recent advances in sensing technology of local field potentials (LFPs) may enable improvements. Few studies have compared the use of this technology with standard of care. OBJECTIVE/HYPOTHESIS Sensing technology of subthalamic nucleus (STN) DBS leads in Parkinson's disease (PD) is reliable and predicts the optimal contacts and settings as predicted by clinical assessment. MATERIALS AND METHODS Five subjects with PD (n = 9 hemispheres) with bilateral STN DBS and sensing capable battery replacement were recruited. An LFP sensing review of all bipolar contact pairs was performed three times. Contact with the maximal beta peak power (MBP) was then clinically assessed in a double-blinded fashion, and five conditions were tested: 1) entry settings, 2) off stimulation, 3) MBP at 30 μs, 4) MBP at 60 μs, and 5) MBP at 90 μs. RESULTS Contact and frequency of the MBP power in all hemispheres did not differ across sessions. The entry settings matched with the contact with the MBP power in 5 of 9 hemispheres. No clinical difference was evident in the stimulation conditions. The clinician and subject preferred settings determined by MBP power in 7 of 9 and 5 of 7 hemispheres, respectively. CONCLUSIONS This study indicates that STN LFPs in PD recorded directly from contacts of the DBS lead provide consistent recordings across the frequency range and a reliably detected beta peak. Furthermore, programming based on the MBP power provides at least clinical equivalence to standard of care programming with STN DBS.
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Affiliation(s)
- Sydnei Lewis
- Biomedical Engineering, University of Colorado Boulder, Boulder, CO, USA
| | - Erin Radcliffe
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Department of Bioengineering, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Steven Ojemann
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Daniel R Kramer
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Lisa Hirt
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Michelle Case
- Brain Modulation Business, Neuromodulation Operating Unit, Medtronic, Plc, Minneapolis, MN, USA
| | - Abbey B Holt-Becker
- Brain Modulation Business, Neuromodulation Operating Unit, Medtronic, Plc, Minneapolis, MN, USA
| | - Robert Raike
- Brain Modulation Business, Neuromodulation Operating Unit, Medtronic, Plc, Minneapolis, MN, USA
| | - Drew S Kern
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - John A Thompson
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Department of Bioengineering, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
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Anjum MF, Smyth C, Zuzuárregui R, Dijk DJ, Starr PA, Denison T, Little S. Multi-night cortico-basal recordings reveal mechanisms of NREM slow-wave suppression and spontaneous awakenings in Parkinson's disease. Nat Commun 2024; 15:1793. [PMID: 38413587 PMCID: PMC10899224 DOI: 10.1038/s41467-024-46002-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 02/12/2024] [Indexed: 02/29/2024] Open
Abstract
Sleep disturbance is a prevalent and disabling comorbidity in Parkinson's disease (PD). We performed multi-night (n = 57) at-home intracranial recordings from electrocorticography and subcortical electrodes using sensing-enabled Deep Brain Stimulation (DBS), paired with portable polysomnography in four PD participants and one with cervical dystonia (clinical trial: NCT03582891). Cortico-basal activity in delta increased and in beta decreased during NREM (N2 + N3) versus wakefulness in PD. DBS caused further elevation in cortical delta and decrease in alpha and low-beta compared to DBS OFF state. Our primary outcome demonstrated an inverse interaction between subcortical beta and cortical slow-wave during NREM. Our secondary outcome revealed subcortical beta increases prior to spontaneous awakenings in PD. We classified NREM vs. wakefulness with high accuracy in both traditional (30 s: 92.6 ± 1.7%) and rapid (5 s: 88.3 ± 2.1%) data epochs of intracranial signals. Our findings elucidate sleep neurophysiology and impacts of DBS on sleep in PD informing adaptive DBS for sleep dysfunction.
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Affiliation(s)
- Md Fahim Anjum
- Movement Disorders and Neuromodulation Centre, University California San Francisco, San Francisco, CA, USA.
| | - Clay Smyth
- Movement Disorders and Neuromodulation Centre, University California San Francisco, San Francisco, CA, USA
| | - Rafael Zuzuárregui
- Movement Disorders and Neuromodulation Centre, University California San Francisco, San Francisco, CA, USA
- Parkinson's Disease Research Education and Clinical Center, San Francisco Veteran's Affairs Medical Center, San Francisco, CA, USA
| | - Derk Jan Dijk
- Surrey Sleep Research Centre, University of Surrey, Guildford, UK
- UK Dementia Research Institute, Care Research and Technology Centre at Imperial College, London and The University of Surrey, Guildford, UK
| | - Philip A Starr
- Movement Disorders and Neuromodulation Centre, University California San Francisco, San Francisco, CA, USA
| | - Timothy Denison
- MRC Brain Network Dynamics Unit, University of Oxford, Oxford, UK
| | - Simon Little
- Movement Disorders and Neuromodulation Centre, University California San Francisco, San Francisco, CA, USA
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Xie T, Foutz TJ, Adamek M, Swift JR, Inman CS, Manns JR, Leuthardt EC, Willie JT, Brunner P. Single-pulse electrical stimulation artifact removal using the novel matching pursuit-based artifact reconstruction and removal method (MPARRM). J Neural Eng 2023; 20:066036. [PMID: 38063368 PMCID: PMC10751949 DOI: 10.1088/1741-2552/ad1385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 11/02/2023] [Accepted: 12/07/2023] [Indexed: 12/28/2023]
Abstract
Objective.Single-pulse electrical stimulation (SPES) has been widely used to probe effective connectivity. However, analysis of the neural response is often confounded by stimulation artifacts. We developed a novel matching pursuit-based artifact reconstruction and removal method (MPARRM) capable of removing artifacts from stimulation-artifact-affected electrophysiological signals.Approach.To validate MPARRM across a wide range of potential stimulation artifact types, we performed a bench-top experiment in which we suspended electrodes in a saline solution to generate 110 types of real-world stimulation artifacts. We then added the generated stimulation artifacts to ground truth signals (stereoelectroencephalography signals from nine human subjects recorded during a receptive speech task), applied MPARRM to the combined signal, and compared the resultant denoised signal with the ground truth signal. We further applied MPARRM to artifact-affected neural signals recorded from the hippocampus while performing SPES on the ipsilateral basolateral amygdala in nine human subjects.Main results.MPARRM could remove stimulation artifacts without introducing spectral leakage or temporal spread. It accommodated variable stimulation parameters and recovered the early response to SPES within a wide range of frequency bands. Specifically, in the early response period (5-10 ms following stimulation onset), we found that the broadband gamma power (70-170 Hz) of the denoised signal was highly correlated with the ground truth signal (R=0.98±0.02, Pearson), and the broadband gamma activity of the denoised signal faithfully revealed the responses to the auditory stimuli within the ground truth signal with94%±1.47%sensitivity and99%±1.01%specificity. We further found that MPARRM could reveal the expected temporal progression of broadband gamma activity along the anterior-posterior axis of the hippocampus in response to the ipsilateral amygdala stimulation.Significance.MPARRM could faithfully remove SPES artifacts without confounding the electrophysiological signal components, especially during the early-response period. This method can facilitate the understanding of the neural response mechanisms of SPES.
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Affiliation(s)
- Tao Xie
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO, United States of America
- National Center for Adaptive Neurotechnologies, St. Louis, MO, United States of America
| | - Thomas J Foutz
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, United States of America
| | - Markus Adamek
- National Center for Adaptive Neurotechnologies, St. Louis, MO, United States of America
- Department of Neuroscience, Washington University School of Medicine, St. Louis, MO, United States of America
| | - James R Swift
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO, United States of America
- National Center for Adaptive Neurotechnologies, St. Louis, MO, United States of America
| | - Cory S Inman
- Department of Psychology, University of Utah, Salt Lake City, UT, United States of America
| | - Joseph R Manns
- Department of Psychology, Emory University, Atlanta, GA, United States of America
| | - Eric C Leuthardt
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO, United States of America
| | - Jon T Willie
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO, United States of America
- National Center for Adaptive Neurotechnologies, St. Louis, MO, United States of America
| | - Peter Brunner
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO, United States of America
- National Center for Adaptive Neurotechnologies, St. Louis, MO, United States of America
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Wilkins KB, Melbourne JA, Akella P, Bronte-Stewart HM. Unraveling the complexities of programming neural adaptive deep brain stimulation in Parkinson's disease. Front Hum Neurosci 2023; 17:1310393. [PMID: 38094147 PMCID: PMC10716917 DOI: 10.3389/fnhum.2023.1310393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 11/09/2023] [Indexed: 02/01/2024] Open
Abstract
Over the past three decades, deep brain stimulation (DBS) for Parkinson's disease (PD) has been applied in a continuous open loop fashion, unresponsive to changes in a given patient's state or symptoms over the course of a day. Advances in recent neurostimulator technology enable the possibility for closed loop adaptive DBS (aDBS) for PD as a treatment option in the near future in which stimulation adjusts in a demand-based manner. Although aDBS offers great clinical potential for treatment of motor symptoms, it also brings with it the need for better understanding how to implement it in order to maximize its benefits. In this perspective, we outline considerations for programing several key parameters for aDBS based on our experience across several aDBS-capable research neurostimulators. At its core, aDBS hinges on successful identification of relevant biomarkers that can be measured reliably in real-time working in cohesion with a control policy that governs stimulation adaption. However, auxiliary parameters such as the window in which stimulation is allowed to adapt, as well as the rate it changes, can be just as impactful on performance and vary depending on the control policy and patient. A standardize protocol for programming aDBS will be crucial to ensuring its effective application in clinical practice.
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Affiliation(s)
- Kevin B. Wilkins
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Jillian A. Melbourne
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Pranav Akella
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Helen M. Bronte-Stewart
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, United States
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, United States
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Anjum MF, Smyth C, Dijk DJ, Starr P, Denison T, Little S. Multi-night cortico-basal recordings reveal mechanisms of NREM slow wave suppression and spontaneous awakenings at high-temporal resolution in Parkinson's disease. RESEARCH SQUARE 2023:rs.3.rs-3484527. [PMID: 37986864 PMCID: PMC10659541 DOI: 10.21203/rs.3.rs-3484527/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
Background Sleep disturbance is a prevalent and highly disabling comorbidity in individuals with Parkinson's disease (PD) that leads to worsening of daytime symptoms, reduced quality of life and accelerated disease progression. Objectives We aimed to record naturalistic overnight cortico-basal neural activity in people with PD, in order to determine the neurophysiology of spontaneous awakenings and slow wave suppression in non-rapid eye movement (NREM) sleep, towards the development of novel sleep-targeted neurostimulation therapies. Methods Multi-night (n=58) intracranial recordings were performed at-home, from chronic electrocorticography and subcortical electrodes, with sensing-enabled Deep Brain Stimulation (DBS), paired with portable polysomnography. Four participants with PD and one participant with cervical dystonia were evaluated to determine the neural structures, signals and functional connectivity modulated during NREM sleep and prior to spontaneous awakenings. Intracranial recordings were performed both ON and OFF DBS to evaluate the impact of stimulation. Sleep staging was then classified with machine-learning models using intracranial cortico-basal signals on classical (30 s) and rapid (5 s) timescales. Results We demonstrate an increase in cortico-basal slow wave delta (1-4 Hz) activity and a decrease in beta (13-31 Hz) activity during NREM (N2 and N3) versus wakefulness in PD. Cortical-basal ganglia coherence was also found to be higher in the delta range and lower in the beta range during NREM. DBS stimulation resulted in a further elevation in cortical delta and a decrease in alpha (8-13 Hz) and low beta (13-15 Hz) power compared to the OFF stimulation state. Within NREM sleep, we observed a strong inverse interaction between subcortical beta and cortical slow wave activity and found that subcortical beta increases prior to spontaneous awakenings at high-temporal resolution (5s). Our machine-learning models trained on intracranial cortical or subcortical power features achieved high accuracy in both traditional (30s) and rapid (5s) time windows for NREM vs. wakefulness classification (30s: 92.6±1.7%; 5s: 88.3±2.1%). Conclusions Chronic, multi-night recordings in PD reveal increased cortico-basal slow wave, decreased beta activity, and changes in functional connectivity in NREM vs wakefulness, effects that are enhanced in the presence of DBS. Within NREM, subcortical beta and cortical delta are strongly inversely correlated and subcortical beta power increases prior to spontaneous awakenings. Our findings elucidate the network-level neurophysiology of sleep dysfunction in PD and the mechanistic impact of conventional DBS. Additionally, through accurate machine-learning classification of spontaneous awakenings, this study also provides a foundation for future personalized adaptive DBS therapies for sleep dysfunction in PD.
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Affiliation(s)
- Md Fahim Anjum
- Movement Disorders and Neuromodulation Centre, University California San Francisco, CA, USA
| | - Clay Smyth
- Movement Disorders and Neuromodulation Centre, University California San Francisco, CA, USA
| | - Derk-Jan Dijk
- Surrey Sleep Research Centre, University of Surrey, Guildford, United Kingdom
- UK Dementia Research Institute, Care Research and Technology Centre at Imperial College, London and the University of Surrey, Guildford, United Kingdom
| | - Philip Starr
- Movement Disorders and Neuromodulation Centre, University California San Francisco, CA, USA
| | - Timothy Denison
- MRC Brain Network Dynamics Unit, University of Oxford, United Kingdom
| | - Simon Little
- Movement Disorders and Neuromodulation Centre, University California San Francisco, CA, USA
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Sil T, Hanafi I, Eldebakey H, Palmisano C, Volkmann J, Muthuraman M, Reich MM, Peach R. Wavelet-Based Bracketing, Time-Frequency Beta Burst Detection: New Insights in Parkinson's Disease. Neurotherapeutics 2023; 20:1767-1778. [PMID: 37819489 PMCID: PMC10684463 DOI: 10.1007/s13311-023-01447-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2023] [Indexed: 10/13/2023] Open
Abstract
Studies have shown that beta band activity is not tonically elevated but comprises exaggerated phasic bursts of varying durations and magnitudes, for Parkinson's disease (PD) patients. Current methods for detecting beta bursts target a single frequency peak in beta band, potentially ignoring bursts in the wider beta band. In this study, we propose a new robust framework for beta burst identification across wide frequency ranges. Chronic local field potential at-rest recordings were obtained from seven PD patients implanted with Medtronic SenSight™ deep brain stimulation (DBS) electrodes. The proposed method uses wavelet decomposition to compute the time-frequency spectrum and identifies bursts spanning multiple frequency bins by thresholding, offering an additional burst measure, ∆f, that captures the width of a burst in the frequency domain. Analysis included calculating burst duration, magnitude, and ∆f and evaluating the distribution and likelihood of bursts between the low beta (13-20 Hz) and high beta (21-35 Hz). Finally, the results of the analysis were correlated to motor impairment (MDS-UPDRS III) med off scores. We found that low beta bursts with longer durations and larger width in the frequency domain (∆f) were positively correlated, while high beta bursts with longer durations and larger ∆f were negatively correlated with motor impairment. The proposed method, finding clear differences between bursting behavior in high and low beta bands, has clearly demonstrated the importance of considering wide frequency bands for beta burst behavior with implications for closed-loop DBS paradigms.
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Affiliation(s)
- Tanmoy Sil
- Department of Neurology, University Hospital Würzburg (UKW), Josef-Schneider-Str. 11, 97080, Würzburg, Germany
| | - Ibrahem Hanafi
- Department of Neurology, University Hospital Würzburg (UKW), Josef-Schneider-Str. 11, 97080, Würzburg, Germany
| | - Hazem Eldebakey
- Department of Neurology, University Hospital Würzburg (UKW), Josef-Schneider-Str. 11, 97080, Würzburg, Germany
| | - Chiara Palmisano
- Department of Neurology, University Hospital Würzburg (UKW), Josef-Schneider-Str. 11, 97080, Würzburg, Germany
| | - Jens Volkmann
- Department of Neurology, University Hospital Würzburg (UKW), Josef-Schneider-Str. 11, 97080, Würzburg, Germany
| | - Muthuraman Muthuraman
- Department of Neurology, University Hospital Würzburg (UKW), Josef-Schneider-Str. 11, 97080, Würzburg, Germany.
| | - Martin M Reich
- Department of Neurology, University Hospital Würzburg (UKW), Josef-Schneider-Str. 11, 97080, Würzburg, Germany
| | - Robert Peach
- Department of Neurology, University Hospital Würzburg (UKW), Josef-Schneider-Str. 11, 97080, Würzburg, Germany
- Department of Brain Sciences, Imperial College London, London, UK
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Oehrn CR, Cernera S, Hammer LH, Shcherbakova M, Yao J, Hahn A, Wang S, Ostrem JL, Little S, Starr PA. Personalized chronic adaptive deep brain stimulation outperforms conventional stimulation in Parkinson's disease. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.08.03.23293450. [PMID: 37649907 PMCID: PMC10463549 DOI: 10.1101/2023.08.03.23293450] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
Deep brain stimulation is a widely used therapy for Parkinson's disease (PD) but currently lacks dynamic responsiveness to changing clinical and neural states. Feedback control has the potential to improve therapeutic effectiveness, but optimal control strategy and additional benefits of "adaptive" neurostimulation are unclear. We implemented adaptive subthalamic nucleus stimulation, controlled by subthalamic or cortical signals, in three PD patients (five hemispheres) during normal daily life. We identified neurophysiological biomarkers of residual motor fluctuations using data-driven analyses of field potentials over a wide frequency range and varying stimulation amplitudes. Narrowband gamma oscillations (65-70 Hz) at either site emerged as the best control signal for sensing during stimulation. A blinded, randomized trial demonstrated improved motor symptoms and quality of life compared to clinically optimized standard stimulation. Our approach highlights the promise of personalized adaptive neurostimulation based on data-driven selection of control signals and may be applied to other neurological disorders.
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Affiliation(s)
- Carina R Oehrn
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Stephanie Cernera
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Lauren H Hammer
- Department of Neurology, University of California, San Francisco, San Francisco, California, USA
| | - Maria Shcherbakova
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Jiaang Yao
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
- University of California, Berkeley - University of California, San Francisco Graduate Program in Bioengineering, Berkeley, CA, USA
| | - Amelia Hahn
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Sarah Wang
- Department of Neurology, University of California, San Francisco, San Francisco, California, USA
- Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Jill L Ostrem
- Department of Neurology, University of California, San Francisco, San Francisco, California, USA
- Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Simon Little
- Department of Neurology, University of California, San Francisco, San Francisco, California, USA
- University of California, Berkeley - University of California, San Francisco Graduate Program in Bioengineering, Berkeley, CA, USA
- Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Philip A Starr
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
- University of California, Berkeley - University of California, San Francisco Graduate Program in Bioengineering, Berkeley, CA, USA
- Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
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Bahador N, Saha J, Rezaei MR, Utpal S, Ghahremani A, Chen R, Lankarany M. Robust Removal of Slow Artifactual Dynamics Induced by Deep Brain Stimulation in Local Field Potential Recordings Using SVD-Based Adaptive Filtering. Bioengineering (Basel) 2023; 10:719. [PMID: 37370650 DOI: 10.3390/bioengineering10060719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 06/07/2023] [Accepted: 06/09/2023] [Indexed: 06/29/2023] Open
Abstract
Deep brain stimulation (DBS) is widely used as a treatment option for patients with movement disorders. In addition to its clinical impact, DBS has been utilized in the field of cognitive neuroscience, wherein the answers to several fundamental questions underpinning the mechanisms of neuromodulation in decision making rely on the ways in which a burst of DBS pulses, usually delivered at a clinical frequency, i.e., 130 Hz, perturb participants' choices. It was observed that neural activities recorded during DBS were contaminated with large artifacts, which lasts for a few milliseconds, as well as a low-frequency (slow) signal (~1-2 Hz) that can persist for hundreds of milliseconds. While the focus of most of methods for removing DBS artifacts was on the former, the artifact removal capabilities of the slow signal have not been addressed. In this work, we propose a new method based on combining singular value decomposition (SVD) and normalized adaptive filtering to remove both large (fast) and slow artifacts in local field potentials, recorded during a cognitive task in which bursts of DBS were utilized. Using synthetic data, we show that our proposed algorithm outperforms four commonly used techniques in the literature, namely, (1) normalized least mean square adaptive filtering, (2) optimal FIR Wiener filtering, (3) Gaussian model matching, and (4) moving average. The algorithm's capabilities are further demonstrated by its ability to effectively remove DBS artifacts in local field potentials recorded from the subthalamic nucleus during a verbal Stroop task, highlighting its utility in real-world applications.
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Affiliation(s)
- Nooshin Bahador
- Krembil Research Institute, University Health Network (UHN), 60 Leonard Ave, Toronto, ON M5T 0S8, Canada
- Institute of Biomedical Engineering (BME), University of Toronto, Toronto, ON M5S 2E8, Canada
| | - Josh Saha
- Krembil Research Institute, University Health Network (UHN), 60 Leonard Ave, Toronto, ON M5T 0S8, Canada
- Department of Electrical and Computer Engineering, University of Waterloo, Toronto, ON N2L 3G1, Canada
| | - Mohammad R Rezaei
- Krembil Research Institute, University Health Network (UHN), 60 Leonard Ave, Toronto, ON M5T 0S8, Canada
- Institute of Biomedical Engineering (BME), University of Toronto, Toronto, ON M5S 2E8, Canada
| | - Saha Utpal
- Krembil Research Institute, University Health Network (UHN), 60 Leonard Ave, Toronto, ON M5T 0S8, Canada
| | - Ayda Ghahremani
- Krembil Research Institute, University Health Network (UHN), 60 Leonard Ave, Toronto, ON M5T 0S8, Canada
- School of Medicine, Stanford University, Stanford, CA 94305, USA
| | - Robert Chen
- Krembil Research Institute, University Health Network (UHN), 60 Leonard Ave, Toronto, ON M5T 0S8, Canada
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, ON M5S 2E8, Canada
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network (UHN), Toronto, ON M5G 2A2, Canada
| | - Milad Lankarany
- Krembil Research Institute, University Health Network (UHN), 60 Leonard Ave, Toronto, ON M5T 0S8, Canada
- Institute of Biomedical Engineering (BME), University of Toronto, Toronto, ON M5S 2E8, Canada
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network (UHN), Toronto, ON M5G 2A2, Canada
- Department of Physiology, University of Toronto, Toronto, ON M5S 2E8, Canada
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10
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Satzer D, Wu S, Henry J, Doll E, Issa NP, Warnke PC. Ambulatory Local Field Potential Recordings from the Thalamus in Epilepsy: A Feasibility Study. Stereotact Funct Neurosurg 2023; 101:195-206. [PMID: 37232010 PMCID: PMC11227660 DOI: 10.1159/000529961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 02/24/2023] [Indexed: 05/27/2023]
Abstract
INTRODUCTION Stimulation of the thalamus is gaining favor in the treatment of medically refractory multifocal and generalized epilepsy. Implanted brain stimulators capable of recording ambulatory local field potentials (LFPs) have recently been introduced, but there is little information to guide their use in thalamic stimulation for epilepsy. This study sought to assess the feasibility of chronically recording ambulatory interictal LFP from the thalamus in patients with epilepsy. METHODS In this pilot study, ambulatory LFP was recorded from patients who underwent sensing-enabled deep brain stimulation (DBS, 2 participants) or responsive neurostimulation (RNS, 3 participants) targeting the anterior nucleus of the thalamus (ANT, 2 electrodes), centromedian nucleus (CM, 7 electrodes), or medial pulvinar (PuM, 1 electrode) for multifocal or generalized epilepsy. Time-domain and frequency-domain LFP was investigated for epileptiform discharges, spectral peaks, circadian variation, and peri-ictal patterns. RESULTS Thalamic interictal discharges were visible on ambulatory recordings from both DBS and RNS. At-home interictal frequency-domain data could be extracted from both devices. Spectral peaks were noted at 10-15 Hz in CM, 6-11 Hz in ANT, and 19-24 Hz in PuM but varied in prominence and were not visible in all electrodes. In CM, 10-15 Hz power exhibited circadian variation and was attenuated by eye opening. CONCLUSION Chronic ambulatory recording of thalamic LFP is feasible. Common spectral peaks can be observed but vary between electrodes and across neural states. DBS and RNS devices provide a wealth of complementary data that have the potential to better inform thalamic stimulation for epilepsy.
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Affiliation(s)
- David Satzer
- Department of Neurological Surgery, University of Chicago, Chicago, IL, USA
| | - Shasha Wu
- Department of Neurology, University of Chicago, Chicago, IL, USA
| | - Julia Henry
- Department of Pediatrics, Child Neurology Section, University of Chicago, Chicago, IL, USA
| | - Emily Doll
- Department of Pediatrics, Child Neurology Section, University of Chicago, Chicago, IL, USA
| | - Naoum P. Issa
- Department of Neurology, University of Chicago, Chicago, IL, USA
| | - Peter C. Warnke
- Department of Neurological Surgery, University of Chicago, Chicago, IL, USA
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11
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Liang YW, Lai ML, Chiu FM, Tseng HY, Lo YC, Li SJ, Chang CW, Chen PC, Chen YY. Experimental Verification for Numerical Simulation of Thalamic Stimulation-Evoked Calcium-Sensitive Fluorescence and Electrophysiology with Self-Assembled Multifunctional Optrode. BIOSENSORS 2023; 13:265. [PMID: 36832031 PMCID: PMC9953878 DOI: 10.3390/bios13020265] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 02/07/2023] [Accepted: 02/10/2023] [Indexed: 06/18/2023]
Abstract
Owing to its capacity to eliminate a long-standing methodological limitation, fiber photometry can assist research gaining novel insight into neural systems. Fiber photometry can reveal artifact-free neural activity under deep brain stimulation (DBS). Although evoking neural potential with DBS is an effective method for mediating neural activity and neural function, the relationship between DBS-evoked neural Ca2+ change and DBS-evoked neural electrophysiology remains unknown. Therefore, in this study, a self-assembled optrode was demonstrated as a DBS stimulator and an optical biosensor capable of concurrently recording Ca2+ fluorescence and electrophysiological signals. Before the in vivo experiment, the volume of tissue activated (VTA) was estimated, and the simulated Ca2+ signals were presented using Monte Carlo (MC) simulation to approach the realistic in vivo environment. When VTA and the simulated Ca2+ signals were combined, the distribution of simulated Ca2+ fluorescence signals matched the VTA region. In addition, the in vivo experiment revealed a correlation between the local field potential (LFP) and the Ca2+ fluorescence signal in the evoked region, revealing the relationship between electrophysiology and the performance of neural Ca2+ concentration behavior. Concurrent with the VTA volume, simulated Ca2+ intensity, and the in vivo experiment, these data suggested that the behavior of neural electrophysiology was consistent with the phenomenon of Ca2+ influx to neurons.
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Affiliation(s)
- Yao-Wen Liang
- Department of Biomedical Engineering, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
| | - Ming-Liang Lai
- Graduate Institute of Intellectual Property, National Taipei University of Technology, Taipei 10608, Taiwan
| | - Feng-Mao Chiu
- Department of Biomedical Engineering, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
| | - Hsin-Yi Tseng
- The Ph.D. Program in Medical Neuroscience, College of Medical Science and Technology, Taipei Medical University and National Health Research Institutes, Taipei 11031, Taiwan
| | - Yu-Chun Lo
- The Ph.D. Program in Medical Neuroscience, College of Medical Science and Technology, Taipei Medical University, Taipei 11031, Taiwan
| | - Ssu-Ju Li
- Department of Biomedical Engineering, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
| | - Ching-Wen Chang
- Department of Biomedical Engineering, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
| | - Po-Chuan Chen
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA
| | - You-Yin Chen
- Department of Biomedical Engineering, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
- The Ph.D. Program in Medical Neuroscience, College of Medical Science and Technology, Taipei Medical University, Taipei 11031, Taiwan
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12
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Stam MJ, van Wijk BCM, Sharma P, Beudel M, Piña-Fuentes DA, de Bie RMA, Schuurman PR, Neumann WJ, Buijink AWG. A comparison of methods to suppress electrocardiographic artifacts in local field potential recordings. Clin Neurophysiol 2023; 146:147-161. [PMID: 36543611 DOI: 10.1016/j.clinph.2022.11.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 10/06/2022] [Accepted: 11/15/2022] [Indexed: 12/03/2022]
Abstract
OBJECTIVE Local field potential (LFP) recordings from deep brain stimulation (DBS) electrodes are often contaminated with electrocardiographic (ECG) artifacts that hinder the detection of disease-specific electrical brain activity. METHODS Three ECG suppression methods were evaluated: (1) QRS interpolation of the Perceive toolbox, (2) template subtraction, and (3) singular value decomposition (SVD). LFPs were recorded with the Medtronic PerceptTM PC system in nine Parkinson's disease patients with stimulation OFF ("OFF-DBS"; anode disconnected) and ON at 0 mA ("ON-DBS 0 mA"; anode connected). Findings were verified with simulated ECG-contaminated time series. RESULTS ECG artifacts were present in 10 out of 18 ON-DBS 0 mA recordings. All ECG suppression methods drastically reduced artifact-induced beta band (13-35 Hz) power and at least partly recovered the beta peak and beta burst dynamics. Using external ECG recordings and lengthening artifact epoch length improved the performance of the suppression methods. Increasing epoch length, however, elevated the risk of flattening the beta peak and losing beta burst dynamics. CONCLUSIONS The SVD method formed the preferred trade-off between artifact cleaning and signal loss, as long as its parameter settings are adequately chosen. SIGNIFICANCE ECG suppression methods enable analysis of disease-specific neural activity from signals affected by ECG artifacts.
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Affiliation(s)
- M J Stam
- Department of Neurology, Amsterdam University Medical Centers, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, The Netherlands
| | - B C M van Wijk
- Department of Neurology, Amsterdam University Medical Centers, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, The Netherlands; Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - P Sharma
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany; Department of Electrical Engineering and Information Technology, Otto von Guericke University, Magdeburg, Germany
| | - M Beudel
- Department of Neurology, Amsterdam University Medical Centers, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, The Netherlands
| | - D A Piña-Fuentes
- Department of Neurology, Amsterdam University Medical Centers, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, The Netherlands
| | - R M A de Bie
- Department of Neurology, Amsterdam University Medical Centers, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, The Netherlands
| | - P R Schuurman
- Department of Neurosurgery, Amsterdam University Medical Centers, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, The Netherlands
| | - W-J Neumann
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - A W G Buijink
- Department of Neurology, Amsterdam University Medical Centers, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, The Netherlands.
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13
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Ding H, Volkmann J, Muthuraman M. Electrocardiographic artifact suppression in local field potentials. Clin Neurophysiol 2023; 146:133-134. [PMID: 36609098 DOI: 10.1016/j.clinph.2022.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 12/19/2022] [Indexed: 12/29/2022]
Affiliation(s)
- Hao Ding
- Department of Neurology, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Jens Volkmann
- Department of Neurology, Universitätsklinikum Würzburg, Würzburg, Germany
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14
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van Rheede JJ, Feldmann LK, Busch JL, Fleming JE, Mathiopoulou V, Denison T, Sharott A, Kühn AA. Diurnal modulation of subthalamic beta oscillatory power in Parkinson’s disease patients during deep brain stimulation. NPJ Parkinsons Dis 2022; 8:88. [PMID: 35804160 PMCID: PMC9270436 DOI: 10.1038/s41531-022-00350-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 06/10/2022] [Indexed: 11/09/2022] Open
Abstract
Beta-band activity in the subthalamic local field potential (LFP) is correlated with Parkinson’s disease (PD) symptom severity and is the therapeutic target of deep brain stimulation (DBS). While beta fluctuations in PD patients are well characterized on shorter timescales, it is not known how beta activity evolves around the diurnal cycle, outside a clinical setting. Here, we obtained chronic recordings (34 ± 13 days) of subthalamic beta power in PD patients implanted with the Percept DBS device during high-frequency DBS and analysed their diurnal properties as well as sensitivity to artifacts. Time of day explained 41 ± 9% of the variance in beta power (p < 0.001 in all patients), with increased beta during the day and reduced beta at night. Certain movements affected LFP quality, which may have contributed to diurnal patterns in some patients. Future DBS algorithms may benefit from taking such diurnal and artifactual fluctuations in beta power into account.
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15
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Alarie ME, Provenza NR, Avendano-Ortega M, McKay SA, Waite AS, Mathura RK, Herron JA, Sheth SA, Borton DA, Goodman WK. Artifact characterization and mitigation techniques during concurrent sensing and stimulation using bidirectional deep brain stimulation platforms. Front Hum Neurosci 2022; 16:1016379. [PMID: 36337849 PMCID: PMC9626519 DOI: 10.3389/fnhum.2022.1016379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 10/03/2022] [Indexed: 11/30/2022] Open
Abstract
Bidirectional deep brain stimulation (DBS) platforms have enabled a surge in hours of recordings in naturalistic environments, allowing further insight into neurological and psychiatric disease states. However, high amplitude, high frequency stimulation generates artifacts that contaminate neural signals and hinder our ability to interpret the data. This is especially true in psychiatric disorders, for which high amplitude stimulation is commonly applied to deep brain structures where the native neural activity is miniscule in comparison. Here, we characterized artifact sources in recordings from a bidirectional DBS platform, the Medtronic Summit RC + S, with the goal of optimizing recording configurations to improve signal to noise ratio (SNR). Data were collected from three subjects in a clinical trial of DBS for obsessive-compulsive disorder. Stimulation was provided bilaterally to the ventral capsule/ventral striatum (VC/VS) using two independent implantable neurostimulators. We first manipulated DBS amplitude within safe limits (2–5.3 mA) to characterize the impact of stimulation artifacts on neural recordings. We found that high amplitude stimulation produces slew overflow, defined as exceeding the rate of change that the analog to digital converter can accurately measure. Overflow led to expanded spectral distortion of the stimulation artifact, with a six fold increase in the bandwidth of the 150.6 Hz stimulation artifact from 147–153 to 140–180 Hz. By increasing sense blank values during high amplitude stimulation, we reduced overflow by as much as 30% and improved artifact distortion, reducing the bandwidth from 140–180 Hz artifact to 147–153 Hz. We also identified artifacts that shifted in frequency through modulation of telemetry parameters. We found that telemetry ratio changes led to predictable shifts in the center-frequencies of the associated artifacts, allowing us to proactively shift the artifacts outside of our frequency range of interest. Overall, the artifact characterization methods and results described here enable increased data interpretability and unconstrained biomarker exploration using data collected from bidirectional DBS devices.
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Affiliation(s)
| | - Nicole R. Provenza
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United States
| | - Michelle Avendano-Ortega
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
| | - Sarah A. McKay
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
| | - Ayan S. Waite
- Brown University School of Engineering, Providence, RI, United States
| | - Raissa K. Mathura
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United States
| | - Jeffrey A. Herron
- Department of Neurological Surgery, University of Washington, Seattle, WA, United States
| | - Sameer A. Sheth
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United States
| | - David A. Borton
- Brown University School of Engineering, Providence, RI, United States
- Department of Veterans Affairs, Center for Neurorestoration and Neurotechnology, Rehabilitation R&D Service, Providence, RI, United States
| | - Wayne K. Goodman
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
- *Correspondence: Wayne K. Goodman,
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16
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Sevcencu C. Single-interface bioelectronic medicines - concept, clinical applications and preclinical data. J Neural Eng 2022; 19. [PMID: 35533654 DOI: 10.1088/1741-2552/ac6e08] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 05/08/2022] [Indexed: 11/12/2022]
Abstract
Presently, large groups of patients with various diseases are either intolerant, or irresponsive to drug therapies and also intractable by surgery. For several diseases, one option which is available for such patients is the implantable neurostimulation therapy. However, lacking closed-loop control and selective stimulation capabilities, the present neurostimulation therapies are not optimal and are therefore used as only "third" therapeutic options when a disease cannot be treated by drugs or surgery. Addressing those limitations, a next generation class of closed-loop controlled and selective neurostimulators generically named bioelectronic medicines seems within reach. A sub-class of such devices is meant to monitor and treat impaired functions by intercepting, analyzing and modulating neural signals involved in the regulation of such functions using just one neural interface for those purposes. The primary objective of this review is to provide a first broad perspective on this type of single-interface devices for bioelectronic therapies. For this purpose, the concept, clinical applications and preclinical studies for further developments with such devices are here analyzed in a narrative manner.
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Affiliation(s)
- Cristian Sevcencu
- National Institute for Research and Development of Isotopic and Molecular Technologies, 67-103 Donat Street, Cluj-Napoca, 400293, ROMANIA
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