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Alfihed S, Majrashi M, Ansary M, Alshamrani N, Albrahim SH, Alsolami A, Alamari HA, Zaman A, Almutairi D, Kurdi A, Alzaydi MM, Tabbakh T, Al-Otaibi F. Non-Invasive Brain Sensing Technologies for Modulation of Neurological Disorders. BIOSENSORS 2024; 14:335. [PMID: 39056611 PMCID: PMC11274405 DOI: 10.3390/bios14070335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Revised: 07/01/2024] [Accepted: 07/06/2024] [Indexed: 07/28/2024]
Abstract
The non-invasive brain sensing modulation technology field is experiencing rapid development, with new techniques constantly emerging. This study delves into the field of non-invasive brain neuromodulation, a safer and potentially effective approach for treating a spectrum of neurological and psychiatric disorders. Unlike traditional deep brain stimulation (DBS) surgery, non-invasive techniques employ ultrasound, electrical currents, and electromagnetic field stimulation to stimulate the brain from outside the skull, thereby eliminating surgery risks and enhancing patient comfort. This study explores the mechanisms of various modalities, including transcranial direct current stimulation (tDCS) and transcranial magnetic stimulation (TMS), highlighting their potential to address chronic pain, anxiety, Parkinson's disease, and depression. We also probe into the concept of closed-loop neuromodulation, which personalizes stimulation based on real-time brain activity. While we acknowledge the limitations of current technologies, our study concludes by proposing future research avenues to advance this rapidly evolving field with its immense potential to revolutionize neurological and psychiatric care and lay the foundation for the continuing advancement of innovative non-invasive brain sensing technologies.
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Affiliation(s)
- Salman Alfihed
- Microelectronics and Semiconductor Institute, King Abdulaziz City for Science and Technology (KACST), Riyadh 11442, Saudi Arabia; (S.A.)
| | - Majed Majrashi
- Bioengineering Institute, King Abdulaziz City for Science and Technology (KACST), Riyadh 11442, Saudi Arabia
| | - Muhammad Ansary
- Neuroscience Center Research Unit, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia
| | - Naif Alshamrani
- Microelectronics and Semiconductor Institute, King Abdulaziz City for Science and Technology (KACST), Riyadh 11442, Saudi Arabia; (S.A.)
| | - Shahad H. Albrahim
- Bioengineering Institute, King Abdulaziz City for Science and Technology (KACST), Riyadh 11442, Saudi Arabia
| | - Abdulrahman Alsolami
- Microelectronics and Semiconductor Institute, King Abdulaziz City for Science and Technology (KACST), Riyadh 11442, Saudi Arabia; (S.A.)
| | - Hala A. Alamari
- Bioengineering Institute, King Abdulaziz City for Science and Technology (KACST), Riyadh 11442, Saudi Arabia
| | - Adnan Zaman
- Microelectronics and Semiconductor Institute, King Abdulaziz City for Science and Technology (KACST), Riyadh 11442, Saudi Arabia; (S.A.)
| | - Dhaifallah Almutairi
- Microelectronics and Semiconductor Institute, King Abdulaziz City for Science and Technology (KACST), Riyadh 11442, Saudi Arabia; (S.A.)
| | - Abdulaziz Kurdi
- Advanced Materials Institute, King Abdulaziz City for Science and Technology (KACST), Riyadh 11442, Saudi Arabia;
| | - Mai M. Alzaydi
- Bioengineering Institute, King Abdulaziz City for Science and Technology (KACST), Riyadh 11442, Saudi Arabia
| | - Thamer Tabbakh
- Microelectronics and Semiconductor Institute, King Abdulaziz City for Science and Technology (KACST), Riyadh 11442, Saudi Arabia; (S.A.)
| | - Faisal Al-Otaibi
- Neuroscience Center Research Unit, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia
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2
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Breeze J, Whitford A, Gensheimer WG, Berg C. Physiological and radiological parameters predicting outcome from penetrating traumatic brain injury treated in the deployed military setting. BMJ Mil Health 2024; 170:228-231. [PMID: 36028282 DOI: 10.1136/military-2022-002118] [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: 03/16/2022] [Accepted: 08/07/2022] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Penetrating traumatic brain injury (TBI) is the most common cause of death in current military conflicts, and results in significant morbidity in survivors. Identifying those physiological and radiological parameters associated with worse clinical outcomes following penetrating TBI in the austere setting may assist military clinicians to provide optimal care. METHOD All emergency neurosurgical procedures performed at a Role 3 Medical Treatment Facility in Afghanistan for penetrating TBI between 01 January 2016 and 18 December 2020 were analysed. The odds of certain clinical outcomes (death and functional dependence post-discharge) occurring following surgery were matched to existing agreed preoperative variables described in current US and UK military guidelines. Additional physiological and radiological variables including those comprising the Rotterdam criteria of TBI used in civilian settings were additionally analysed to determine their potential utility in a military austere setting. RESULTS 55 casualties with penetrating TBI underwent surgery, all either by decompressive craniectomy (n=42) or craniotomy±elevation of skull fragments (n=13). The odds of dying in hospital attributable to TBI were greater with casualties with increased glucose on arrival (OR=70.014, CI=3.0399 to 1612.528, OR=70.014, p=0.008) or a mean arterial pressure <90 mm Hg (OR=4.721, CI=0.969 to 22.979, p=0.049). Preoperative hyperglycaemia was also associated with increased odds of being functionally dependent on others on discharge (OR=11.165, CI=1.905 to 65.427, p=0.007). Bihemispheric injury had greater odds of being functionally dependent on others at discharge (OR=5.275, CI=1.094 to 25.433, p=0.038). CONCLUSIONS We would recommend that consideration of these three additional preoperative clinical parameters (hyperglycaemia, hypotension and bihemispheric injury on CT) when managing penetrating TBI be considered in future updates of guidelines for deployed neurosurgical care.
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Affiliation(s)
- John Breeze
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK
- Department of Bioengineering, Imperial College London, London, UK
| | - A Whitford
- Gaza Barracks, Joint Hospital Group, Catterick, UK
| | - W G Gensheimer
- Warfighter Eye Center, Malcolm Grow Medical Clinics and Surgery Center Joint Base Andrews, Prince George's County, Maryland, USA
| | - C Berg
- Department of Neurosurgery, Wright-Patterson Air Force Base, Dayton, Ohio, USA
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Quan Z, Li Y, Wang S. Multi-timescale neuromodulation strategy for closed-loop deep brain stimulation in Parkinson's disease. J Neural Eng 2024; 21:036006. [PMID: 38653252 DOI: 10.1088/1741-2552/ad4210] [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: 02/01/2024] [Accepted: 04/23/2024] [Indexed: 04/25/2024]
Abstract
Objective.Beta triggered closed-loop deep brain stimulation (DBS) shows great potential for improving the efficacy while reducing side effect for Parkinson's disease. However, there remain great challenges due to the dynamics and stochasticity of neural activities. In this study, we aimed to tune the amplitude of beta oscillations with different time scales taking into account influence of inherent variations in the basal ganglia-thalamus-cortical circuit.Approach. A dynamic basal ganglia-thalamus-cortical mean-field model was established to emulate the medication rhythm. Then, a dynamic target model was designed to embody the multi-timescale dynamic of beta power with milliseconds, seconds and minutes. Moreover, we proposed a closed-loop DBS strategy based on a proportional-integral-differential (PID) controller with the dynamic control target. In addition, the bounds of stimulation amplitude increments and different parameters of the dynamic target were considered to meet the clinical constraints. The performance of the proposed closed-loop strategy, including beta power modulation accuracy, mean stimulation amplitude, and stimulation variation were calculated to determine the PID parameters and evaluate neuromodulation performance in the computational dynamic mean-field model.Main results. The Results show that the dynamic basal ganglia-thalamus-cortical mean-field model simulated the medication rhythm with the fasted and the slowest rate. The dynamic control target reflected the temporal variation in beta power from milliseconds to minutes. With the proposed closed-loop strategy, the beta power tracked the dynamic target with a smoother stimulation sequence compared with closed-loop DBS with the constant target. Furthermore, the beta power could be modulated to track the control target under different long-term targets, modulation strengths, and bounds of the stimulation increment.Significance. This work provides a new method of closed-loop DBS for multi-timescale beta power modulation with clinical constraints.
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Affiliation(s)
- Zhaoyu Quan
- Academy for Engineering and Technology, Fudan University, Shanghai, People's Republic of China
- Shanghai Engineering Research Center of AI & Robotics, Fudan University, Shanghai, People's Republic of China
- Engineering Research Center of AI & Robotics, Ministry of Education, Fudan University, Shanghai, People's Republic of China
| | - Yan Li
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, People's Republic of China
- Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence (Fudan University), Shanghai, Ministry of Education, People's Republic of China
- MOE Frontiers Center for Brain Science, Fudan University, Shanghai, People's Republic of China
- Zhangjiang Fudan International Innovation Center, Shanghai, People's Republic of China
| | - Shouyan Wang
- Shanghai Engineering Research Center of AI & Robotics, Fudan University, Shanghai, People's Republic of China
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, People's Republic of China
- Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence (Fudan University), Shanghai, Ministry of Education, People's Republic of China
- MOE Frontiers Center for Brain Science, Fudan University, Shanghai, People's Republic of China
- Zhangjiang Fudan International Innovation Center, Shanghai, People's Republic of China
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Tian Y, Saradhi S, Bello E, Johnson MD, D’Eleuterio G, Popovic MR, Lankarany M. Model-based closed-loop control of thalamic deep brain stimulation. FRONTIERS IN NETWORK PHYSIOLOGY 2024; 4:1356653. [PMID: 38650608 PMCID: PMC11033853 DOI: 10.3389/fnetp.2024.1356653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 03/18/2024] [Indexed: 04/25/2024]
Abstract
Introduction: Closed-loop control of deep brain stimulation (DBS) is beneficial for effective and automatic treatment of various neurological disorders like Parkinson's disease (PD) and essential tremor (ET). Manual (open-loop) DBS programming solely based on clinical observations relies on neurologists' expertise and patients' experience. Continuous stimulation in open-loop DBS may decrease battery life and cause side effects. On the contrary, a closed-loop DBS system uses a feedback biomarker/signal to track worsening (or improving) of patients' symptoms and offers several advantages compared to the open-loop DBS system. Existing closed-loop DBS control systems do not incorporate physiological mechanisms underlying DBS or symptoms, e.g., how DBS modulates dynamics of synaptic plasticity. Methods: In this work, we propose a computational framework for development of a model-based DBS controller where a neural model can describe the relationship between DBS and neural activity and a polynomial-based approximation can estimate the relationship between neural and behavioral activities. A controller is used in our model in a quasi-real-time manner to find DBS patterns that significantly reduce the worsening of symptoms. By using the proposed computational framework, these DBS patterns can be tested clinically by predicting the effect of DBS before delivering it to the patient. We applied this framework to the problem of finding optimal DBS frequencies for essential tremor given electromyography (EMG) recordings solely. Building on our recent network model of ventral intermediate nuclei (Vim), the main surgical target of the tremor, in response to DBS, we developed neural model simulation in which physiological mechanisms underlying Vim-DBS are linked to symptomatic changes in EMG signals. By using a proportional-integral-derivative (PID) controller, we showed that a closed-loop system can track EMG signals and adjust the stimulation frequency of Vim-DBS so that the power of EMG reaches a desired control target. Results and discussion: We demonstrated that the model-based DBS frequency aligns well with that used in clinical studies. Our model-based closed-loop system is adaptable to different control targets and can potentially be used for different diseases and personalized systems.
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Affiliation(s)
- Yupeng Tian
- Krembil Brain Institute—University Health Network, Toronto, ON, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
- KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, Toronto, ON, Canada
| | - Srikar Saradhi
- Krembil Brain Institute—University Health Network, Toronto, ON, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - Edward Bello
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, United States
| | - Matthew D. Johnson
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, United States
| | | | - Milos R. Popovic
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
- KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, Toronto, ON, Canada
- Center for Advancing Neurotechnological Innovation to Application, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Milad Lankarany
- Krembil Brain Institute—University Health Network, Toronto, ON, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
- KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, Toronto, ON, Canada
- Center for Advancing Neurotechnological Innovation to Application, University Health Network and University of Toronto, Toronto, ON, Canada
- Department of Physiology, University of Toronto, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
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Leite de Castro D, Aroso M, Aguiar AP, Grayden DB, Aguiar P. Disrupting abnormal neuronal oscillations with adaptive delayed feedback control. eLife 2024; 13:e89151. [PMID: 38450635 PMCID: PMC10987087 DOI: 10.7554/elife.89151] [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: 05/05/2023] [Accepted: 03/05/2024] [Indexed: 03/08/2024] Open
Abstract
Closed-loop neuronal stimulation has a strong therapeutic potential for neurological disorders such as Parkinson's disease. However, at the moment, standard stimulation protocols rely on continuous open-loop stimulation and the design of adaptive controllers is an active field of research. Delayed feedback control (DFC), a popular method used to control chaotic systems, has been proposed as a closed-loop technique for desynchronisation of neuronal populations but, so far, was only tested in computational studies. We implement DFC for the first time in neuronal populations and access its efficacy in disrupting unwanted neuronal oscillations. To analyse in detail the performance of this activity control algorithm, we used specialised in vitro platforms with high spatiotemporal monitoring/stimulating capabilities. We show that the conventional DFC in fact worsens the neuronal population oscillatory behaviour, which was never reported before. Conversely, we present an improved control algorithm, adaptive DFC (aDFC), which monitors the ongoing oscillation periodicity and self-tunes accordingly. aDFC effectively disrupts collective neuronal oscillations restoring a more physiological state. Overall, these results support aDFC as a better candidate for therapeutic closed-loop brain stimulation.
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Affiliation(s)
- Domingos Leite de Castro
- Neuroengineering and Computational Neuroscience Lab, i3S - Instituto de Investigação e Inovação em Saúde, Universidade do PortoPortoPortugal
- Faculdade de Engenharia, Universidade do PortoPortoPortugal
| | - Miguel Aroso
- Neuroengineering and Computational Neuroscience Lab, i3S - Instituto de Investigação e Inovação em Saúde, Universidade do PortoPortoPortugal
| | - A Pedro Aguiar
- Faculdade de Engenharia, Universidade do PortoPortoPortugal
| | - David B Grayden
- Department of Biomedical Engineering, University of MelbourneMelbourneAustralia
| | - Paulo Aguiar
- Neuroengineering and Computational Neuroscience Lab, i3S - Instituto de Investigação e Inovação em Saúde, Universidade do PortoPortoPortugal
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Siddique MAB, Zhang Y, An H. Monitoring time domain characteristics of Parkinson's disease using 3D memristive neuromorphic system. Front Comput Neurosci 2023; 17:1274575. [PMID: 38162516 PMCID: PMC10754992 DOI: 10.3389/fncom.2023.1274575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 11/06/2023] [Indexed: 01/03/2024] Open
Abstract
Introduction Parkinson's disease (PD) is a neurodegenerative disorder affecting millions of patients. Closed-Loop Deep Brain Stimulation (CL-DBS) is a therapy that can alleviate the symptoms of PD. The CL-DBS system consists of an electrode sending electrical stimulation signals to a specific region of the brain and a battery-powered stimulator implanted in the chest. The electrical stimuli in CL-DBS systems need to be adjusted in real-time in accordance with the state of PD symptoms. Therefore, fast and precise monitoring of PD symptoms is a critical function for CL-DBS systems. However, the current CL-DBS techniques suffer from high computational demands for real-time PD symptom monitoring, which are not feasible for implanted and wearable medical devices. Methods In this paper, we present an energy-efficient neuromorphic PD symptom detector using memristive three-dimensional integrated circuits (3D-ICs). The excessive oscillation at beta frequencies (13-35 Hz) at the subthalamic nucleus (STN) is used as a biomarker of PD symptoms. Results Simulation results demonstrate that our neuromorphic PD detector, implemented with an 8-layer spiking Long Short-Term Memory (S-LSTM), excels in recognizing PD symptoms, achieving a training accuracy of 99.74% and a validation accuracy of 99.52% for a 75%-25% data split. Furthermore, we evaluated the improvement of our neuromorphic CL-DBS detector using NeuroSIM. The chip area, latency, energy, and power consumption of our CL-DBS detector were reduced by 47.4%, 66.63%, 65.6%, and 67.5%, respectively, for monolithic 3D-ICs. Similarly, for heterogeneous 3D-ICs, employing memristive synapses to replace traditional Static Random Access Memory (SRAM) resulted in reductions of 44.8%, 64.75%, 65.28%, and 67.7% in chip area, latency, and power usage. Discussion This study introduces a novel approach for PD symptom evaluation by directly utilizing spiking signals from neural activities in the time domain. This method significantly reduces the time and energy required for signal conversion compared to traditional frequency domain approaches. The study pioneers the use of neuromorphic computing and memristors in designing CL-DBS systems, surpassing SRAM-based designs in chip design area, latency, and energy efficiency. Lastly, the proposed neuromorphic PD detector demonstrates high resilience to timing variations in brain neural signals, as confirmed by robustness analysis.
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Affiliation(s)
- Md Abu Bakr Siddique
- Department of Electrical and Computer Engineering, Michigan Technological University, Houghton, MI, United States
| | - Yan Zhang
- Department of Biological Sciences, Michigan Technological University, Houghton, MI, United States
| | - Hongyu An
- Department of Electrical and Computer Engineering, Michigan Technological University, Houghton, MI, United States
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7
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Won SM, Cai L, Gutruf P, Rogers JA. Wireless and battery-free technologies for neuroengineering. Nat Biomed Eng 2023; 7:405-423. [PMID: 33686282 PMCID: PMC8423863 DOI: 10.1038/s41551-021-00683-3] [Citation(s) in RCA: 96] [Impact Index Per Article: 96.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 12/28/2020] [Indexed: 12/16/2022]
Abstract
Tethered and battery-powered devices that interface with neural tissues can restrict natural motions and prevent social interactions in animal models, thereby limiting the utility of these devices in behavioural neuroscience research. In this Review Article, we discuss recent progress in the development of miniaturized and ultralightweight devices as neuroengineering platforms that are wireless, battery-free and fully implantable, with capabilities that match or exceed those of wired or battery-powered alternatives. Such classes of advanced neural interfaces with optical, electrical or fluidic functionality can also combine recording and stimulation modalities for closed-loop applications in basic studies or in the practical treatment of abnormal physiological processes.
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Affiliation(s)
- Sang Min Won
- Department of Electrical and Computer Engineering, Sungkyunkwan University, Suwon, South Korea
| | - Le Cai
- Biomedical Engineering, College of Engineering, The University of Arizona, Tucson, AZ, USA
| | - Philipp Gutruf
- Biomedical Engineering, College of Engineering, The University of Arizona, Tucson, AZ, USA.
- Bio5 Institute and Neuroscience GIDP, University of Arizona, Tucson, AZ, USA.
- Department of Electrical and Computer Engineering, University of Arizona, Tucson, AZ, USA.
| | - John A Rogers
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL, USA.
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL, USA.
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA.
- Center for Advanced Molecular Imaging, Northwestern University, Evanston, IL, USA.
- Department of Mechanical Engineering, Northwestern University, Evanston, IL, USA.
- Department of Chemistry, Northwestern University, Evanston, IL, USA.
- Department of Neurological Surgery, Northwestern University, Evanston, IL, USA.
- Department of Electrical and Computer Engineering, Northwestern University, Evanston, IL, USA.
- Simpson Querrey Institute for BioNanotechnology, Northwestern University, Evanston, IL, USA.
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8
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A wearable platform for closed-loop stimulation and recording of single-neuron and local field potential activity in freely moving humans. Nat Neurosci 2023; 26:517-527. [PMID: 36804647 PMCID: PMC9991917 DOI: 10.1038/s41593-023-01260-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 01/17/2023] [Indexed: 02/22/2023]
Abstract
Advances in technologies that can record and stimulate deep brain activity in humans have led to impactful discoveries within the field of neuroscience and contributed to the development of novel therapies for neurological and psychiatric disorders. Further progress, however, has been hindered by device limitations in that recording of single-neuron activity during freely moving behaviors in humans has not been possible. Additionally, implantable neurostimulation devices, currently approved for human use, have limited stimulation programmability and restricted full-duplex bidirectional capability. In this study, we developed a wearable bidirectional closed-loop neuromodulation system (Neuro-stack) and used it to record single-neuron and local field potential activity during stationary and ambulatory behavior in humans. Together with a highly flexible and customizable stimulation capability, the Neuro-stack provides an opportunity to investigate the neurophysiological basis of disease, develop improved responsive neuromodulation therapies, explore brain function during naturalistic behaviors in humans and, consequently, bridge decades of neuroscientific findings across species.
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9
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Xue J, Wu Y, Bao Y, Zhao M, Li F, Sun J, Sun Y, Wang J, Chen L, Mao Y, Schweitzer JS, Song B. Clinical considerations in Parkinson's disease cell therapy. Ageing Res Rev 2023; 83:101792. [PMID: 36402405 DOI: 10.1016/j.arr.2022.101792] [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: 06/18/2022] [Revised: 11/13/2022] [Accepted: 11/13/2022] [Indexed: 11/18/2022]
Abstract
Cell replacement therapy is an area of increasing interest for treating Parkinson's disease (PD). However, to become a clinically practical option for PD patients, it must first overcome significant barriers, including establishment of safe and standardized surgical procedures, determination of appropriate perioperative medication regimens, demonstration of long-term graft survival and incorporation, and standardized, clinically meaningful follow-up measures. In this review, we will describe the current status of cell therapy for PD with special attention to these critical requirements, to define guideposts on the road to bring the benefit of this therapy to the Parkinson's clinic.
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Affiliation(s)
- Jun Xue
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai 200040, China; National Center for Neurological Disorders, Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Neurosurgical Institute of Fudan University, Shanghai Clinical Medical Center of Neurosurgery, Shanghai 200040, China
| | - Yifan Wu
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai 200040, China; National Center for Neurological Disorders, Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Neurosurgical Institute of Fudan University, Shanghai Clinical Medical Center of Neurosurgery, Shanghai 200040, China
| | - Yuting Bao
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai 200040, China; National Center for Neurological Disorders, Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Neurosurgical Institute of Fudan University, Shanghai Clinical Medical Center of Neurosurgery, Shanghai 200040, China
| | - Minglai Zhao
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai 200040, China; National Center for Neurological Disorders, Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Neurosurgical Institute of Fudan University, Shanghai Clinical Medical Center of Neurosurgery, Shanghai 200040, China
| | - Fangzhou Li
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai 200040, China; National Center for Neurological Disorders, Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Neurosurgical Institute of Fudan University, Shanghai Clinical Medical Center of Neurosurgery, Shanghai 200040, China
| | - Jing Sun
- Institute for Translational Brain Research, State Key Laboratory of Medical Neurobiology, MOE Frontiers Center for Brain Science, Fudan University, Shanghai 200032, China
| | - Yimin Sun
- Institute of Neurology, National Clinical Research Center for Aging and Medicine, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Jian Wang
- Institute of Neurology, National Clinical Research Center for Aging and Medicine, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Liang Chen
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai 200040, China; National Center for Neurological Disorders, Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Neurosurgical Institute of Fudan University, Shanghai Clinical Medical Center of Neurosurgery, Shanghai 200040, China
| | - Ying Mao
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai 200040, China; National Center for Neurological Disorders, Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Neurosurgical Institute of Fudan University, Shanghai Clinical Medical Center of Neurosurgery, Shanghai 200040, China.
| | - Jeffrey S Schweitzer
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
| | - Bin Song
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai 200040, China; Institute for Translational Brain Research, State Key Laboratory of Medical Neurobiology, MOE Frontiers Center for Brain Science, Fudan University, Shanghai 200032, China.
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10
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Baloglu O, Latifi SQ, Nazha A. What is machine learning? Arch Dis Child Educ Pract Ed 2022; 107:386-388. [PMID: 33558304 DOI: 10.1136/archdischild-2020-319415] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 12/28/2020] [Accepted: 01/20/2021] [Indexed: 11/03/2022]
Affiliation(s)
- Orkun Baloglu
- Department of Pediatric Critical Care Medicine, Cleveland Clinic Children's, Cleveland Clinic, Cleveland, Ohio, USA .,Cleveland Clinic Children's Center for Artificial Intelligence, Cleveland, Ohio, USA
| | - Samir Q Latifi
- Department of Pediatric Critical Care Medicine, Cleveland Clinic Children's, Cleveland Clinic, Cleveland, Ohio, USA.,Cleveland Clinic Children's Center for Artificial Intelligence, Cleveland, Ohio, USA
| | - Aziz Nazha
- Department of Medical Hematology and Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
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11
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Han M, Karatum O, Nizamoglu S. Optoelectronic Neural Interfaces Based on Quantum Dots. ACS APPLIED MATERIALS & INTERFACES 2022; 14:20468-20490. [PMID: 35482955 PMCID: PMC9100496 DOI: 10.1021/acsami.1c25009] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 04/15/2022] [Indexed: 05/26/2023]
Abstract
Optoelectronic modulation of neural activity is an emerging field for the investigation of neural circuits and the development of neural therapeutics. Among a wide variety of nanomaterials, colloidal quantum dots provide unique optoelectronic features for neural interfaces such as sensitive tuning of electron and hole energy levels via the quantum confinement effect, controlling the carrier localization via band alignment, and engineering the surface by shell growth and ligand engineering. Even though colloidal quantum dots have been frontier nanomaterials for solar energy harvesting and lighting, their application to optoelectronic neural interfaces has remained below their significant potential. However, this potential has recently gained attention with the rise of bioelectronic medicine. In this review, we unravel the fundamentals of quantum-dot-based optoelectronic biointerfaces and discuss their neuromodulation mechanisms starting from the quantum dot level up to electrode-electrolyte interactions and stimulation of neurons with their physiological pathways. We conclude the review by proposing new strategies and possible perspectives toward nanodevices for the optoelectronic stimulation of neural tissue by utilizing the exceptional nanoscale properties of colloidal quantum dots.
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Affiliation(s)
- Mertcan Han
- Department
of Electrical and Electronics Engineering, Koç University, Istanbul 34450, Turkey
| | - Onuralp Karatum
- Department
of Electrical and Electronics Engineering, Koç University, Istanbul 34450, Turkey
| | - Sedat Nizamoglu
- Department
of Electrical and Electronics Engineering, Koç University, Istanbul 34450, Turkey
- Graduate
School of Biomedical Science and Engineering, Koç University, Istanbul 34450, Turkey
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12
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Zamora M, Toth R, Morgante F, Ottaway J, Gillbe T, Martin S, Lamb G, Noone T, Benjaber M, Nairac Z, Sehgal D, Constandinou TG, Herron J, Aziz TZ, Gillbe I, Green AL, Pereira EAC, Denison T. DyNeuMo Mk-1: Design and pilot validation of an investigational motion-adaptive neurostimulator with integrated chronotherapy. Exp Neurol 2022; 351:113977. [PMID: 35016994 PMCID: PMC7612891 DOI: 10.1016/j.expneurol.2022.113977] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 12/20/2021] [Accepted: 01/06/2022] [Indexed: 11/19/2022]
Abstract
There is growing interest in using adaptive neuromodulation to provide a more personalized therapy experience that might improve patient outcomes. Current implant technology, however, can be limited in its adaptive algorithm capability. To enable exploration of adaptive algorithms with chronic implants, we designed and validated the 'Picostim DyNeuMo Mk-1' (DyNeuMo Mk-1 for short), a fully-implantable, adaptive research stimulator that titrates stimulation based on circadian rhythms (e.g. sleep, wake) and the patient's movement state (e.g. posture, activity, shock, free-fall). The design leverages off-the-shelf consumer technology that provides inertial sensing with low-power, high reliability, and relatively modest cost. The DyNeuMo Mk-1 system was designed, manufactured and verified using ISO 13485 design controls, including ISO 14971 risk management techniques to ensure patient safety, while enabling novel algorithms. The system was validated for an intended use case in movement disorders under an emergency-device authorization from the Medicines and Healthcare Products Regulatory Agency (MHRA). The algorithm configurability and expanded stimulation parameter space allows for a number of applications to be explored in both central and peripheral applications. Intended applications include adaptive stimulation for movement disorders, synchronizing stimulation with circadian patterns, and reacting to transient inertial events such as posture changes, general activity, and walking. With appropriate design controls in place, first-in-human research trials are now being prepared to explore the utility of automated motion-adaptive algorithms.
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Affiliation(s)
- Mayela Zamora
- Institute of Biomedical Engineering, Department of Engineering Sciences, University of Oxford, Oxford, United Kingdom; MRC Brain Network Dynamics Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom.
| | - Robert Toth
- MRC Brain Network Dynamics Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Francesca Morgante
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's, University of London, London, United Kingdom; Department of Neurosurgery, Atkinson Morley Regional Neurosciences Centre, St George's Hospital, London, United Kingdom
| | | | - Tom Gillbe
- Bioinduction Ltd., Bristol, United Kingdom
| | - Sean Martin
- Department of Neurosurgery, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Guy Lamb
- Bioinduction Ltd., Bristol, United Kingdom
| | - Tara Noone
- Bioinduction Ltd., Bristol, United Kingdom
| | - Moaad Benjaber
- Institute of Biomedical Engineering, Department of Engineering Sciences, University of Oxford, Oxford, United Kingdom; MRC Brain Network Dynamics Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Zachary Nairac
- Institute of Biomedical Engineering, Department of Engineering Sciences, University of Oxford, Oxford, United Kingdom
| | - Devang Sehgal
- Institute of Biomedical Engineering, Department of Engineering Sciences, University of Oxford, Oxford, United Kingdom
| | - Timothy G Constandinou
- Department of Electrical and Electronic Engineering, Imperial College London, London, United Kingdom; Care Research and Technology Centre, UK Dementia Research Institute, London, United Kingdom
| | - Jeffrey Herron
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA
| | - Tipu Z Aziz
- Department of Neurosurgery, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | | | - Alexander L Green
- Department of Neurosurgery, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Erlick A C Pereira
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's, University of London, London, United Kingdom; Department of Neurosurgery, Atkinson Morley Regional Neurosciences Centre, St George's Hospital, London, United Kingdom
| | - Timothy Denison
- Institute of Biomedical Engineering, Department of Engineering Sciences, University of Oxford, Oxford, United Kingdom; MRC Brain Network Dynamics Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom.
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13
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Frey J, Cagle J, Johnson KA, Wong JK, Hilliard JD, Butson CR, Okun MS, de Hemptinne C. Past, Present, and Future of Deep Brain Stimulation: Hardware, Software, Imaging, Physiology and Novel Approaches. Front Neurol 2022; 13:825178. [PMID: 35356461 PMCID: PMC8959612 DOI: 10.3389/fneur.2022.825178] [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: 11/30/2021] [Accepted: 02/04/2022] [Indexed: 11/13/2022] Open
Abstract
Deep brain stimulation (DBS) has advanced treatment options for a variety of neurologic and neuropsychiatric conditions. As the technology for DBS continues to progress, treatment efficacy will continue to improve and disease indications will expand. Hardware advances such as longer-lasting batteries will reduce the frequency of battery replacement and segmented leads will facilitate improvements in the effectiveness of stimulation and have the potential to minimize stimulation side effects. Targeting advances such as specialized imaging sequences and “connectomics” will facilitate improved accuracy for lead positioning and trajectory planning. Software advances such as closed-loop stimulation and remote programming will enable DBS to be a more personalized and accessible technology. The future of DBS continues to be promising and holds the potential to further improve quality of life. In this review we will address the past, present and future of DBS.
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Affiliation(s)
- Jessica Frey
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Jackson Cagle
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Kara A. Johnson
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Joshua K. Wong
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Justin D. Hilliard
- Department of Neurosurgery, University of Florida, Gainesville, FL, United States
| | - Christopher R. Butson
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
- Department of Neurosurgery, University of Florida, Gainesville, FL, United States
| | - Michael S. Okun
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Coralie de Hemptinne
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
- *Correspondence: Coralie de Hemptinne
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14
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Tian H, Xu K, Zou L, Fang Y. Multimodal neural probes for combined optogenetics and electrophysiology. iScience 2022; 25:103612. [PMID: 35106461 PMCID: PMC8786639 DOI: 10.1016/j.isci.2021.103612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
To understand how brain functions arise from interconnected neural networks, it is necessary to develop tools that can allow simultaneous manipulation and recording of neural activities. Multimodal neural probes, especially those that combine optogenetics with electrophysiology, provide a powerful tool for the dissection of neural circuit functions and understanding of brain diseases. In this review, we provide an overview of recent developments in multimodal neural probes. We will focus on materials and integration strategies of multimodal neural probes to achieve combined optogenetic stimulation and electrical recordings with high spatiotemporal precision and low invasiveness. In addition, we will also discuss future opportunities of multimodal neural interfaces in basic and translational neuroscience.
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Affiliation(s)
- Huihui Tian
- CAS Center for Excellence in Nanoscience, National Center for Nanoscience and Technology, Beijing 100190, China
| | - Ke Xu
- CAS Center for Excellence in Nanoscience, National Center for Nanoscience and Technology, Beijing 100190, China
- CAS Center for Excellence in Brain Science and Intelligence Technology, Institute of Neuroscience, Chinese Academy of Sciences, Shanghai 200031, China
- University of Chinese Academy of Sciences, Beijing 100049, China
| | - Liang Zou
- CAS Center for Excellence in Nanoscience, National Center for Nanoscience and Technology, Beijing 100190, China
- CAS Center for Excellence in Brain Science and Intelligence Technology, Institute of Neuroscience, Chinese Academy of Sciences, Shanghai 200031, China
- University of Chinese Academy of Sciences, Beijing 100049, China
| | - Ying Fang
- CAS Center for Excellence in Nanoscience, National Center for Nanoscience and Technology, Beijing 100190, China
- CAS Center for Excellence in Brain Science and Intelligence Technology, Institute of Neuroscience, Chinese Academy of Sciences, Shanghai 200031, China
- University of Chinese Academy of Sciences, Beijing 100049, China
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15
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Prosky J, Cagle J, Sellers KK, Gilron R, de Hemptinne C, Schmitgen A, Starr PA, Chang EF, Shirvalkar P. Practical Closed-Loop Strategies for Deep Brain Stimulation: Lessons From Chronic Pain. Front Neurosci 2022; 15:762097. [PMID: 34975374 PMCID: PMC8716790 DOI: 10.3389/fnins.2021.762097] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 11/24/2021] [Indexed: 11/22/2022] Open
Abstract
Deep brain stimulation (DBS) is a plausible therapy for various neuropsychiatric disorders, though continuous tonic stimulation without regard to underlying physiology (open-loop) has had variable success. Recently available DBS devices can sense neural signals which, in turn, can be used to control stimulation in a closed-loop mode. Closed-loop DBS strategies may mitigate many drawbacks of open-loop stimulation and provide more personalized therapy. These devices contain many adjustable parameters that control how the closed-loop system operates, which need to be optimized using a combination of empirically and clinically informed decision making. We offer a practical guide for the implementation of a closed-loop DBS system, using examples from patients with chronic pain. Focusing on two research devices from Medtronic, the Activa PC+S and Summit RC+S, we provide pragmatic details on implementing closed- loop programming from a clinician’s perspective. Specifically, by combining our understanding of chronic pain with data-driven heuristics, we describe how to tune key parameters to handle feature selection, state thresholding, and stimulation artifacts. Finally, we discuss logistical and practical considerations that clinicians must be aware of when programming closed-loop devices.
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Affiliation(s)
- Jordan Prosky
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States.,UCSF Weill Institute for Neurosciences, San Francisco, CA, United States
| | - Jackson Cagle
- Department of Neurology, University of Florida, Gainesville, FL, United States
| | - Kristin K Sellers
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States.,UCSF Weill Institute for Neurosciences, San Francisco, CA, United States
| | - Ro'ee Gilron
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Cora de Hemptinne
- Department of Neurology, University of Florida, Gainesville, FL, United States.,Normal Fixel Institute for Neurological Diseases, Gainesville, FL, United States
| | - Ashlyn Schmitgen
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States.,UCSF Weill Institute for Neurosciences, San Francisco, CA, United States
| | - Philip A Starr
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States.,UCSF Weill Institute for Neurosciences, San Francisco, CA, United States.,UCSF Department of Physiology, San Francisco, CA, United States
| | - Edward F Chang
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States.,UCSF Weill Institute for Neurosciences, San Francisco, CA, United States.,UCSF Department of Physiology, San Francisco, CA, United States
| | - Prasad Shirvalkar
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States.,UCSF Weill Institute for Neurosciences, San Francisco, CA, United States.,Division of Pain Medicine, UCSF Department of Anesthesiology and Perioperative Care, San Francisco, CA, United States.,UCSF Department of Neurology, San Francisco, CA, United States
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16
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Radmard S, Ortega RA, Ford B, Vanegas-Arroyave N, McKhann GM, Sheth SA, Winfield L, Luciano MS, Saunders-Pullman R, Pullman SL. Using computerized spiral analysis to evaluate deep brain stimulation outcomes in Parkinson disease. Clin Neurol Neurosurg 2021; 208:106878. [PMID: 34418700 DOI: 10.1016/j.clineuro.2021.106878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 08/02/2021] [Accepted: 08/04/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine whether spiral analysis can monitor the effects of deep brain stimulation (DBS) in Parkinson disease (PD) and provide a window on clinical features that change post-operatively. Clinical evaluation after DBS is subjective and insensitive to small changes. Spiral analysis is a computerized test that quantifies kinematic, dynamic, and spatial aspects of spiral drawing. Validated computational indices are generated and correlate with a range of clinically relevant motor findings. These include measures of overall clinical severity (Severity), bradykinesia and rigidity (Smoothness), amount of tremor (Tremor), irregularity of drawing movements (Variability), and micrographia (Tightness). METHODS We retrospectively evaluated the effect of subthalamic nucleus (STN) (n = 66) and ventral intermediate thalamus (Vim) (n = 10) DBS on spiral drawing in PD subjects using spiral analysis. Subjects freely drew ten spirals on plain paper with an inking pen on a graphics tablet. Five spiral indices (Severity, Smoothness, Tremor, Variability, Tightness) were calculated and compared pre- and post-operatively using Wilcoxon-rank sum tests, adjusting for multiple comparisons. RESULTS Severity improved after STN and Vim DBS (p < 0.005). Smoothness (p < 0.01) and Tremor (p < 0.02) both improved after STN and Vim DBS. Variability improved only with Vim DBS. Neither STN nor Vim DBS significantly changed Tightness. CONCLUSIONS All major spiral indices, except Tightness, improved after DBS. This suggests spiral analysis monitors DBS effects in PD and provides an objective window on relevant clinical features that change post-operatively. It may thus have utilization in clinical trials or investigations into the neural pathways altered by DBS. The lack of change in Tightness supports the notion that DBS does not improve micrographia.
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Affiliation(s)
- Sara Radmard
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA.
| | | | - Blair Ford
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Nora Vanegas-Arroyave
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Guy M McKhann
- Department of Neurological Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Sameer A Sheth
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Linda Winfield
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Marta San Luciano
- Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA
| | | | - Seth L Pullman
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
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17
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Price JB, Rusheen AE, Barath AS, Rojas Cabrera JM, Shin H, Chang SY, Kimble CJ, Bennet KE, Blaha CD, Lee KH, Oh Y. Clinical applications of neurochemical and electrophysiological measurements for closed-loop neurostimulation. Neurosurg Focus 2021; 49:E6. [PMID: 32610297 DOI: 10.3171/2020.4.focus20167] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 04/16/2020] [Indexed: 12/21/2022]
Abstract
The development of closed-loop deep brain stimulation (DBS) systems represents a significant opportunity for innovation in the clinical application of neurostimulation therapies. Despite the highly dynamic nature of neurological diseases, open-loop DBS applications are incapable of modifying parameters in real time to react to fluctuations in disease states. Thus, current practice for the designation of stimulation parameters, such as duration, amplitude, and pulse frequency, is an algorithmic process. Ideal stimulation parameters are highly individualized and must reflect both the specific disease presentation and the unique pathophysiology presented by the individual. Stimulation parameters currently require a lengthy trial-and-error process to achieve the maximal therapeutic effect and can only be modified during clinical visits. The major impediment to the development of automated, adaptive closed-loop systems involves the selection of highly specific disease-related biomarkers to provide feedback for the stimulation platform. This review explores the disease relevance of neurochemical and electrophysiological biomarkers for the development of closed-loop neurostimulation technologies. Electrophysiological biomarkers, such as local field potentials, have been used to monitor disease states. Real-time measurement of neurochemical substances may be similarly useful for disease characterization. Thus, the introduction of measurable neurochemical analytes has significantly expanded biomarker options for feedback-sensitive neuromodulation systems. The potential use of biomarker monitoring to advance neurostimulation approaches for treatment of Parkinson's disease, essential tremor, epilepsy, Tourette syndrome, obsessive-compulsive disorder, chronic pain, and depression is examined. Further, challenges and advances in the development of closed-loop neurostimulation technology are reviewed, as well as opportunities for next-generation closed-loop platforms.
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Affiliation(s)
| | - Aaron E Rusheen
- 1Department of Neurologic Surgery.,2Medical Scientist Training Program
| | | | | | | | | | | | - Kevin E Bennet
- 1Department of Neurologic Surgery.,3Division of Engineering, and
| | | | - Kendall H Lee
- 1Department of Neurologic Surgery.,4Department of Biomedical Engineering, Mayo Clinic, Rochester, Minnesota
| | - Yoonbae Oh
- 1Department of Neurologic Surgery.,4Department of Biomedical Engineering, Mayo Clinic, Rochester, Minnesota
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18
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Flouty O, Yamamoto K, Green A, Aziz T. Commentary: Operative Technique and Lessons Learned From Surgical Implantation of the NeuroPace Responsive Neurostimulation® System in 57 Consecutive Patients. Oper Neurosurg (Hagerstown) 2021; 20:E110-E111. [PMID: 33294928 DOI: 10.1093/ons/opaa349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 08/24/2020] [Indexed: 11/12/2022] Open
Affiliation(s)
- Oliver Flouty
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Canada.,Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Kazuaki Yamamoto
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Canada.,Department of Neurosurgery, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Alexander Green
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Tipu Aziz
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
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19
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Electrical stimulation of the nucleus basalis of meynert: a systematic review of preclinical and clinical data. Sci Rep 2021; 11:11751. [PMID: 34083732 PMCID: PMC8175342 DOI: 10.1038/s41598-021-91391-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 05/24/2021] [Indexed: 12/09/2022] Open
Abstract
Deep brain stimulation (DBS) of the nucleus basalis of Meynert (NBM) has been clinically investigated in Alzheimer’s disease (AD) and Lewy body dementia (LBD). However, the clinical effects are highly variable, which questions the suggested basic principles underlying these clinical trials. Therefore, preclinical and clinical data on the design of NBM stimulation experiments and its effects on behavioral and neurophysiological aspects are systematically reviewed here. Animal studies have shown that electrical stimulation of the NBM enhanced cognition, increased the release of acetylcholine, enhanced cerebral blood flow, released several neuroprotective factors, and facilitates plasticity of cortical and subcortical receptive fields. However, the translation of these outcomes to current clinical practice is hampered by the fact that mainly animals with an intact NBM were used, whereas most animals were stimulated unilaterally, with different stimulation paradigms for only restricted timeframes. Future animal research has to refine the NBM stimulation methods, using partially lesioned NBM nuclei, to better resemble the clinical situation in AD, and LBD. More preclinical data on the effect of stimulation of lesioned NBM should be present, before DBS of the NBM in human is explored further.
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20
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Jimenez-Shahed J. Device profile of the percept PC deep brain stimulation system for the treatment of Parkinson's disease and related disorders. Expert Rev Med Devices 2021; 18:319-332. [PMID: 33765395 DOI: 10.1080/17434440.2021.1909471] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Several software and hardware advances in the field of deep brain stimulation (DBS) have been realized in recent years and devices from three manufacturers are available. The Percept™ PC platform (Medtronic, Inc.) enables brain sensing, the latest innovation. Clinicians should be familiar with the differences in devices, and with the latest technologies to deliver optimized patient care.Areas covered: In this device profile, the sensing capabilities of the Percept™ PC platform are described, and the system capabilities are differentiated from other available platforms. The development of the preceding Activa™ PC+S research platform, an investigational device to simultaneously sense brain signals and provide therapeutic stimulation, is provided to place Percept™ PC in the appropriate context.Expert opinion: Percept™ PC offers unique sensing and diary functions as a means to refine therapeutic stimulation, track symptoms and correlate them to neurophysiologic characteristics. Additional features enhance the patient experience with DBS, including 3 T magnetic resonance imaging compatibility, wireless telemetry, a smaller and thinner battery profile, and increased battery longevity. Future work will be needed to illustrate the clinical utility and added value of using sensing to optimize DBS therapy. Patients implanted with Percept™ PC will have ready access to future technology developments.
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Affiliation(s)
- Joohi Jimenez-Shahed
- Movement Disorders Neuromodulation & Brain Circuit Therapeutics, Neurology and Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, USA
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21
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Neural implant for the treatment of multiple sclerosis. Med Hypotheses 2020; 145:110324. [PMID: 33038587 DOI: 10.1016/j.mehy.2020.110324] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 09/06/2020] [Accepted: 09/26/2020] [Indexed: 11/20/2022]
Abstract
The methods used to treat various neurological diseases are evolving. The facilities provided by the technology have led to creation of new treatment opportunities. Neuromodulation is one of these important methods. By definition, the neuromodulation is a change in neural activity which occurs by stimulating a specific area of nervous system. The mentioned stimulation can be electrical, magnetic, or chemical. This method is used in various diseases, such as stroke, Parkinson's, Alzheimer's, and amyotrophic lateral sclerosis (ALS). Multiple sclerosis (MS) is no exception in this regard and methods including the neurofeedback and transcranial magnetic stimulation (TMS) are used to treat various complications of the MS. One aspect of neuromodulation is the use of neural implant, which is applied nowadays, especially in the Parkinson's disease, and the use of microchips and prostheses to treat various symptoms in different neurological diseases has received significant attention. Although neural implant has been exploited to improve the symptoms of MS, they appear to have much greater potential to improve the condition of patients with MS. It seems that more attention to the symptoms of MS, on the one hand, and a new approach to the pathogenesis of this disease and considering it as a connectomopathy, on the other hand, can provide new opportunities for application of this method in the treatment of MS.
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22
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Jarosiewicz B, Morrell M. The RNS System: brain-responsive neurostimulation for the treatment of epilepsy. Expert Rev Med Devices 2020; 18:129-138. [PMID: 32936673 DOI: 10.1080/17434440.2019.1683445] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Introduction: Epilepsy affects more than 1% of the US population, and over 30% of adults with epilepsy do not respond to antiseizure medications without life-impacting medication-related side effects. Resection of the seizure focus is not an option for many patients because it would cause unacceptable neurological or cognitive harm. For these patients, neuromodulation has emerged as a nondestructive, effective, and safe alternative. The NeuroPace® RNS® System, the only brain-responsive neurostimulation device, records neural activity from leads placed at one or two seizure foci. When the neurostimulator detects epileptiform activity, as defined for each patient by his or her physician, brief pulses of electrical stimulation are delivered to normalize the activity.Areas covered: This review describes the RNS System, the results of multi-year clinical trials, and the research discoveries enabled by the chronic ambulatory brain data collected by the RNS System.Expert commentary: Brain-responsive neurostimulation could potentially be used to treat any episodic neurological disorder that's accompanied by a neurophysiological biomarker of severity. Combining advanced machine learning approaches with the chronic ambulatory brain data collected by the RNS System could eventually enable automatic fine-tuning of detection and stimulation for each patient, creating a general-purpose neurotechnological platform for precision medicine.
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Affiliation(s)
| | - Martha Morrell
- NeuroPace, Inc, Mountain View, CA, USA.,Neurology & Neurological Sciences, Stanford University, Stanford Neuroscience Health Center, Palo Alto, CA, USA
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23
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Brown AM, White JJ, van der Heijden ME, Zhou J, Lin T, Sillitoe RV. Purkinje cell misfiring generates high-amplitude action tremors that are corrected by cerebellar deep brain stimulation. eLife 2020; 9:e51928. [PMID: 32180549 PMCID: PMC7077982 DOI: 10.7554/elife.51928] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 02/26/2020] [Indexed: 02/06/2023] Open
Abstract
Tremor is currently ranked as the most common movement disorder. The brain regions and neural signals that initiate the debilitating shakiness of different body parts remain unclear. Here, we found that genetically silencing cerebellar Purkinje cell output blocked tremor in mice that were given the tremorgenic drug harmaline. We show in awake behaving mice that the onset of tremor is coincident with rhythmic Purkinje cell firing, which alters the activity of their target cerebellar nuclei cells. We mimic the tremorgenic action of the drug with optogenetics and present evidence that highly patterned Purkinje cell activity drives a powerful tremor in otherwise normal mice. Modulating the altered activity with deep brain stimulation directed to the Purkinje cell output in the cerebellar nuclei reduced tremor in freely moving mice. Together, the data implicate Purkinje cell connectivity as a neural substrate for tremor and a gateway for signals that mediate the disease.
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Affiliation(s)
- Amanda M Brown
- Department of Pathology and Immunology, Baylor College of MedicineHoustonUnited States
- Department of Neuroscience, Baylor College of MedicineHoustonUnited States
- Jan and Dan Duncan Neurological Research Institute of Texas Children's HospitalHoustonUnited States
| | - Joshua J White
- Department of Pathology and Immunology, Baylor College of MedicineHoustonUnited States
- Department of Neuroscience, Baylor College of MedicineHoustonUnited States
- Jan and Dan Duncan Neurological Research Institute of Texas Children's HospitalHoustonUnited States
| | - Meike E van der Heijden
- Department of Pathology and Immunology, Baylor College of MedicineHoustonUnited States
- Jan and Dan Duncan Neurological Research Institute of Texas Children's HospitalHoustonUnited States
| | - Joy Zhou
- Department of Pathology and Immunology, Baylor College of MedicineHoustonUnited States
- Department of Neuroscience, Baylor College of MedicineHoustonUnited States
- Jan and Dan Duncan Neurological Research Institute of Texas Children's HospitalHoustonUnited States
| | - Tao Lin
- Department of Pathology and Immunology, Baylor College of MedicineHoustonUnited States
- Jan and Dan Duncan Neurological Research Institute of Texas Children's HospitalHoustonUnited States
| | - Roy V Sillitoe
- Department of Pathology and Immunology, Baylor College of MedicineHoustonUnited States
- Department of Neuroscience, Baylor College of MedicineHoustonUnited States
- Jan and Dan Duncan Neurological Research Institute of Texas Children's HospitalHoustonUnited States
- Development, Disease Models & Therapeutics Graduate Program, Baylor College of MedicineHoustonUnited States
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Castano-Candamil S, Vaihinger M, Tangermann M. A simulated environment for early development stages of reinforcement learning algorithms for closed-loop deep brain stimulation. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2019:2900-2904. [PMID: 31946497 DOI: 10.1109/embc.2019.8857533] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In recent years, closed-loop adaptive deep brain stimulation (aDBS) for Parkinson's disease (PD) has gained focus in the research community, due to promising proof-of-concept studies showing its suitability for improving DBS therapy and ameliorating related side effects.The main challenges faced in the aDBS control problem is the presence of non-stationary/non-linear dynamics and the heterogeneity of PD's phenotype, making the exploration of data-driven dynamics-aware control algorithms a promising research direction. However, due to the severe safety constraints related to working with patients, aDBS is a sensitive research field that requires surrogate development platforms with growing complexity, as novel control algorithms are validated.With our current contribution, we propose the characterization and categorization of non-stationary dynamics found in the aDBS problem. We show how knowledge about these dynamics can be embedded in a surrogate simulation environment, which has been designed to support early development stages of aDBS control strategies, specifically those based on reinforcement learning (RL) algorithms. Finally, we present a comparison of representative RL methods designed to cope with the type of non-stationary dynamics found in aDBS.To allow reproducibility and encourage adoption of our approach, the source code of the developed methods and simulation environment are made available online.
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Xu W, Zhang C, Deeb W, Patel B, Wu Y, Voon V, Okun MS, Sun B. Deep brain stimulation for Tourette's syndrome. Transl Neurodegener 2020; 9:4. [PMID: 31956406 PMCID: PMC6956485 DOI: 10.1186/s40035-020-0183-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 01/05/2020] [Indexed: 01/11/2023] Open
Abstract
Tourette syndrome (TS) is a childhood-onset neuropsychiatric disorder characterized by the presence of multiple motor and vocal tics. TS usually co-occurs with one or multiple psychiatric disorders. Although behavioral and pharmacological treatments for TS are available, some patients do not respond to the available treatments. For these patients, TS is a severe, chronic, and disabling disorder. In recent years, deep brain stimulation (DBS) of basal ganglia-thalamocortical networks has emerged as a promising intervention for refractory TS with or without psychiatric comorbidities. Three major challenges need to be addressed to move the field of DBS treatment for TS forward: (1) patient and DBS target selection, (2) ethical concerns with treating pediatric patients, and (3) DBS treatment optimization and improvement of individual patient outcomes (motor and phonic tics, as well as functioning and quality of life). The Tourette Association of America and the American Academy of Neurology have recently released their recommendations regarding surgical treatment for refractory TS. Here, we describe the challenges, advancements, and promises of the use of DBS in the treatment of TS. We summarize the results of clinical studies and discuss the ethical issues involved in treating pediatric patients. Our aim is to provide a better understanding of the feasibility, safety, selection process, and clinical effectiveness of DBS treatment for select cases of severe and medically intractable TS.
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Affiliation(s)
- Wenying Xu
- 1Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Ruijin Hospital, 197 Ruijin Er Road, Shanghai, 200025 China
| | - Chencheng Zhang
- 1Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Ruijin Hospital, 197 Ruijin Er Road, Shanghai, 200025 China
| | - Wissam Deeb
- 2Norman Fixel Institute for Neurological Diseases, Department of Neurology, College of Medicine, University of Florida, Gainesville, FL 32608 USA
| | - Bhavana Patel
- 2Norman Fixel Institute for Neurological Diseases, Department of Neurology, College of Medicine, University of Florida, Gainesville, FL 32608 USA
| | - Yiwen Wu
- 3Department of Neurology & Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Valerie Voon
- 1Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Ruijin Hospital, 197 Ruijin Er Road, Shanghai, 200025 China.,4Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Michael S Okun
- 2Norman Fixel Institute for Neurological Diseases, Department of Neurology, College of Medicine, University of Florida, Gainesville, FL 32608 USA
| | - Bomin Sun
- 1Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Ruijin Hospital, 197 Ruijin Er Road, Shanghai, 200025 China
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Gummadavelli A, Quraishi IH, Gerrard JL. Responsive Neurostimulation. Stereotact Funct Neurosurg 2020. [DOI: 10.1007/978-3-030-34906-6_12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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27
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Dorsey ER, Omberg L, Waddell E, Adams JL, Adams R, Ali MR, Amodeo K, Arky A, Augustine EF, Dinesh K, Hoque ME, Glidden AM, Jensen-Roberts S, Kabelac Z, Katabi D, Kieburtz K, Kinel DR, Little MA, Lizarraga KJ, Myers T, Riggare S, Rosero SZ, Saria S, Schifitto G, Schneider RB, Sharma G, Shoulson I, Stevenson EA, Tarolli CG, Luo J, McDermott MP. Deep Phenotyping of Parkinson's Disease. JOURNAL OF PARKINSON'S DISEASE 2020; 10:855-873. [PMID: 32444562 PMCID: PMC7458535 DOI: 10.3233/jpd-202006] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/01/2020] [Indexed: 12/13/2022]
Abstract
Phenotype is the set of observable traits of an organism or condition. While advances in genetics, imaging, and molecular biology have improved our understanding of the underlying biology of Parkinson's disease (PD), clinical phenotyping of PD still relies primarily on history and physical examination. These subjective, episodic, categorical assessments are valuable for diagnosis and care but have left gaps in our understanding of the PD phenotype. Sensors can provide objective, continuous, real-world data about the PD clinical phenotype, increase our knowledge of its pathology, enhance evaluation of therapies, and ultimately, improve patient care. In this paper, we explore the concept of deep phenotyping-the comprehensive assessment of a condition using multiple clinical, biological, genetic, imaging, and sensor-based tools-for PD. We discuss the rationale for, outline current approaches to, identify benefits and limitations of, and consider future directions for deep clinical phenotyping.
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Affiliation(s)
- E. Ray Dorsey
- Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, USA
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | | | - Emma Waddell
- Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, USA
| | - Jamie L. Adams
- Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, USA
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Roy Adams
- Machine Learning, AI and Healthcare Lab, Johns Hopkins University, Baltimore, MD, USA
| | | | - Katherine Amodeo
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Abigail Arky
- Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, USA
| | - Erika F. Augustine
- Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, USA
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Karthik Dinesh
- Department of Electrical and Computer Engineering, University of Rochester, Rochester, NY, USA
| | | | - Alistair M. Glidden
- Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, USA
| | - Stella Jensen-Roberts
- Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, USA
| | - Zachary Kabelac
- Department of Computer Science and Artificial Intelligence, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Dina Katabi
- Department of Computer Science and Artificial Intelligence, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Karl Kieburtz
- Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, USA
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Daniel R. Kinel
- Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, USA
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Max A. Little
- School of Computer Science, University of Birmingham, UK
- Massachusetts Institute of Technology, MA, USA
| | - Karlo J. Lizarraga
- Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, USA
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Taylor Myers
- Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, USA
| | - Sara Riggare
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | | | - Suchi Saria
- Machine Learning, AI and Healthcare Lab, Johns Hopkins University, Baltimore, MD, USA
- Department of Computer Science, Statistics, and Health Policy, Johns Hopkins University, MD, USA
| | - Giovanni Schifitto
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Ruth B. Schneider
- Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, USA
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Gaurav Sharma
- Department of Electrical and Computer Engineering, University of Rochester, Rochester, NY, USA
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, NY, USA
| | - Ira Shoulson
- Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, USA
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
- Grey Matter Technologies, Sarasota, FL, USA
| | - E. Anna Stevenson
- Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, USA
| | - Christopher G. Tarolli
- Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, USA
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Jiebo Luo
- Department of Computer Science, University of Rochester, Rochester, NY, USA
| | - Michael P. McDermott
- Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, USA
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, NY, USA
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Zanos S. Closed-Loop Neuromodulation in Physiological and Translational Research. Cold Spring Harb Perspect Med 2019; 9:cshperspect.a034314. [PMID: 30559253 DOI: 10.1101/cshperspect.a034314] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Neuromodulation, the focused delivery of energy to neural tissue to affect neural or physiological processes, is a common method to study the physiology of the nervous system. It is also successfully used as treatment for disorders in which the nervous system is affected or implicated. Typically, neurostimulation is delivered in open-loop mode (i.e., according to a predetermined schedule and independently of the state of the organ or physiological system whose function is sought to be modulated). However, the physiology of the nervous system or the modulated organ can be dynamic, and the same stimulus may have different effects depending on the underlying state. As a result, open-loop stimulation may fail to restore the desired function or cause side effects. In such cases, a neuromodulation intervention may be preferable to be administered in closed-loop mode. In a closed-loop neuromodulation (CLN) system, stimulation is delivered when certain physiological states or conditions are met (responsive neurostimulation); the stimulation parameters can also be adjusted dynamically to optimize the effect of stimulation in real time (adaptive neurostimulation). In this review, the reasons and the conditions for using CLN are discussed, the basic components of a CLN system are described, and examples of CLN systems used in physiological and translational research are presented.
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Affiliation(s)
- Stavros Zanos
- Translational Neurophysiology Laboratory, Center for Bioelectronic Medicine, Feinstein Institute for Medical Research, Northwell Health, Manhasset, New York 11030
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29
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Ramirez-Zamora A, Giordano J, Boyden ES, Gradinaru V, Gunduz A, Starr PA, Sheth SA, McIntyre CC, Fox MD, Vitek J, Vedam-Mai V, Akbar U, Almeida L, Bronte-Stewart HM, Mayberg HS, Pouratian N, Gittis AH, Singer AC, Creed MC, Lazaro-Munoz G, Richardson M, Rossi MA, Cendejas-Zaragoza L, D'Haese PF, Chiong W, Gilron R, Chizeck H, Ko A, Baker KB, Wagenaar J, Harel N, Deeb W, Foote KD, Okun MS. Proceedings of the Sixth Deep Brain Stimulation Think Tank Modulation of Brain Networks and Application of Advanced Neuroimaging, Neurophysiology, and Optogenetics. Front Neurosci 2019; 13:936. [PMID: 31572109 PMCID: PMC6751331 DOI: 10.3389/fnins.2019.00936] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 08/21/2019] [Indexed: 02/05/2023] Open
Abstract
The annual deep brain stimulation (DBS) Think Tank aims to create an opportunity for a multidisciplinary discussion in the field of neuromodulation to examine developments, opportunities and challenges in the field. The proceedings of the Sixth Annual Think Tank recapitulate progress in applications of neurotechnology, neurophysiology, and emerging techniques for the treatment of a range of psychiatric and neurological conditions including Parkinson’s disease, essential tremor, Tourette syndrome, epilepsy, cognitive disorders, and addiction. Each section of this overview provides insight about the understanding of neuromodulation for specific disease and discusses current challenges and future directions. This year’s report addresses key issues in implementing advanced neurophysiological techniques, evolving use of novel modulation techniques to deliver DBS, ans improved neuroimaging techniques. The proceedings also offer insights into the new era of brain network neuromodulation and connectomic DBS to define and target dysfunctional brain networks. The proceedings also focused on innovations in applications and understanding of adaptive DBS (closed-loop systems), the use and applications of optogenetics in the field of neurostimulation and the need to develop databases for DBS indications. Finally, updates on neuroethical, legal, social, and policy issues relevant to DBS research are discussed.
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Affiliation(s)
- Adolfo Ramirez-Zamora
- Department of Neurology, Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - James Giordano
- Neuroethics Studies Program, Department of Neurology and Department of Biochemistry, Georgetown University Medical Center, Washington, DC, United States
| | - Edward S Boyden
- Media Laboratory, Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA, United States.,Center for Neurobiological Engineering, Massachusetts Institute of Technology, Cambridge, MA, United States.,Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Viviana Gradinaru
- Division of Biology and Biological Engineering, California Institute of Technology, Pasadena, CA, United States
| | - Aysegul Gunduz
- Department of Neuroscience and Department of Biomedical Engineering and Department of Neurology, Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Philip A Starr
- Graduate Program in Neuroscience, Department of Neurological Surgery, Kavli Institute for Fundamental Neuroscience, University of California, San Francisco, San Francisco, CA, United States
| | - Sameer A Sheth
- Department of Neurological Surgery, Baylor College of Medicine, Houston, TX, United States
| | - Cameron C McIntyre
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States
| | - Michael D Fox
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Jerrold Vitek
- Department of Neurology, University of Minnesota, Minneapolis, MN, United States
| | - Vinata Vedam-Mai
- Department of Neurosurgery, Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Umer Akbar
- Center for Neurorestoration and Neurotechnology, Rehabilitation R&D Service, Veterans Affairs Medical Center, Brown Institute for Brain Science, Brown University, Providence, RI, United States
| | - Leonardo Almeida
- Department of Neurology, Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Helen M Bronte-Stewart
- Department of Neurology and Department of Neurological Sciences and Department of Neurosurgery, Stanford University, Stanford, CA, United States
| | - Helen S Mayberg
- Department of Neurology and Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Nader Pouratian
- Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Aryn H Gittis
- Biological Sciences and Center for Neural Basis of Cognition, Carnegie Mellon University, Pittsburgh, PA, United States
| | - Annabelle C Singer
- Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Emory University School of Medicine, Atlanta, GA, United States
| | - Meaghan C Creed
- Department of Pharmacology, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Gabriel Lazaro-Munoz
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, United States
| | - Mark Richardson
- Center for the Neural Basis of Cognition, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Marvin A Rossi
- Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, Chicago, IL, United States
| | | | | | - Winston Chiong
- Department of Neurology, University of California, San Francisco, San Francisco, CA, United States
| | - Ro'ee Gilron
- Graduate Program in Neuroscience, Department of Neurological Surgery, Kavli Institute for Fundamental Neuroscience, University of California, San Francisco, San Francisco, CA, United States
| | - Howard Chizeck
- Graduate Program in Neuroscience, Department of Electrical Engineering, University of Washington, Seattle, WA, United States
| | - Andrew Ko
- Department of Neurological Surgery, University of Washington, Seattle, WA, United States
| | - Kenneth B Baker
- Movement Disorders Program, Cleveland Clinic Foundation, Cleveland, OH, United States
| | - Joost Wagenaar
- Department of Neurology, Center for Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia, PA, United States
| | - Noam Harel
- Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN, United States
| | - Wissam Deeb
- Department of Neurology, Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Kelly D Foote
- Department of Neurosurgery, Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Michael S Okun
- Department of Neurology, Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
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30
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Deligianni F, Guo Y, Yang GZ. From Emotions to Mood Disorders: A Survey on Gait Analysis Methodology. IEEE J Biomed Health Inform 2019; 23:2302-2316. [PMID: 31502995 DOI: 10.1109/jbhi.2019.2938111] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Mood disorders affect more than 300 million people worldwide and can cause devastating consequences. Elderly people and patients with neurological conditions are particularly susceptible to depression. Gait and body movements can be affected by mood disorders, and thus they can be used as a surrogate sign, as well as an objective index for pervasive monitoring of emotion and mood disorders in daily life. Here we review evidence that demonstrates the relationship between gait, emotions and mood disorders, highlighting the potential of a multimodal approach that couples gait data with physiological signals and home-based monitoring for early detection and management of mood disorders. This could enhance self-awareness, enable the development of objective biomarkers that identify high risk subjects and promote subject-specific treatment.
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Amoozegar S, Pooyan M, Roughani M. Toward a closed-loop deep brain stimulation in Parkinson's disease using local field potential in parkinsonian rat model. Med Hypotheses 2019; 132:109360. [PMID: 31442919 DOI: 10.1016/j.mehy.2019.109360] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 08/04/2019] [Accepted: 08/11/2019] [Indexed: 02/06/2023]
Abstract
Deep brain stimulation (DBS) is an invasive method used for treating Parkinson's disease in its advanced stages. Nowadays, the initial adjustment of DBS parameters and their automatic matching proportion to the progression of the disease is viewed as one of the research areas discussed by the researchers, which is called closed-loop DBS. Various studies were conducted regarding finding the signal(s) which reflects different symptoms of the disease. Local Field Potential (LFP) is one of the signals that is suitable for using as feedback, because it can be recorded by the same implemented electrodes for stimulation. The present study aimed to identify the distinguishing features of patients from healthy individuals using LFP signals. METHODS In the present study, LFP was recorded from the rats in sham and parkinsonian model groups. After evaluating the signals in the frequency domain, sixty-six features were extracted from power spectral density of LFPs. The features were classified by Support Vector Machine (SVM) to determine the ability of features for separating parkinsonian rats from healthy ones. Finally, the most effective features were selected for distinguishing between the sham and parkinsonian model groups using a genetic algorithm. RESULTS The results indicated that the frequency domain features of LFP signals from rats have capacity of using them as a feedback for closed-loop DBS. The accuracy of the Support Vector Machine classification using all 66 features was 80.42% which increased to 84.41% using 38 features selected by genetic algorithm. The proposed method not only increase the accuracy, but it also reduce computation by decreasing the number of the effective features. The results indicate the significant capacity of the proposed method for identifying the effective high-frequency features to control the closed-loop DBS. CONCLUSIONS The ability of using LFP signals as feedback in closed-loop DBS was shown by extracting useful information in frequency bands below and above 100 Hz regarding LFP signals of parkinsonian rats and sham ones. Based on the results, features at frequencies above 100 Hz were more powerful and robust than below 100 Hz. The genetic algorithm was used for optimizing the classification problem.
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Affiliation(s)
- Sana Amoozegar
- Department of Biomedical Engineering, Faculty of Engineering, Shahed University, Tehran, Iran
| | - Mohammad Pooyan
- Department of Biomedical Engineering, Faculty of Engineering, Shahed University, Tehran, Iran.
| | - Mehrdad Roughani
- Department of Physiology, Faculty of Medical Sciences, Shahed University, Tehran, Iran
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Abstract
Parkinson disease (PD) is the second most common neurodegenerative disorder and affects more than 1 million individuals in the United States. Deep brain stimulation (DBS) is one form of treatment of PD. DBS treatment is still evolving due to technological innovations that shape how this therapy is used.
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Affiliation(s)
- Michael Kogan
- Department of Neurosurgery, University at Buffalo, 100 High Street Section B, 4th Floor, Buffalo, NY 14203, USA
| | - Matthew McGuire
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 875 Ellicott Street, 6071 CTRC, Buffalo, NY 14203, USA
| | - Jonathan Riley
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Functional Neurosurgery Kaleida Health System, 5959 Big Tree Road, Orchard Park, NY 14207, USA.
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Abstract
Deep brain stimulation is now the most common surgical treatment of tremor. Tremor can be classified as action or resting tremor and is one of the most common movement disorders. Initial treatment of tremor should focus on medical treatment but, if patients fail medical therapy, deep brain stimulation should be considered with likely success. The usual target is the ventral intermediate nucleus of the thalamus. Common side effects of treatment include paresthesias, dysarthria, and less often ataxia. Future directions of research and development, including directional leads and closed-loop stimulation, may eventually lead to additional improvement in patient outcomes.
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Affiliation(s)
- Wendell Lake
- University of Wisconsin-Madison, 600 Highland Avenue, Box 8660, Madison, WI 53792, USA
| | - Peter Hedera
- Vanderbilt University Medical Center, 645 21st Avenue South, Nashville, TN 37240, USA
| | - Peter Konrad
- Vanderbilt University Medical Center, Room 4333, VAV, 1500 21st Avenue, Nashville, TN 37212, USA.
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34
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Gilat M. Towards closed-loop deep brain stimulation for freezing of gait in Parkinson's disease. Clin Neurophysiol 2018; 129:2448-2450. [PMID: 30195971 DOI: 10.1016/j.clinph.2018.08.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 08/24/2018] [Indexed: 01/17/2023]
Affiliation(s)
- Moran Gilat
- Research Group for Neuromotor Rehabilitation, Department of Rehabilitation, KU Leuven, Leuven, Belgium.
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