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Evers J, Orłowski J, Jahns H, Lowery MM. On-Off and Proportional Closed-Loop Adaptive Deep Brain Stimulation Reduces Motor Symptoms in Freely Moving Hemiparkinsonian Rats. Neuromodulation 2024; 27:476-488. [PMID: 37245140 DOI: 10.1016/j.neurom.2023.03.018] [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: 12/19/2022] [Revised: 03/16/2023] [Accepted: 03/29/2023] [Indexed: 05/29/2023]
Abstract
OBJECTIVES Closed-loop adaptive deep brain stimulation (aDBS) continuously adjusts stimulation parameters, with the potential to improve efficacy and reduce side effects of deep brain stimulation (DBS) for Parkinson's disease (PD). Rodent models can provide an effective platform for testing aDBS algorithms and establishing efficacy before clinical investigation. In this study, we compare two aDBS algorithms, on-off and proportional modulation of DBS amplitude, with conventional DBS in hemiparkinsonian rats. MATERIALS AND METHODS DBS of the subthalamic nucleus (STN) was delivered wirelessly in freely moving male and female hemiparkinsonian (N = 7) and sham (N = 3) Wistar rats. On-off and proportional aDBS, based on STN local field potential beta power, were compared with conventional DBS and three control stimulation algorithms. Behavior was assessed during cylinder tests (CT) and stepping tests (ST). Successful model creation was confirmed via apomorphine-induced rotation test and Tyrosine Hydroxylase-immunocytochemistry. Electrode location was histologically confirmed. Data were analyzed using linear mixed models. RESULTS Contralateral paw use in parkinsonian rats was reduced to 20% and 25% in CT and ST, respectively. Conventional, on-off, and proportional aDBS significantly improved motor function, restoring contralateral paw use to approximately 45% in both tests. No improvement in motor behavior was observed with either randomly applied on-off or low-amplitude continuous stimulation. Relative STN beta power was suppressed during DBS. Relative power in the alpha and gamma bands decreased and increased, respectively. Therapeutically effective adaptive DBS used approximately 40% less energy than did conventional DBS. CONCLUSIONS Adaptive DBS, using both on-off and proportional control schemes, is as effective as conventional DBS in reducing motor symptoms of PD in parkinsonian rats. Both aDBS algorithms yield substantial reductions in stimulation power. These findings support using hemiparkinsonian rats as a viable model for testing aDBS based on beta power and provide a path to investigate more complex closed-loop algorithms in freely behaving animals.
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Affiliation(s)
- Judith Evers
- Neuromuscular Systems Lab, School of Electrical and Electronic Engineering, University College Dublin Belfield, Belfield, Dublin, Ireland.
| | - Jakub Orłowski
- Neuromuscular Systems Lab, School of Electrical and Electronic Engineering, University College Dublin Belfield, Belfield, Dublin, Ireland
| | - Hanne Jahns
- Department of Pathology, School of Veterinary Medicine, University College Dublin Belfield, Dublin, Ireland
| | - Madeleine M Lowery
- Neuromuscular Systems Lab, School of Electrical and Electronic Engineering, University College Dublin Belfield, Belfield, Dublin, Ireland
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Maxwell WD, Fierke KK, Zumach GM. Outcomes of a "virtual think tank" to establish collaborative leadership initiative plans ("CLIPs"). EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2024; 13:100409. [PMID: 38317647 PMCID: PMC10839148 DOI: 10.1016/j.rcsop.2024.100409] [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: 11/29/2023] [Revised: 01/05/2024] [Accepted: 01/17/2024] [Indexed: 02/07/2024] Open
Abstract
Goal The American Association of Colleges of Pharmacy (AACP) Leadership Development Special Interest Group (LD SIG) held a one-hour "Virtual Think Tank" (VTT) interactive session in 2020 for pharmacy educators interested in leadership development. The purpose of this study was to evaluate the quantitative and qualitative outcomes of this VTT. Methods VTT attendees worked together in small groups created based on pre-selected common interest areas related to leadership development to create collaborative leadership initiative plans (CLIPs), which were ideas for new collaborative scholarly or programmatic initiatives. Principal findings Quantitative outcomes of this VTT included statistically significant increases in positive perceptions toward the organization hosting the VTT regarding networking, scholarly collaboration, educational collaboration, and professional service opportunities, as well as significant improvements in attitudes regarding engagement with the sponsoring organization. Additionally, 18.4% of VTT attendees continued communicating with CLIP groups post-VTT and 13.2% of respondents indicated that they successfully implemented the CLIP ideas that were generated during the VTT. Qualitative outcomes included findings that the two most commonly encountered barriers were insufficient traction of the initial idea and lack of time (41.9% (n = 13) for both). Other barriers included lack of alignment with priorities at 12.9% (n = 4). Practical applications This leadership VTT for pharmacy academicians led to development and implementation of important scholarly and programmatic outcomes, and fostered cross-institutional partnerships. Findings from this study evaluating a VTT provide a framework of expectations for other organizations seeking to implement a similar initiative.
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Affiliation(s)
- Whitney D. Maxwell
- Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina College of Pharmacy, 715 Sumter Street, Columbia, SC 29208, United States of America
| | - Kerry K. Fierke
- Department of Pharmacy Practice and Pharmaceutical Sciences, University of Minnesota, College of Pharmacy, 232 Life Science, 1110 Kirby Drive, Duluth, MN 55812-3003, United States of America
| | - Gregory M. Zumach
- Department of Pharmacy Practice and Science, University of Nebraska Medical Center College of Pharmacy, 986120 Nebraska Medical CenterOmaha, NE 68198-6120, United States of America
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Rissardo JP, Vora NM, Tariq I, Mujtaba A, Caprara ALF. Deep Brain Stimulation for the Management of Refractory Neurological Disorders: A Comprehensive Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1991. [PMID: 38004040 PMCID: PMC10673515 DOI: 10.3390/medicina59111991] [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: 10/17/2023] [Revised: 11/04/2023] [Accepted: 11/10/2023] [Indexed: 11/26/2023]
Abstract
In recent decades, deep brain stimulation (DBS) has been extensively studied due to its reversibility and significantly fewer side effects. DBS is mainly a symptomatic therapy, but the stimulation of subcortical areas by DBS is believed to affect the cytoarchitecture of the brain, leading to adaptability and neurogenesis. The neurological disorders most commonly studied with DBS were Parkinson's disease, essential tremor, obsessive-compulsive disorder, and major depressive disorder. The most precise approach to evaluating the location of the leads still relies on the stimulus-induced side effects reported by the patients. Moreover, the adequate voltage and DBS current field could correlate with the patient's symptoms. Implantable pulse generators are the main parts of the DBS, and their main characteristics, such as rechargeable capability, magnetic resonance imaging (MRI) safety, and device size, should always be discussed with patients. The safety of MRI will depend on several parameters: the part of the body where the device is implanted, the part of the body scanned, and the MRI-tesla magnetic field. It is worth mentioning that drug-resistant individuals may have different pathophysiological explanations for their resistance to medications, which could affect the efficacy of DBS therapy. Therefore, this could explain the significant difference in the outcomes of studies with DBS in individuals with drug-resistant neurological conditions.
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Affiliation(s)
| | - Nilofar Murtaza Vora
- Medicine Department, Terna Speciality Hospital and Research Centre, Navi Mumbai 400706, India;
| | - Irra Tariq
- Medicine Department, United Medical & Dental College, Karachi 75600, Pakistan;
| | - Amna Mujtaba
- Medicine Department, Karachi Medical & Dental College, Karachi 74700, Pakistan;
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Chagot C, Bustuchina Vlaicu M, Frismand S, Colnat-Coulbois S, Nguyen JP, Palfi S. Deep brain stimulation in multiple sclerosis-associated tremor. A large, retrospective, longitudinal open label study, with long-term follow-up. Mult Scler Relat Disord 2023; 79:104928. [PMID: 37657308 DOI: 10.1016/j.msard.2023.104928] [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: 09/23/2021] [Revised: 07/28/2023] [Accepted: 08/04/2023] [Indexed: 09/03/2023]
Abstract
BACKGROUND Tremor affects up to 25%-58% in multiple sclerosis (MS) population. Deep-brain stimulation (DBS) of the ventral-intermediate nucleus (VIM) of the thalamus is considered as a potential option following medical treatments. Long term DBS efficacy is not well known in these patients with a poor outcome mostly related to disease progression. OBJECTIVE To report a large and retrospective study of thalamic DBS in MS tremor. METHODS We conducted a large and retrospective study of patients with MS disabling and pharmacologically resistant upper limb tremor, who underwent thalamic DBS procedure from January 1992 to January 2015 in University Hospital of Henri Mondor, France. Demographic data, clinical assessment and activity daily living were collected. A three-month and twelve-month post-operative assessment with clinical and functional rating scales have been achieved, as well as long term follow-up for most patients. RESULTS One hundred and four patients underwent DBS procedure. There were 71 female (68%) and 33 male (32%). At three-month post-operative assessment, 64% patients were improved clinically and functionally. Among these, 93% of patients kept a good efficacy at one-year post-operative assessment. Mean duration of follow-up for these patients was 6 years. CONCLUSION We described a long-term sustained clinical and functional improvement in this large and retrospective report of thalamic DBS. This neuromodulation approach could be a therapeutic option for all severe upper extremity refractory tremor in MS patients.
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Affiliation(s)
- Claire Chagot
- University Hospital of Nancy, Department of Neurology, 29 av Mar De Lattre de Tassigny, 54000 NANCY, France
| | - Mihaela Bustuchina Vlaicu
- Pitié Salpêtrière Hospital, Department of Neurosurgery, 83 Boulevard de l'Hôpital, Bâtiment Babinski, 75013, Paris, France; INSERM (National Institute of Health and Medical Research), U0955, Translational Neuro Psychiatry team, Avenue de Maréchal de Lattre de Tassigny, 94000, Créteil, France.
| | - Solène Frismand
- University Hospital of Nancy, Department of Neurology, 29 av Mar De Lattre de Tassigny, 54000 NANCY, France
| | - Sophie Colnat-Coulbois
- University Hospital of Nancy, Department of Neurosurgery, 29 av Mar De Lattre de Tassigny, 54000 NANCY, France
| | - Jean Paul Nguyen
- Department of Neurosurgery, Clinique Brétéché, Groupe Elsan, 3 Rue De La Béraudiere, 44046 Nantes, France
| | - Stéphane Palfi
- INSERM (National Institute of Health and Medical Research), U0955, Translational Neuro Psychiatry team, Avenue de Maréchal de Lattre de Tassigny, 94000, Créteil, France; Henri-Mondor Hospital, University Hospital APHP, Department of Neurosurgery, 51 AV Mar de Lattre de Tassigny, 94000 Créteil, France
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Hariz M, Cif L, Blomstedt P. Thirty Years of Global Deep Brain Stimulation: "Plus ça change, plus c'est la même chose"? Stereotact Funct Neurosurg 2023; 101:395-406. [PMID: 37844558 DOI: 10.1159/000533430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 07/31/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND The advent of deep brain stimulation (DBS) of the subthalamic nucleus (STN) for Parkinson's disease 30 years ago has ushered a global breakthrough of DBS as a universal method for therapy and research in wide areas of neurology and psychiatry. The literature of the last three decades has described numerous concepts and practices of DBS, often branded as novelties or discoveries. However, reading the contemporary publications often elicits a sense of déjà vu in relation to several methods, attributes, and practices of DBS. Here, we review various applications and techniques of the modern-era DBS and compare them with practices of the past. SUMMARY Compared with modern literature, publications of the old-era functional stereotactic neurosurgery, including old-era DBS, show that from the very beginning multidisciplinarity and teamwork were often prevalent and insisted upon, ethical concerns were recognized, brain circuitries and rational for brain targets were discussed, surgical indications were similar, closed-loop stimulation was attempted, evaluations of surgical results were debated, and controversies were common. Thus, it appears that virtually everything done today in the field of DBS bears resemblance to old-time practices, or has been done before, albeit with partly other tools and techniques. Movement disorders remain the main indications for modern DBS as was the case for lesional surgery and old-era DBS. The novelties today consist of the STN as the dominant target for DBS, the tremendous advances in computerized brain imaging, the sophistication and versatility of implantable DBS hardware, and the large potential for research. KEY MESSAGES Many aspects of contemporary DBS bear strong resemblance to practices of the past. The dominant clinical indications remain movement disorders with virtually the same brain targets as in the past, with one exception: the STN. Other novel brain targets - that are so far subject to DBS trials - are the pedunculopontine nucleus for gait freezing, the anteromedial internal pallidum for Gilles de la Tourette and the fornix for Alzheimer's disease. The major innovations and novelties compared to the past concern mainly the unmatched level of research activity, its high degree of sponsorship, and the outstanding advances in technology that have enabled multimodal brain imaging and the miniaturization, versatility, and sophistication of implantable hardware. The greatest benefit for patients today, compared to the past, is the higher level of precision and safety of DBS, and of all functional stereotactic neurosurgery.
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Affiliation(s)
- Marwan Hariz
- Department of Clinical Neuroscience, Umeå University, Umeå, Sweden
- UCL Institute of Neurology, Queen Square, London, UK
| | - Laura Cif
- Laboratoire de Recherche en Neurosciences Cliniques, Montpellier, France
| | - Patric Blomstedt
- Department of Clinical Neuroscience, Umeå University, Umeå, Sweden
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López-Blanco R, Sorrentino Rodriguez A, Cubo E, Gabilondo Í, Ezpeleta D, Labrador-Espinosa MÁ, Sánchez-Ferro Á, Tejero C, Matarazzo M. Impact of new technologies on neurology in Spain. Review by the New Technologies Ad-Hoc Committee of the Spanish Society of Neurology. Neurologia 2023; 38:591-598. [PMID: 35842132 DOI: 10.1016/j.nrleng.2020.10.011] [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: 09/30/2020] [Accepted: 10/10/2020] [Indexed: 10/17/2022] Open
Abstract
INTRODUCTION New technologies are increasingly widespread in biomedicine. Using the consensus definition of new technologies established by the New Technologies Ad-Hoc Committee of the Spanish Society of Neurology (SEN), we evaluated the impact of these technologies on Spanish neurology, based on communications presented at Annual Meetings of the SEN. MATERIAL AND METHODS We defined the concept of new technology in neurology as a novel technology or novel application of an existing technology, characterised by a certain degree of coherence persisting over time, with the potential to have an impact on the present and/or future of neurology. We conducted a descriptive study of scientific communications presented at the SEN's annual meetings from 2012 to 2018, analysing the type of technology, the field of neurology, and the geographical provenance of the studies. RESULTS We identified 299 communications related with new technologies from a total of 8139 (3.7%), including 120 posters and 179 oral communications, ranging from 1.6% of all communications in 2012 to 6.8% in 2018. The technologies most commonly addressed were advanced neuroimaging (24.7%), biosensors (17.1%), electrophysiology and neurostimulation (14.7%), and telemedicine (13.7%). The neurological fields where new technologies were most widely employed were movement disorders (18.4%), cerebrovascular diseases (15.7%), and dementia (13.4%). Madrid was the region presenting the highest number of communications related to new technologies (32.8%), followed by Catalonia (26.8%) and Andalusia (9.0%). CONCLUSIONS The number of communications addressing new technologies follows an upward trend. The number of technologies used in neurology has increased in parallel with their availability. We found scientific communications in all neurological subspecialties, with a heterogeneous geographical distribution.
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Affiliation(s)
- R López-Blanco
- Servicio Integrado de Neurología, Hospital Universitario Rey Juan Carlos (Móstoles), Hospital General de Villalba, Hospital Universitario Infanta Elena (Valdemoro), Madrid, Spain
| | | | - E Cubo
- Hospital Universitario Burgos, Burgos, Spain
| | - Í Gabilondo
- Hospital Universitario de Cruces, Barakaldo, Spain
| | - D Ezpeleta
- Hospital Universitario Quirónsalud Madrid, Pozuelo de Alarcón, Madrid, Spain
| | - M Á Labrador-Espinosa
- Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Á Sánchez-Ferro
- HM CINAC, Hospital Universitario HM Puerta del Sur, Móstoles, Madrid, Spain
| | - C Tejero
- Hospital Clinico Universitario Lozano Blesa, Zaragoza, Spain
| | - M Matarazzo
- HM CINAC, Hospital Universitario HM Puerta del Sur, Móstoles, Madrid, Spain; Pacific Parkinson's Research Centre, University of British Columbia, Vancouver, BC, Canada.
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Herrera-Ferrá K, Muñoz JM, Nicolini H, Saruwatari Zavala G, Martínez Bullé Goyri VM. Contextual and Cultural Perspectives on Neurorights: Reflections Toward an International Consensus. AJOB Neurosci 2023; 14:360-368. [PMID: 35341473 DOI: 10.1080/21507740.2022.2048722] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The development and use of advanced and innovative neuroscience, neurotechnology and some forms of artificial intelligence have exposed potential threats to the human condition, including human rights. As a result, reconceptualizing or creating human rights (i.e. neurorights) has been proposed to address specific brain and mind issues like free will, personal identity and cognitive liberty. However, perceptions, interpretations and meanings of these issues-and of neurorights-may vary between countries, contexts and cultures, all relevant for an international-consensus definition and implementation of neurorights. Thus, we encourage reflecting on the proactive inclusion of transnational, cross-cultural and contextual considerations and concerns to contribute to the global discourse. This inclusion does not mean endorsing ethical relativism but rather a call to foster a universal understanding of key concepts and concerns. Including contextual and cultural perspectives may truly anticipate global concerns which could be addressed while developing and implementing neurorights. Consequently, any ethical and/or legal regulatory framework(s) for the translational and transnational use of advanced neuroscience, neurotechnology and some forms of artificial intelligence intended to protect and safeguard human dignity should be contextually and culturally mindful, responsible, respectful and inclusive of not only human rights and fundamental freedoms but also of neurocognitive cultural diversity.
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Affiliation(s)
| | - José M Muñoz
- Asociación Mexicana de Neuroética
- Institute for Culture and Society, University of Navarra
- Tatiana Foundation
| | - Humberto Nicolini
- Asociación Mexicana de Neuroética
- National Institute of Genomic Medicine (INMEGEN)
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Rusheen AE, Jensen MA, Gregg NM, Kaufmann TJ, VanGompel JJ, Lee KH, Klassen BT, Miller KJ. Preliminary Experience with a Four-Lead Implantable Pulse Generator for Deep Brain Stimulation. Stereotact Funct Neurosurg 2023; 101:254-264. [PMID: 37454656 DOI: 10.1159/000530782] [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: 12/14/2022] [Accepted: 04/07/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Implantable pulse generators (IPGs) store energy and deliver electrical impulses for deep brain stimulation (DBS) to treat neurological and psychiatric disorders. IPGs have evolved over time to meet the demands of expanding clinical indications and more nuanced therapeutic approaches. OBJECTIVES The aim of this study was to examine the workflow of the first 4-lead IPG for DBS in patients with complex disease. METHOD The engineering capabilities, clinical use cases, and surgical technique are described in a cohort of 12 patients with epilepsy, essential tremor, Parkinson's disease, mixed tremor, and Tourette's syndrome with comorbid obsessive-compulsive disorder between July 2021 and July 2022. RESULTS This system is a rechargeable 32-channel, 4-port system with independent current control that can be connected to 8 contact linear or directionally segmented leads. The system is ideal for patients with mixed disease or those with multiple severe symptoms amenable to >2 lead implantations. A multidisciplinary team including neurologists, radiologists, and neurosurgeons is necessary to safely plan the procedure. There were no serious intraoperative or postoperative adverse events. One patient required revision surgery for bowstringing. CONCLUSIONS This new 4-lead IPG represents an important new tool for DBS surgery with the ability to expand lead implantation paradigms for patients with complex disease.
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Affiliation(s)
- Aaron Elliott Rusheen
- Medical Scientist Training Program, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael A Jensen
- Medical Scientist Training Program, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Jamie J VanGompel
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Kendall H Lee
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
- Department of Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, USA
| | - Bryan T Klassen
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Kai Joshua Miller
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
- Department of Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, USA
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Zuk P, Sanchez CE, Kostick-Quenet K, Muñoz KA, Kalwani L, Lavingia R, Torgerson L, Sierra-Mercado D, Robinson JO, Pereira S, Outram S, Koenig BA, McGuire AL, Lázaro-Muñoz G. Researcher Views on Changes in Personality, Mood, and Behavior in Next-Generation Deep Brain Stimulation. AJOB Neurosci 2023; 14:287-299. [PMID: 35435795 PMCID: PMC9639000 DOI: 10.1080/21507740.2022.2048724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The literature on deep brain stimulation (DBS) and adaptive DBS (aDBS) raises concerns that these technologies may affect personality, mood, and behavior. We conducted semi-structured interviews with researchers (n = 23) involved in developing next-generation DBS systems, exploring their perspectives on ethics and policy topics including whether DBS/aDBS can cause such changes. The majority of researchers reported being aware of personality, mood, or behavioral (PMB) changes in recipients of DBS/aDBS. Researchers offered varying estimates of the frequency of PMB changes. A smaller majority reported changes in personality specifically. Some expressed reservations about the scientific status of the term 'personality,' while others used it freely. Most researchers discussed negative PMB changes, but a majority said that DBS/aDBS can also result in positive changes. Several researchers viewed positive PMB changes as part of the therapeutic goal in psychiatric applications of DBS/aDBS. Finally, several discussed potential causes of PMB changes other than the device itself.
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Das A, Menon V. Concurrent- and After-Effects of Medial Temporal Lobe Stimulation on Directed Information Flow to and from Prefrontal and Parietal Cortices during Memory Formation. J Neurosci 2023; 43:3159-3175. [PMID: 36963847 PMCID: PMC10146497 DOI: 10.1523/jneurosci.1728-22.2023] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 03/06/2023] [Accepted: 03/13/2023] [Indexed: 03/26/2023] Open
Abstract
Electrical stimulation of the medial temporal lobe (MTL) has the potential to uncover causal circuit mechanisms underlying memory function. However, little is known about how MTL stimulation alters information flow with frontoparietal cortical regions implicated in episodic memory. We used intracranial EEG recordings from humans (14 participants, 10 females) to investigate how MTL stimulation alters directed information flow between MTL and PFC and between MTL and posterior parietal cortex (PPC). Participants performed a verbal episodic memory task during which they were presented with words and asked to recall them after a delay of ∼20 s; 50 Hz stimulation was applied to MTL electrodes on selected trials during memory encoding. Directed information flow was examined using phase transfer entropy. Behaviorally, we observed that MTL stimulation reduced memory recall. MTL stimulation decreased top-down PFC→MTL directed information flow during both memory encoding and subsequent memory recall, revealing aftereffects more than 20 s after end of stimulation. Stimulation suppressed top-down PFC→MTL influences to a greater extent than PPC→MTL. Finally, MTL→PFC information flow on stimulation trials was significantly lower for successful, compared with unsuccessful, memory recall; in contrast, MTL→ventral PPC information flow was higher for successful, compared with unsuccessful, memory recall. Together, these results demonstrate that the effects of MTL stimulation are behaviorally, regionally, and directionally specific, that MTL stimulation selectively impairs directional signaling with PFC, and that causal MTL-ventral PPC circuits support successful memory recall. Findings provide new insights into dynamic casual circuits underling episodic memory and their modulation by MTL stimulation.SIGNIFICANCE STATEMENT The medial temporal lobe (MTL) and its interactions with prefrontal and parietal cortices (PFC and PPC) play a critical role in human memory. Dysfunctional MTL-PFC and MTL-PPC circuits are prominent in psychiatric and neurologic disorders, including Alzheimer's disease and schizophrenia. Brain stimulation has emerged as a potential mechanism for enhancing memory and cognitive functions, but the underlying neurophysiological mechanisms and dynamic causal circuitry underlying bottom-up and top-down signaling involving the MTL are unknown. Here, we use intracranial EEG recordings to investigate the effects of MTL stimulation on causal signaling in key episodic memory circuits linking the MTL with PFC and PPC. Our findings have implications for translational applications aimed at realizing the promise of brain stimulation-based treatment of memory disorders.
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Affiliation(s)
- Anup Das
- Department of Psychiatry & Behavioral Sciences
| | - Vinod Menon
- Department of Psychiatry & Behavioral Sciences
- Department of Neurology & Neurological Sciences
- Stanford Neurosciences Institute, Stanford University School of Medicine, Stanford, California 94305
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11
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Wang Y, Yang J, Cai M, Liu X, Lu K, Lou Y, Li Z. Application of optimized convolutional neural networks for early aided diagnosis of essential tremor: Automatic handwriting recognition and feature analysis. Med Eng Phys 2023; 113:103962. [PMID: 36966002 DOI: 10.1016/j.medengphy.2023.103962] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 02/05/2023] [Accepted: 02/20/2023] [Indexed: 02/24/2023]
Abstract
Essential tremor (ET) is one of the most common neurological disorders, and its mainly clinical symptoms, including patient hand's kinetic tremor, dystonia, ataxia, etc., would influence the daily life of patients inordinately. Current ET diagnosis highly replies on the clinical evaluation and neurological examination, so the objective measurement indicators are particularly important in the auxiliary diagnosis of ET. In this research, the Archimedes spiral line freehand sketching samples without template assistance is collected and the Convolutional Neural Network (CNN) model of optimized structure is adopted to fully analyze the tremor, spacing of turns, shape, etc. shown in the handwriting samples of patients with ET, including the following main process: characteristics extraction, model visualization and subregional relevance evaluation. Dropout is used as a regularization technique in the network structure. The test group consisted of 50 patients with confirmed ET and the control group consisted of 40 healthy individuals. The main research objectives of this paper comprise two points: on the one hand, to achieve effective automatic classification of patients with ET and healthy controls using a scheme combining deep learning and simple hand mapping for the purpose of primary disease screening; on the other hand, to design sub-regional automatic classification experiments to demonstrate that Archimedean spiral hand drawings of patients with ET do have distinct local features, and to lay the experimental foundation for future hand drawing-based automatic aid for the identification of a variety of neurodegenerative diseases. Our model's average accuracy rate in test set reaches 89.3%, and average AUC is 0.972, with favorable stability and generalization performance. Besides, subregional characteristics recognition proofs that the spiral line samples of most of the patients with ET show more category-related characteristics in the local area of upper right, which provides evidences and theory update for predecessors' medical research.
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Affiliation(s)
- Yanwen Wang
- Neurology Department, Zhejiang Hospital, Zhejiang 310013, China
| | - Jiayu Yang
- School of Electronics and Information, Hangzhou Dianzi University, Zhejiang 310018, China
| | - Miao Cai
- Neurology Department, Zhejiang Hospital, Zhejiang 310013, China
| | - Xiaoli Liu
- Neurology Department, Zhejiang Hospital, Zhejiang 310013, China
| | - Kang Lu
- School of Electronics and Information, Hangzhou Dianzi University, Zhejiang 310018, China
| | - Yue Lou
- Neurology Department, Zhejiang Hospital, Zhejiang 310013, China
| | - Zhu Li
- School of Electronics and Information, Hangzhou Dianzi University, Zhejiang 310018, China.
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Gault JM, Hosokawa P, Kramer D, Saks ER, Appelbaum PS, Thompson JA, Olincy A, Cascella N, Sawa A, Goodman W, Moukaddam N, Sheth SA, Anderson WS, Davis RA. Postsurgical morbidity and mortality favorably informs deep brain stimulation for new indications including schizophrenia and schizoaffective disorder. Front Surg 2023; 10:958452. [PMID: 37066004 PMCID: PMC10098000 DOI: 10.3389/fsurg.2023.958452] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 03/07/2023] [Indexed: 04/18/2023] Open
Abstract
Background Deep brain stimulation (DBS) shows promise for new indications like treatment-refractory schizophrenia in early clinical trials. In the first DBS clinical trial for treatment refractory schizophrenia, despite promising results in treating psychosis, one of the eight subjects experienced both a symptomatic hemorrhage and an infection requiring device removal. Now, ethical concerns about higher surgical risk in schizophrenia/schizoaffective disorder (SZ/SAD) are impacting clinical trial progress. However, insufficient cases preclude conclusions regarding DBS risk in SZ/SAD. Therefore, we directly compare adverse surgical outcomes for all surgical procedures between SZ/SAD and Parkinson's disease (PD) cases to infer relative surgical risk relevant to gauging DBS risks in subjects with SZ/SAD. Design In the primary analysis, we used browser-based statistical analysis software, TriNetX Live (trinetx.com TriNetX LLC, Cambridge, MA), for Measures of Association using the Z-test. Postsurgical morbidity and mortality after matching for ethnicity, over 39 risk factors, and 19 CPT 1003143 coded surgical procedures from over 35,000 electronic medical records, over 19 years, from 48 United States health care organizations (HCOs) through the TriNetX Research Network™. TriNetXis a global, federated, web-based health research network providing access and statistical analysis of aggregate counts of deidentified EMR data. Diagnoses were based on ICD-10 codes. In the final analysis, logistic regression was used to determine relative frequencies of outcomes among 21 diagnostic groups/cohorts being treated with or considered for DBS and 3 control cohorts. Results Postsurgical mortality was 1.01-4.11% lower in SZ/SAD compared to the matched PD cohort at 1 month and 1 year after any surgery, while morbidity was 1.91-2.73% higher and associated with postsurgical noncompliance with medical treatment. Hemorrhages and infections were not increased. Across the 21 cohorts compared, PD and SZ/SAD were among eight cohorts with fewer surgeries, nine cohorts with higher postsurgical morbidity, and fifteen cohorts within the control-group range for 1-month postsurgical mortality. Conclusions Given that the subjects with SZ or SAD, along with most other diagnostic groups examined, had lower postsurgical mortality than PD subjects, it is reasonable to apply existing ethical and clinical guidelines to identify appropriate surgical candidates for inclusion of these patient populations in DBS clinical trials.
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Affiliation(s)
- Judith M. Gault
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- Correspondence: Judith M. Gault
| | - Patrick Hosokawa
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Daniel Kramer
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Elyn R. Saks
- The Law School, University of Southern California, Los Angeles, CA, United States
| | - Paul S. Appelbaum
- Department of Psychiatry, Columbia University, New York, Ny, United States Of America
| | - John A. Thompson
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Ann Olincy
- VA Eastern Colorado Medical Center, Aurora, CO, United States
| | - Nicola Cascella
- Department of Psychiatry, Johns Hopkins University, Baltimore, MD, United States
| | - Akira Sawa
- Department of Psychiatry, Johns Hopkins University, Baltimore, MD, United States
| | - Wayne Goodman
- Department of Psychiatry, Baylor College of Medicine, Houston, TX, United States
| | - Nidal Moukaddam
- Department of Psychiatry, Baylor College of Medicine, Houston, TX, United States
| | - Sameer A. Sheth
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United States
| | - William S. Anderson
- Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, United States
| | - Rachel A. Davis
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
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13
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Durrani S, Onyedimma C, Jarrah R, Bhatti A, Nathani KR, Bhandarkar AR, Mualem W, Ghaith AK, Zamanian C, Michalopoulos GD, Alexander AY, Jean W, Bydon M. The Virtual Vision of Neurosurgery: How Augmented Reality and Virtual Reality are Transforming the Neurosurgical Operating Room. World Neurosurg 2022; 168:190-201. [DOI: 10.1016/j.wneu.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 09/30/2022] [Accepted: 10/01/2022] [Indexed: 11/22/2022]
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14
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Cassar IR, Grill WM. The cortical evoked potential corresponds with deep brain stimulation efficacy in rats. J Neurophysiol 2022; 127:1253-1268. [PMID: 35389751 PMCID: PMC9054265 DOI: 10.1152/jn.00353.2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 03/28/2022] [Accepted: 04/02/2022] [Indexed: 01/21/2023] Open
Abstract
Deep brain stimulation (DBS) of the subthalamic nucleus (STN) antidromically activates the motor cortex (M1), and this cortical activation appears to play a role in the treatment of hypokinetic motor behaviors (Gradinaru V, Mogri M, Thompson KR, Henderson JM, Deisseroth K. Science 324: 354-359, 2009; Yu C, Cassar IR, Sambangi J, Grill WM. J Neurosci 40: 4323-4334, 2020). The synchronous antidromic activation takes the form of a short-latency cortical evoked potential (cEP) in electrocorticography (ECoG) recordings of M1. We assessed the utility of the cEP as a biomarker for STN DBS in unilateral 6-hydroxydopamine-lesioned female Sprague Dawley rats, with stimulating electrodes implanted in the STN and the ECoG recorded above M1. We quantified the correlations of the cEP magnitude and latency with changes in motor behavior from DBS and compared them to the correlation between motor behaviors and several commonly used spectral-based biomarkers. The cEP features correlated strongly with motor behaviors and were highly consistent across animals, whereas the spectral biomarkers correlated weakly with motor behaviors and were highly variable across animals. The cEP may thus be a useful biomarker for assessing the therapeutic efficacy of DBS parameters, as its features strongly correlate with motor behavior, it is consistent across time and subjects, it can be recorded under anesthesia, and it is simple to quantify with a large signal-to-noise ratio, enabling rapid, real-time evaluation. Additionally, our work provides further evidence that antidromic cortical activation mediates changes in motor behavior from STN DBS and that the dependence of DBS efficacy on stimulation frequency may be related to antidromic spike failure.NEW & NOTEWORTHY We characterize a new potential biomarker for deep brain stimulation (DBS), the cortical evoked potential (cEP), and demonstrate that it exhibits a robust correlation with motor behaviors as a function of stimulation frequency. The cEP may thus be a useful clinical biomarker for changes in motor behavior. This work also provides insight into the cortical mechanisms of DBS, suggesting that motor behaviors are strongly affected by the rate of antidromic spike failure during DBS.
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Affiliation(s)
- Isaac R Cassar
- Department of Biomedical Engineering, Duke University, Durham, North Carolina
| | - Warren M Grill
- Department of Biomedical Engineering, Duke University, Durham, North Carolina
- Department of Electrical and Computer Engineering, Duke University, Durham, North Carolina
- Department of Neurobiology, Duke University, Durham, North Carolina
- Department of Neurosurgery, Duke University, Durham, North Carolina
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15
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Stevens I, Gilbert F. International Regulatory Standards for the Qualitative Measurement of Deep Brain Stimulation in Clinical Research. J Empir Res Hum Res Ethics 2022; 17:228-241. [DOI: 10.1177/15562646221094922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Deep brain stimulation (DBS) has progressed to become a promising treatment modality for neurologic and psychiatric disorders like epilepsy and major depressive disorder due to its growing personalization. Despite evidence pointing to the benefits of DBS if tested on these personalized qualitative metrics, rather than randomized-control trial quantitative standards, the evaluation of these novel devices appears to be based on the latter. This study surveyed the presence of this trend in the national regulatory guidelines of the prominent DBS researching countries. It was found that two governing bodies, in the European Union and Australia, acknowledged the option for qualitative measures. These findings support further development of national regulatory guidelines, so the neuroscientific community developing these neurotechnologies can better understand the impact their treatments have on patients.
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Affiliation(s)
- I. Stevens
- School of Humanities, University of Tasmania, Hobart, Tasmania, Australia
| | - F. Gilbert
- School of Humanities, University of Tasmania, Hobart, Tasmania, Australia
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16
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Villamil V, Wolbring G. Influencing discussions and use of neuroadvancements as professionals and citizens: Perspectives of Canadian speech-language pathologists and audiologists. Work 2022; 71:565-584. [DOI: 10.3233/wor-205104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND: Early involvement of stakeholders in neuroethics and neurogovernance discourses of neuroscientific and neurotechnological advancements is seen as essential to curtail negative consequences. Speech-language pathologists (SLPs) and audiologists (AUs) make use of neuroadvancements including cochlear implants, brain-computer interfaces, and deep-brain stimulation. Although they have a stake in neuroethics and neurogovernance discussions, they are rarely mentioned in having a role, whether as professionals or as citizens. OBJECTIVE: The objective of the study was to explore the role of SLPs and AUs as professionals and citizens in neuroethics and neurogovernance discussions and examine the utility of lifelong learning mechanisms to learn about the implications of neuroadvancements to contribute in a meaningful way to these discussions. METHODS: Semi-structured interviews conducted with 7 SLPs and 3 AUs were analyzed using thematic analysis. RESULTS: Participants stated that their roles expected from them as professionals and as citizens indicate the importance to be knowledgeable on ethical, legal, and social implications of neuroadvancements and that lifelong learning is not used to learn about these implications. CONCLUSION: More must be done to facilitate the participation of SLPs and AUs in neuroethics and neurogovernance discussions, which would enrich the neuroethics and neurogovernance discourses benefitting patients, professionals, and the public.
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Affiliation(s)
- Valentina Villamil
- Speech-Language Pathology, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Gregor Wolbring
- Community Rehabilitation and Disability Studies, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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17
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Widge AS, Zhang F, Gosai A, Papadimitrou G, Wilson-Braun P, Tsintou M, Palanivelu S, Noecker AM, McIntyre CC, O’Donnell L, McLaughlin NCR, Greenberg BD, Makris N, Dougherty DD, Rathi Y. Patient-specific connectomic models correlate with, but do not reliably predict, outcomes in deep brain stimulation for obsessive-compulsive disorder. Neuropsychopharmacology 2022; 47:965-972. [PMID: 34621015 PMCID: PMC8882183 DOI: 10.1038/s41386-021-01199-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 08/11/2021] [Accepted: 09/23/2021] [Indexed: 12/15/2022]
Abstract
Deep brain stimulation (DBS) of the ventral internal capsule/ventral striatum (VCVS) is an emerging treatment for obsessive-compulsive disorder (OCD). Recently, multiple studies using normative connectomes have correlated DBS outcomes to stimulation of specific white matter tracts. Those studies did not test whether these correlations are clinically predictive, and did not apply cross-validation approaches that are necessary for biomarker development. Further, they did not account for the possibility of systematic differences between DBS patients and the non-diagnosed controls used in normative connectomes. To address these gaps, we performed patient-specific diffusion imaging in 8 patients who underwent VCVS DBS for OCD. We delineated tracts connecting thalamus and subthalamic nucleus (STN) to prefrontal cortex via VCVS. We then calculated which tracts were likely activated by individual patients' DBS settings. We fit multiple statistical models to predict both OCD and depression outcomes from tract activation. We further attempted to predict hypomania, a VCVS DBS complication. We assessed all models' performance on held-out test sets. With this best-practices approach, no model predicted OCD response, depression response, or hypomania above chance. Coefficient inspection partly supported prior reports, in that capture of tracts projecting to cingulate cortex was associated with both YBOCS and MADRS response. In contrast to prior reports, however, tracts connected to STN were not reliably correlated with response. Thus, patient-specific imaging and a guideline-adherent analysis were unable to identify a tractographic target with sufficient effect size to drive clinical decision-making or predict individual outcomes. These findings suggest caution in interpreting the results of normative connectome studies.
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Affiliation(s)
- Alik S. Widge
- grid.17635.360000000419368657Department of Psychiatry, University of Minnesota, Minneapolis, MN USA
| | - Fan Zhang
- grid.62560.370000 0004 0378 8294Department of Radiology, Brigham and Womens Hospital, Boston, MA USA
| | - Aishwarya Gosai
- grid.32224.350000 0004 0386 9924Department of Psychiatry, Massachusetts General Hospital, Boston, MA USA
| | - George Papadimitrou
- grid.32224.350000 0004 0386 9924Department of Psychiatry, Massachusetts General Hospital, Boston, MA USA
| | - Peter Wilson-Braun
- grid.32224.350000 0004 0386 9924Department of Psychiatry, Massachusetts General Hospital, Boston, MA USA
| | - Magdalini Tsintou
- grid.32224.350000 0004 0386 9924Department of Psychiatry, Massachusetts General Hospital, Boston, MA USA
| | - Senthil Palanivelu
- grid.32224.350000 0004 0386 9924Department of Psychiatry, Massachusetts General Hospital, Boston, MA USA
| | - Angela M. Noecker
- grid.67105.350000 0001 2164 3847Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH USA
| | - Cameron C. McIntyre
- grid.67105.350000 0001 2164 3847Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH USA
| | - Lauren O’Donnell
- grid.62560.370000 0004 0378 8294Department of Radiology, Brigham and Womens Hospital, Boston, MA USA
| | - Nicole C. R. McLaughlin
- grid.40263.330000 0004 1936 9094Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI USA ,grid.273271.20000 0000 8593 9332Butler Hospital, Providence, RI USA
| | - Benjamin D. Greenberg
- grid.40263.330000 0004 1936 9094Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI USA ,grid.273271.20000 0000 8593 9332Butler Hospital, Providence, RI USA ,Center for Neurorestoration and Neurotechnology, VA Providence Healthcare System, Providence, RI USA
| | - Nikolaos Makris
- grid.32224.350000 0004 0386 9924Department of Psychiatry, Massachusetts General Hospital, Boston, MA USA
| | - Darin D. Dougherty
- grid.32224.350000 0004 0386 9924Department of Psychiatry, Massachusetts General Hospital, Boston, MA USA
| | - Yogesh Rathi
- grid.62560.370000 0004 0378 8294Department of Radiology, Brigham and Womens Hospital, Boston, MA USA ,grid.32224.350000 0004 0386 9924Department of Psychiatry, Massachusetts General Hospital, Boston, MA USA
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18
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Pozzi NG, Isaias IU. Adaptive deep brain stimulation: Retuning Parkinson's disease. HANDBOOK OF CLINICAL NEUROLOGY 2022; 184:273-284. [PMID: 35034741 DOI: 10.1016/b978-0-12-819410-2.00015-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A brain-machine interface represents a promising therapeutic avenue for the treatment of many neurologic conditions. Deep brain stimulation (DBS) is an invasive, neuro-modulatory tool that can improve different neurologic disorders by delivering electric stimulation to selected brain areas. DBS is particularly successful in advanced Parkinson's disease (PD), where it allows sustained improvement of motor symptoms. However, this approach is still poorly standardized, with variable clinical outcomes. To achieve an optimal therapeutic effect, novel adaptive DBS (aDBS) systems are being developed. These devices operate by adapting stimulation parameters in response to an input signal that can represent symptoms, motor activity, or other behavioral features. Emerging evidence suggests greater efficacy with fewer adverse effects during aDBS compared with conventional DBS. We address this topic by discussing the basics principles of aDBS, reviewing current evidence, and tackling the many challenges posed by aDBS for PD.
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Affiliation(s)
- Nicoló G Pozzi
- Department of Neurology, University Hospital Würzburg and Julius Maximilian University Würzburg, Würzburg, Germany
| | - Ioannis U Isaias
- Department of Neurology, University Hospital Würzburg and Julius Maximilian University Würzburg, Würzburg, Germany.
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19
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Xu SS, Sinclair NC, Bulluss KJ, Perera T, Lee WL, McDermott HJ, Thevathasan W. Towards guided and automated programming of subthalamic area stimulation in Parkinson’s disease. Brain Commun 2022; 4:fcac003. [PMID: 35169708 PMCID: PMC8833293 DOI: 10.1093/braincomms/fcac003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 11/25/2021] [Accepted: 01/10/2022] [Indexed: 11/16/2022] Open
Abstract
Selecting the ideal contact to apply subthalamic nucleus deep brain stimulation in Parkinson’s disease can be an arduous process, with outcomes highly dependent on clinician expertise. This study aims to assess whether neuronal signals recorded intraoperatively in awake patients, and the anatomical location of contacts, can assist programming. In a cohort of 14 patients with Parkinson’s disease, implanted with subthalamic nucleus deep brain stimulation, the four contacts on each lead in the 28 hemispheres were ranked according to proximity to a nominated ideal anatomical location and power of the following neuronal signals: evoked resonant neural activity, beta oscillations and high-frequency oscillations. We assessed how these rankings predicted, on each lead: (i) the motor benefit from deep brain stimulation applied through each contact and (ii) the ‘ideal’ contact to apply deep brain stimulation. The ranking of contacts according to each factor predicted motor benefit from subthalamic nucleus deep brain stimulation, as follows: evoked resonant neural activity; r2 = 0.50, Akaike information criterion 1039.9, beta; r2 = 0.50, Akaike information criterion 1041.6, high-frequency oscillations; r2 = 0.44, Akaike information criterion 1057.2 and anatomy; r2 = 0.49, Akaike information criterion 1048.0. Combining evoked resonant neural activity, beta and high-frequency oscillations ranking data yielded the strongest predictive model (r2 = 0.61, Akaike information criterion 1021.5). The ‘ideal’ contact (yielding maximal benefit) was ranked first according to each factor in the following proportion of hemispheres; evoked resonant neural activity 18/28, beta 17/28, anatomy 16/28, high-frequency oscillations 7/28. Across hemispheres, the maximal available deep brain stimulation benefit did not differ from that yielded by contacts chosen by clinicians for chronic therapy or contacts ranked first according to evoked resonant neural activity. Evoked resonant neural activity, beta oscillations and anatomy similarly predicted how motor benefit from subthalamic nucleus deep brain stimulation varied across contacts on each lead. This could assist programming by providing a probability ranking of contacts akin to a ‘monopolar survey’. However, these factors identified the ‘ideal’ contact in only a proportion of hemispheres. More advanced signal processing and anatomical techniques may be needed for the full automation of contact selection.
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Affiliation(s)
- San San Xu
- Bionics Institute, East Melbourne, Victoria, Australia
- Medical Bionics Department, The University of Melbourne, East Melbourne, Victoria, Australia
- Department of Neurology, Austin Hospital, Heidelberg, Victoria, Australia
| | - Nicholas C. Sinclair
- Bionics Institute, East Melbourne, Victoria, Australia
- Medical Bionics Department, The University of Melbourne, East Melbourne, Victoria, Australia
| | - Kristian J. Bulluss
- Bionics Institute, East Melbourne, Victoria, Australia
- Department of Neurosurgery, St Vincent’s Hospital Melbourne, Fitzroy, and Department of Neurosurgery, Austin Hospital, Heidelberg, Victoria, Australia
- Department of Surgery, The University of Melbourne, Parkville, Victoria, Australia
| | - Thushara Perera
- Bionics Institute, East Melbourne, Victoria, Australia
- Medical Bionics Department, The University of Melbourne, East Melbourne, Victoria, Australia
| | - Wee-Lih Lee
- Bionics Institute, East Melbourne, Victoria, Australia
| | - Hugh J. McDermott
- Bionics Institute, East Melbourne, Victoria, Australia
- Medical Bionics Department, The University of Melbourne, East Melbourne, Victoria, Australia
| | - Wesley Thevathasan
- Bionics Institute, East Melbourne, Victoria, Australia
- Department of Neurology, Austin Hospital, Heidelberg, Victoria, Australia
- Department of Medicine, The University of Melbourne, and Department of Neurology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
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20
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Denison T, Morrell MJ. Neuromodulation in 2035: The Neurology Future Forecasting Series. Neurology 2022; 98:65-72. [PMID: 35263267 PMCID: PMC8762584 DOI: 10.1212/wnl.0000000000013061] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 11/08/2021] [Indexed: 11/15/2022] Open
Abstract
Neuromodulation devices are approved in the United States for the treatment of movement disorders, epilepsy, pain, and depression, and are used off-label for other neurologic indications. By 2035, advances in our understanding of neuroanatomical networks and in the mechanism of action of stimulation, coupled with developments in material science, miniaturization, energy storage, and delivery, will expand the use of neuromodulation devices. Neuromodulation approaches are flexible and modifiable. Stimulation can be targeted to a dysfunctional brain focus, region, or network, and can be delivered as a single treatment, continuously, according to a duty cycle, or in response to physiologic changes. Programming can be titrated and modified based on the clinical response or a physiologic biomarker. In addition to keeping pace with clinical and technological developments, neurologists in 2035 will need to navigate complex ethical and economic considerations to ensure access to neuromodulation technology for a rapidly expanding population of patients. This article provides an overview of systems in use today and those that are anticipated and highlights the opportunities and challenges for the future, some of which are technical, but most of which will be addressed by learning about brain networks, and from rapidly growing experience with neuromodulation devices.
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Affiliation(s)
- Tim Denison
- From the Department of Engineering Science (T.D.), University of Oxford, UK; Department of Neurology and Neurological Sciences (M.J.M), Stanford University, CA; and NeuroPace (M.J.M), Mountain View, CA
| | - Martha J Morrell
- From the Department of Engineering Science (T.D.), University of Oxford, UK; Department of Neurology and Neurological Sciences (M.J.M), Stanford University, CA; and NeuroPace (M.J.M), Mountain View, CA.
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21
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Montag M, Paschall C, Ojemann J, Rao R, Herron J. A Platform for Virtual Reality Task Design with Intracranial Electrodes. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:6659-6662. [PMID: 34892635 DOI: 10.1109/embc46164.2021.9630231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Research with human intracranial electrodes has traditionally been constrained by the limitations of the inpatient clinical setting. Immersive virtual reality (VR), however, can transcend setting and enable novel task design with precise control over visual and auditory stimuli. This control over visual and auditory feedback makes VR an exciting platform for new in-patient, human electrocorticography (ECOG) and stereo-electroencephalography (sEEG) research. The integration of intracranial electrode recording and stimulation with VR task dynamics required foundational systems engineering. In this work, we present a custom API that bridges Unity, the leading VR game development engine, and Synapse, the proprietary software of the Tucker Davis Technologies (TDT) neural recording and stimulation platform. To demonstrate the functionality and efficiency of our API, we developed a closed-loop brain-computer interface (BCI) task in which filtered neural signals controlled the movement of a virtual object and virtual object dynamics triggered neural stimulation. This closed-loop VR-BCI task confirmed the utility, safety, and efficacy of our API and its readiness for human task deployment.
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22
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Herrero JL, Smith A, Mishra A, Markowitz N, Mehta AD, Bickel S. Inducing neuroplasticity through intracranial θ-burst stimulation in the human sensorimotor cortex. J Neurophysiol 2021; 126:1723-1739. [PMID: 34644179 PMCID: PMC8782667 DOI: 10.1152/jn.00320.2021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 09/20/2021] [Accepted: 10/08/2021] [Indexed: 01/04/2023] Open
Abstract
The progress of therapeutic neuromodulation greatly depends on improving stimulation parameters to most efficiently induce neuroplasticity effects. Intermittent θ-burst stimulation (iTBS), a form of electrical stimulation that mimics natural brain activity patterns, has proved to efficiently induce such effects in animal studies and rhythmic transcranial magnetic stimulation studies in humans. However, little is known about the potential neuroplasticity effects of iTBS applied through intracranial electrodes in humans. This study characterizes the physiological effects of intracranial iTBS in humans and compare them with α-frequency stimulation, another frequently used neuromodulatory pattern. We applied these two stimulation patterns to well-defined regions in the sensorimotor cortex, which elicited contralateral hand muscle contractions during clinical mapping, in patients with epilepsy implanted with intracranial electrodes. Treatment effects were evaluated using oscillatory coherence across areas connected to the treatment site, as defined with corticocortical-evoked potentials. Our results show that iTBS increases coherence in the β-frequency band within the sensorimotor network indicating a potential neuroplasticity effect. The effect is specific to the sensorimotor system, the β band, and the stimulation pattern and outlasted the stimulation period by ∼3 min. The effect occurred in four out of seven subjects depending on the buildup of the effect during iTBS treatment and other patterns of oscillatory activity related to ceiling effects within the β band and to preexistent coherence within the α band. By characterizing the neurophysiological effects of iTBS within well-defined cortical networks, we hope to provide an electrophysiological framework that allows clinicians/researchers to optimize brain stimulation protocols which may have translational value.NEW & NOTEWORTHY θ-Burst stimulation (TBS) protocols in transcranial magnetic stimulation studies have shown improved treatment efficacy in a variety of neuropsychiatric disorders. The optimal protocol to induce neuroplasticity in invasive direct electrical stimulation approaches is not known. We report that intracranial TBS applied in human sensorimotor cortex increases local coherence of preexistent β rhythms. The effect is specific to the stimulation frequency and the stimulated network and outlasts the stimulation period by ∼3 min.
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Affiliation(s)
- Jose L Herrero
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York
- Department of Neurosurgery, Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York
| | - Alexander Smith
- Department of Neurosurgery, Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York
| | - Akash Mishra
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York
- Department of Neurosurgery, Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York
| | - Noah Markowitz
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York
- Department of Neurosurgery, Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York
| | - Ashesh D Mehta
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York
- Department of Neurosurgery, Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York
| | - Stephan Bickel
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York
- Department of Neurosurgery, Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York
- Department of Neurology, Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York
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23
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Sarica C, Iorio-Morin C, Aguirre-Padilla DH, Najjar A, Paff M, Fomenko A, Yamamoto K, Zemmar A, Lipsman N, Ibrahim GM, Hamani C, Hodaie M, Lozano AM, Munhoz RP, Fasano A, Kalia SK. Implantable Pulse Generators for Deep Brain Stimulation: Challenges, Complications, and Strategies for Practicality and Longevity. Front Hum Neurosci 2021; 15:708481. [PMID: 34512295 PMCID: PMC8427803 DOI: 10.3389/fnhum.2021.708481] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 07/30/2021] [Indexed: 11/29/2022] Open
Abstract
Deep brain stimulation (DBS) represents an important treatment modality for movement disorders and other circuitopathies. Despite their miniaturization and increasing sophistication, DBS systems share a common set of components of which the implantable pulse generator (IPG) is the core power supply and programmable element. Here we provide an overview of key hardware and software specifications of commercially available IPG systems such as rechargeability, MRI compatibility, electrode configuration, pulse delivery, IPG case architecture, and local field potential sensing. We present evidence-based approaches to mitigate hardware complications, of which infection represents the most important factor. Strategies correlating positively with decreased complications include antibiotic impregnation and co-administration and other surgical considerations during IPG implantation such as the use of tack-up sutures and smaller profile devices.Strategies aimed at maximizing battery longevity include patient-related elements such as reliability of IPG recharging or consistency of nightly device shutoff, and device-specific such as parameter delivery, choice of lead configuration, implantation location, and careful selection of electrode materials to minimize impedance mismatch. Finally, experimental DBS systems such as ultrasound, magnetoelectric nanoparticles, and near-infrared that use extracorporeal powered neuromodulation strategies are described as potential future directions for minimally invasive treatment.
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Affiliation(s)
- Can Sarica
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Christian Iorio-Morin
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.,Division of Neurosurgery, Department of Surgery, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - David H Aguirre-Padilla
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.,Department of Neurology & Neurosurgery, Center Campus, Universidad de Chile, Santiago, Chile
| | - Ahmed Najjar
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.,Department of Surgery, College of Medicine, Taibah University, Almadinah Almunawwarah, Saudi Arabia
| | - Michelle Paff
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.,Department of Neurosurgery, University of California, Irvine, Irvine, CA, United States
| | - Anton Fomenko
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Kazuaki Yamamoto
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Ajmal Zemmar
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.,Department of Neurosurgery, Henan University School of Medicine, Zhengzhou, China.,Department of Neurosurgery, University of Louisville School of Medicine, Louisville, KY, United States
| | - Nir Lipsman
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - George M Ibrahim
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Clement Hamani
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.,Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Mojgan Hodaie
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.,Krembil Research Institute, University Health Network, Toronto, ON, Canada.,CRANIA Center for Advancing Neurotechnological Innovation to Application, University of Toronto, ON, Canada
| | - Andres M Lozano
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.,Krembil Research Institute, University Health Network, Toronto, ON, Canada.,CRANIA Center for Advancing Neurotechnological Innovation to Application, University of Toronto, ON, Canada
| | - Renato P Munhoz
- Krembil Research Institute, University Health Network, Toronto, ON, Canada.,Edmond J. Safra Program in Parkinson's Disease Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, and Division of Neurology, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
| | - Alfonso Fasano
- Krembil Research Institute, University Health Network, Toronto, ON, Canada.,CRANIA Center for Advancing Neurotechnological Innovation to Application, University of Toronto, ON, Canada.,Edmond J. Safra Program in Parkinson's Disease Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, and Division of Neurology, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
| | - Suneil K Kalia
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.,Krembil Research Institute, University Health Network, Toronto, ON, Canada.,CRANIA Center for Advancing Neurotechnological Innovation to Application, University of Toronto, ON, Canada.,KITE, University Health Network, Toronto, ON, Canada
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24
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Ivan ME, Eichberg DG, Di L, Shah AH, Luther EM, Lu VM, Komotar RJ, Urakov TM. Augmented reality head-mounted display-based incision planning in cranial neurosurgery: a prospective pilot study. Neurosurg Focus 2021; 51:E3. [PMID: 34333466 DOI: 10.3171/2021.5.focus20735] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 05/13/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Monitor and wand-based neuronavigation stations (MWBNSs) for frameless intraoperative neuronavigation are routinely used in cranial neurosurgery. However, they are temporally and spatially cumbersome; the OR must be arranged around the MWBNS, at least one hand must be used to manipulate the MWBNS wand (interrupting a bimanual surgical technique), and the surgical workflow is interrupted as the surgeon stops to "check the navigation" on a remote monitor. Thus, there is need for continuous, real-time, hands-free, neuronavigation solutions. Augmented reality (AR) is poised to streamline these issues. The authors present the first reported prospective pilot study investigating the feasibility of using the OpenSight application with an AR head-mounted display to map out the borders of tumors in patients undergoing elective craniotomy for tumor resection, and to compare the degree of correspondence with MWBNS tracing. METHODS Eleven consecutive patients undergoing elective craniotomy for brain tumor resection were prospectively identified and underwent circumferential tumor border tracing at the time of incision planning by a surgeon wearing HoloLens AR glasses running the commercially available OpenSight application registered to the patient and preoperative MRI. Then, the same patient underwent circumferential tumor border tracing using the StealthStation S8 MWBNS. Postoperatively, both tumor border tracings were compared by two blinded board-certified neurosurgeons and rated as having an excellent, adequate, or poor correspondence degree based on a subjective sense of the overlap. Objective overlap area measurements were also determined. RESULTS Eleven patients undergoing craniotomy were included in the study. Five patient procedures were rated as having an excellent correspondence degree, 5 had an adequate correspondence degree, and 1 had poor correspondence. Both raters agreed on the rating in all cases. AR tracing was possible in all cases. CONCLUSIONS In this small pilot study, the authors found that AR was implementable in the workflow of a neurosurgery OR, and was a feasible method of preoperative tumor border identification for incision planning. Future studies are needed to identify strategies to improve and optimize AR accuracy.
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Affiliation(s)
- Michael E Ivan
- 1Department of Neurological Surgery, University of Miami Miller School of Medicine; and.,2Sylvester Comprehensive Cancer Center, Miami, Florida
| | - Daniel G Eichberg
- 1Department of Neurological Surgery, University of Miami Miller School of Medicine; and
| | - Long Di
- 1Department of Neurological Surgery, University of Miami Miller School of Medicine; and
| | - Ashish H Shah
- 1Department of Neurological Surgery, University of Miami Miller School of Medicine; and
| | - Evan M Luther
- 1Department of Neurological Surgery, University of Miami Miller School of Medicine; and
| | - Victor M Lu
- 1Department of Neurological Surgery, University of Miami Miller School of Medicine; and
| | - Ricardo J Komotar
- 1Department of Neurological Surgery, University of Miami Miller School of Medicine; and.,2Sylvester Comprehensive Cancer Center, Miami, Florida
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25
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Sammartino F, Taylor P, Chen G, Reynolds RC, Glen D, Krishna V. Functional Neuroimaging During Asleep DBS Surgery: A Proof of Concept Study. Front Neurol 2021; 12:659002. [PMID: 34262518 PMCID: PMC8273165 DOI: 10.3389/fneur.2021.659002] [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] [Received: 01/26/2021] [Accepted: 05/25/2021] [Indexed: 11/30/2022] Open
Abstract
Object: A real-time functional magnetic resonance imaging (fMRI) feedback during ventral intermediate nucleus (VIM) deep brain stimulation (DBS) under general anesthesia (or “asleep” DBS) does not exist. We hypothesized that it was feasible to acquire a reliable and responsive fMRI during asleep VIM DBS surgery. Methods: We prospectively enrolled 10 consecutive patients who underwent asleep DBS for the treatment of medication-refractory essential tremor. Under general anesthesia, we acquired resting-state functional MRI immediately before and after the cannula insertion. Reliability was determined by a temporal signal-to-noise-ratio >100. Responsiveness was determined based on the fMRI signal change upon insertion of the cannula to the VIM. Results: It was feasible to acquire reliable fMRI during asleep DBS surgery. The fMRI signal was responsive to the brain cannula insertion, revealing a reduction in the tremor network's functional connectivity, which did not reach statistical significance in the group analysis. Conclusions: It is feasible to acquire a reliable and responsive fMRI signal during asleep DBS. The acquisition steps and the preprocessing pipeline developed in these experiments will be useful for future investigations to develop fMRI-based feedback for asleep DBS surgery.
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Affiliation(s)
- Francesco Sammartino
- Department of Neurosurgery, The Ohio State University, Columbus, OH, United States
| | - Paul Taylor
- Scientific and Statistical Computing Core, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, United States
| | - Gang Chen
- Scientific and Statistical Computing Core, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, United States
| | - Richard C Reynolds
- Scientific and Statistical Computing Core, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, United States
| | - Daniel Glen
- Scientific and Statistical Computing Core, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, United States
| | - Vibhor Krishna
- Department of Neurosurgery, The Ohio State University, Columbus, OH, United States
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26
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Chen Y, Ma B, Hao H, Li L. Removal of Electrocardiogram Artifacts From Local Field Potentials Recorded by Sensing-Enabled Neurostimulator. Front Neurosci 2021; 15:637274. [PMID: 33912002 PMCID: PMC8071948 DOI: 10.3389/fnins.2021.637274] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 02/17/2021] [Indexed: 01/11/2023] Open
Abstract
Sensing-enabled neurostimulators are an advanced technology for chronic observation of brain activities, and show great potential for closed-loop neuromodulation and as implantable brain-computer interfaces. However, local field potentials (LFPs) recorded by sensing-enabled neurostimulators can be contaminated by electrocardiogram (ECG) signals due to complex recording conditions and limited common-mode-rejection-ratio (CMRR). In this study, we propose a solution for removing such ECG artifacts from local field potentials (LFPs) recorded by a sensing-enabled neurostimulator. A synchronized monopolar channel was added as an ECG reference, and two pre-existing methods, i.e., template subtraction and adaptive filtering, were then applied. ECG artifacts were successfully removed and the performance of the method was insensitive to residual stimulation artifacts. This approach to removal of ECG artifacts broadens the range of applications of sensing-enabled neurostimulators.
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Affiliation(s)
- Yue Chen
- National Engineering Laboratory for Neuromodulation, Tsinghua University, Beijing, China
| | - Bozhi Ma
- National Engineering Laboratory for Neuromodulation, Tsinghua University, Beijing, China
| | - Hongwei Hao
- National Engineering Laboratory for Neuromodulation, Tsinghua University, Beijing, China
| | - Luming Li
- National Engineering Laboratory for Neuromodulation, Tsinghua University, Beijing, China.,Precision Medicine & Healthcare Research Center, Tsinghua-Berkeley Shenzhen Institute, Tsinghua University, Shenzhen, China.,International Data Group (IDG)/McGovern Institute for Brain Research at Tsinghua University, Beijing, China.,Institute of Epilepsy, Beijing Institute for Brain Disorders, Beijing, China
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27
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He S, Baig F, Mostofi A, Pogosyan A, Debarros J, Green AL, Aziz TZ, Pereira E, Brown P, Tan H. Closed-Loop Deep Brain Stimulation for Essential Tremor Based on Thalamic Local Field Potentials. Mov Disord 2021; 36:863-873. [PMID: 33547859 PMCID: PMC7610625 DOI: 10.1002/mds.28513] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 12/07/2020] [Accepted: 01/06/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND High-frequency thalamic stimulation is an effective therapy for essential tremor, which mainly affects voluntary movements and/or sustained postures. However, continuous stimulation may deliver unnecessary current to the brain due to the intermittent nature of the tremor. OBJECTIVE We proposed to close the loop of thalamic stimulation by detecting tremor-provoking movement states using local field potentials recorded from the same electrodes implanted for stimulation, so that the stimulation is only delivered when necessary. METHODS Eight patients with essential tremor participated in this study. Patient-specific support vector machine classifiers were first trained using data recorded while the patient performed tremor-provoking movements. Then, the trained models were applied in real-time to detect these movements and triggered the delivery of stimulation. RESULTS Using the proposed method, stimulation was switched on for 80.37 ± 7.06% of the time when tremor-evoking movements were present. In comparison, the stimulation was switched on for 12.71 ± 7.06% of the time when the patients were at rest and tremor-free. Compared with continuous stimulation, a similar amount of tremor suppression was achieved while only delivering 36.62 ± 13.49% of the energy used in continuous stimulation. CONCLUSIONS The results suggest that responsive thalamic stimulation for essential tremor based on tremor-provoking movement detection can be achieved without any requirement for external sensors or additional electrocorticography strips. Further research is required to investigate whether the decoding model is stable across time and generalizable to the variety of activities patients may engage with in everyday life. © 2021 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Shenghong He
- MRC Brain Network Dynamics Unit, University of Oxford, Oxford, UK.,Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Fahd Baig
- MRC Brain Network Dynamics Unit, University of Oxford, Oxford, UK.,Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.,Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St. George's, University of London, Oxford, UK
| | - Abteen Mostofi
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St. George's, University of London, Oxford, UK
| | - Alek Pogosyan
- MRC Brain Network Dynamics Unit, University of Oxford, Oxford, UK.,Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Jean Debarros
- MRC Brain Network Dynamics Unit, University of Oxford, Oxford, UK.,Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Alexander L Green
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Tipu Z Aziz
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Erlick Pereira
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St. George's, University of London, Oxford, UK
| | - Peter Brown
- MRC Brain Network Dynamics Unit, University of Oxford, Oxford, UK.,Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Huiling Tan
- MRC Brain Network Dynamics Unit, University of Oxford, Oxford, UK.,Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
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28
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Howell B, Isbaine F, Willie JT, Opri E, Gross RE, De Hemptinne C, Starr PA, McIntyre CC, Miocinovic S. Image-based biophysical modeling predicts cortical potentials evoked with subthalamic deep brain stimulation. Brain Stimul 2021; 14:549-563. [PMID: 33757931 DOI: 10.1016/j.brs.2021.03.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 02/19/2021] [Accepted: 03/14/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Subthalamic deep brain stimulation (DBS) is an effective surgical treatment for Parkinson's disease and continues to advance technologically with an enormous parameter space. As such, in-silico DBS modeling systems have become common tools for research and development, but their underlying methods have yet to be standardized and validated. OBJECTIVE Evaluate the accuracy of patient-specific estimates of neural pathway activations in the subthalamic region against intracranial, cortical evoked potential (EP) recordings. METHODS Pathway activations were modeled in eleven patients using the latest advances in connectomic modeling of subthalamic DBS, focusing on the hyperdirect pathway (HDP) and corticospinal/bulbar tract (CSBT) for their relevance in human research studies. Correlations between pathway activations and respective EP amplitudes were quantified. RESULTS Good model performance required accurate lead localization and image fusions, as well as appropriate selection of fiber diameter in the biophysical model. While optimal model parameters varied across patients, good performance could be achieved using a global set of parameters that explained 60% and 73% of electrophysiologic activations of CSBT and HDP, respectively. Moreover, restricted models fit to only EP amplitudes of eight standard (monopolar and bipolar) electrode configurations were able to extrapolate variation in EP amplitudes across other directional electrode configurations and stimulation parameters, with no significant reduction in model performance across the cohort. CONCLUSIONS Our findings demonstrate that connectomic models of DBS with sufficient anatomical and electrical details can predict recruitment dynamics of white matter. These results will help to define connectomic modeling standards for preoperative surgical targeting and postoperative patient programming applications.
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Affiliation(s)
- Bryan Howell
- Department of Biomedical Engineering, Case Western Reserve University, USA
| | | | - Jon T Willie
- Department of Neurosurgery, Emory University, USA
| | - Enrico Opri
- Department of Neurology, Emory University, USA
| | | | | | - Philip A Starr
- Department of Neurological Surgery, University of California San Francisco, USA
| | - Cameron C McIntyre
- Department of Biomedical Engineering, Case Western Reserve University, USA
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29
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Dembek TA, Baldermann JC, Petry-Schmelzer JN, Jergas H, Treuer H, Visser-Vandewalle V, Dafsari HS, Barbe MT. Sweetspot Mapping in Deep Brain Stimulation: Strengths and Limitations of Current Approaches. Neuromodulation 2021; 25:877-887. [PMID: 33476474 DOI: 10.1111/ner.13356] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 12/15/2020] [Accepted: 12/21/2020] [Indexed: 01/23/2023]
Abstract
OBJECTIVES Open questions remain regarding the optimal target, or sweetspot, for deep brain stimulation (DBS) in, for example, Parkinson's disease. Previous studies introduced different methods of mapping DBS effects to determine sweetspots. While having a direct impact on surgical targeting and postoperative programming in DBS, these methods so far have not been compared. MATERIALS AND METHODS This study investigated five previously published DBS mapping approaches regarding their potential to correctly identify a predefined target. Methods were investigated in silico in eight different use-case scenarios, which incorporated different types of clinical data, noise, and differences in underlying neuroanatomy. Dice coefficients were calculated to determine the overlap between identified sweetspots and the predefined target. Additionally, out-of-sample predictive capabilities were assessed using the amount of explained variance R2 . RESULTS The five investigated methods resulted in highly variable sweetspots. Methods based on voxel-wise statistics against average outcomes showed the best performance overall. While predictive capabilities were high, even in the best of cases Dice coefficients remained limited to values around 0.5, highlighting the overall limitations of sweetspot identification. CONCLUSIONS This study highlights the strengths and limitations of current approaches to DBS sweetspot mapping. Those limitations need to be taken into account when considering the clinical implications. All future approaches should be investigated in silico before being applied to clinical data.
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Affiliation(s)
- Till A Dembek
- Department of Neurology, Faculty of Medicine, University of Cologne, Cologne, Germany
| | | | | | - Hannah Jergas
- Department of Neurology, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Harald Treuer
- Department of Stereotactic and Functional Neurosurgery, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Veerle Visser-Vandewalle
- Department of Stereotactic and Functional Neurosurgery, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Haidar S Dafsari
- Department of Neurology, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Michael T Barbe
- Department of Neurology, Faculty of Medicine, University of Cologne, Cologne, Germany
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30
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Sullivan CRP, Olsen S, Widge AS. Deep brain stimulation for psychiatric disorders: From focal brain targets to cognitive networks. Neuroimage 2021; 225:117515. [PMID: 33137473 PMCID: PMC7802517 DOI: 10.1016/j.neuroimage.2020.117515] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 08/19/2020] [Accepted: 10/24/2020] [Indexed: 01/16/2023] Open
Abstract
Deep brain stimulation (DBS) is a promising intervention for treatment-resistant psychiatric disorders, particularly major depressive disorder (MDD) and obsessive-compulsive disorder (OCD). Up to 90% of patients who have not recovered with therapy or medication have reported benefit from DBS in open-label studies. Response rates in randomized controlled trials (RCTs), however, have been much lower. This has been argued to arise from surgical variability between sites, and recent psychiatric DBS research has focused on refining targeting through personalized imaging. Much less attention has been given to the fact that psychiatric disorders arise from dysfunction in distributed brain networks, and that DBS likely acts by altering communication within those networks. This is in part because psychiatric DBS research relies on subjective rating scales that make it difficult to identify network biomarkers. Here, we overview recent DBS RCT results in OCD and MDD, as well as the follow-on imaging studies. We present evidence for a new approach to studying DBS' mechanisms of action, focused on measuring objective cognitive/emotional deficits that underpin these and many other mental disorders. Further, we suggest that a focus on cognition could lead to reliable network biomarkers at an electrophysiologic level, especially those related to inter-regional synchrony of the local field potential (LFP). Developing the network neuroscience of DBS has the potential to finally unlock the potential of this highly specific therapy.
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Affiliation(s)
- Christi R P Sullivan
- University of Minnesota Medical School Department of Psychiatry and Behavioral Sciences, 2001 6th Street SE, Minneapolis, MN 55454, USA.
| | - Sarah Olsen
- University of Minnesota Medical School Department of Psychiatry and Behavioral Sciences, 2001 6th Street SE, Minneapolis, MN 55454, USA.
| | - Alik S Widge
- University of Minnesota Medical School Department of Psychiatry and Behavioral Sciences, 2001 6th Street SE, Minneapolis, MN 55454, USA.
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31
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López-Blanco R, Sorrentino Rodriguez A, Cubo E, Gabilondo Í, Ezpeleta D, Labrador-Espinosa MA, Sánchez-Ferro Á, Tejero C, Matarazzo M. Impact of new technologies on neurology in Spain. Review by the New Technologies Ad-Hoc Committee of the Spanish Society of Neurology. Neurologia 2020; 38:S0213-4853(20)30429-1. [PMID: 33358062 DOI: 10.1016/j.nrl.2020.10.015] [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: 09/30/2020] [Accepted: 10/10/2020] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION New technologies (NT) are increasingly widespread in biomedicine. Using the consensus definition of NT established by the New Technologies Ad-Hoc Committee of the Spanish Society of Neurology (SEN), we evaluated the impact of these technologies on Spanish neurology, based on communications presented at Annual Meetings of the SEN. MATERIAL AND METHODS We defined the concept of NT in neurology as a novel technology or novel application of an existing technology, characterised by a certain degree of coherence persisting over time, with the potential to have an impact on the present and/or future of neurology. We conducted a descriptive study of scientific communications presented at the SEN's annual meetings from 2012 to 2018, analysing the type of NT, the field of neurology, and the geographical provenance of the studies. RESULTS We identified 299 communications related with NT from a total of 8,139 (3.7%), including 120 posters and 179 oral communications, ranging from 1.6% of all communications in 2012 to 6.8% in 2018. The technologies most commonly addressed were advanced neuroimaging (24.7%), biosensors (17.1%), electrophysiology and neurostimulation (14.7%), and telemedicine (13.7%). The neurological fields where NT were most widely employed were movement disorders (18.4%), cerebrovascular diseases (15.7%), and dementia (13.4%). Madrid was the region presenting the highest number of communications related to NT (32.8%), followed by Catalonia (26.8%) and Andalusia (9.0%). CONCLUSIONS The number of communications addressing NT follows an upward trend. The number of NT used in neurology has increased in parallel with their availability. We found scientific communications in all neurological subspecialties, with a heterogeneous geographical distribution.
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Affiliation(s)
- R López-Blanco
- Servicio Integrado de Neurología. Hospital Universitario Rey Juan Carlos (Móstoles), Hospital General de Villalba, Hospital Universitario Infanta Elena (Valdemoro), Madrid, España
| | | | - E Cubo
- Hospital Universitario de Burgos, Burgos, España
| | - Í Gabilondo
- Hospital Universitario de Cruces, Barakaldo, España
| | - D Ezpeleta
- Hospital Universitario Quirónsalud Madrid, Pozuelo de Alarcón, Madrid, España
| | - M A Labrador-Espinosa
- Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - Á Sánchez-Ferro
- HM CINAC, Hospital Universitario HM Puerta del Sur, Móstoles, Madrid, España
| | - C Tejero
- Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | - M Matarazzo
- HM CINAC, Hospital Universitario HM Puerta del Sur, Móstoles, Madrid, España; Pacific Parkinson's Research Centre, University of British Columbia, Vancouver, BC, Canadá.
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32
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Wiest C, Tinkhauser G, Pogosyan A, Bange M, Muthuraman M, Groppa S, Baig F, Mostofi A, Pereira EA, Tan H, Brown P, Torrecillos F. Local field potential activity dynamics in response to deep brain stimulation of the subthalamic nucleus in Parkinson's disease. Neurobiol Dis 2020; 143:105019. [PMID: 32681881 PMCID: PMC7115855 DOI: 10.1016/j.nbd.2020.105019] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 06/17/2020] [Accepted: 07/11/2020] [Indexed: 02/06/2023] Open
Abstract
Local field potentials (LFPs) may afford insight into the mechanisms of action of deep brain stimulation (DBS) and potential feedback signals for adaptive DBS. In Parkinson's disease (PD) DBS of the subthalamic nucleus (STN) suppresses spontaneous activity in the beta band and drives evoked resonant neural activity (ERNA). Here, we investigate how STN LFP activities change over time following the onset and offset of DBS. To this end we recorded LFPs from the STN in 14 PD patients during long (mean: 181.2 s) and short (14.2 s) blocks of continuous stimulation at 130 Hz. LFP activities were evaluated in the temporal and spectral domains. During long stimulation blocks, the frequency and amplitude of the ERNA decreased before reaching a steady state after ~70 s. Maximal ERNA amplitudes diminished over repeated stimulation blocks. Upon DBS cessation, the ERNA was revealed as an under-damped oscillation, and was more marked and lasted longer after short duration stimulation blocks. In contrast, activity in the beta band suppressed within 0.5 s of continuous DBS onset and drifted less over time. Spontaneous activity was also suppressed in the low gamma band, suggesting that the effects of high frequency stimulation on spontaneous oscillations may not be selective for pathological beta activity. High frequency oscillations were present in only six STN recordings before stimulation onset and their frequency was depressed by stimulation. The different dynamics of the ERNA and beta activity with stimulation imply different DBS mechanisms and may impact how these activities may be used in adaptive feedback.
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Affiliation(s)
- C Wiest
- Medical Research Council Brain Network Dynamics Unit, University of Oxford, Oxford, UK; Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - G Tinkhauser
- Department of Neurology, Bern University Hospital, Bern, Switzerland
| | - A Pogosyan
- Medical Research Council Brain Network Dynamics Unit, University of Oxford, Oxford, UK; Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - M Bange
- Movement Disorders and Neurostimulation, Biomedical Statistics and Multimodal Signal Processing Unit, Department of Neurology, Mainz University Hospital, Mainz, Germany
| | - M Muthuraman
- Movement Disorders and Neurostimulation, Biomedical Statistics and Multimodal Signal Processing Unit, Department of Neurology, Mainz University Hospital, Mainz, Germany
| | - S Groppa
- Movement Disorders and Neurostimulation, Biomedical Statistics and Multimodal Signal Processing Unit, Department of Neurology, Mainz University Hospital, Mainz, Germany
| | - F Baig
- Medical Research Council Brain Network Dynamics Unit, University of Oxford, Oxford, UK; Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK; Neurosciences Research Centre, Molecular and Clinical Sciences Institute, St. George's, University of London, London, UK
| | - A Mostofi
- Neurosciences Research Centre, Molecular and Clinical Sciences Institute, St. George's, University of London, London, UK
| | - E A Pereira
- Neurosciences Research Centre, Molecular and Clinical Sciences Institute, St. George's, University of London, London, UK
| | - H Tan
- Medical Research Council Brain Network Dynamics Unit, University of Oxford, Oxford, UK; Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - P Brown
- Medical Research Council Brain Network Dynamics Unit, University of Oxford, Oxford, UK; Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - F Torrecillos
- Medical Research Council Brain Network Dynamics Unit, University of Oxford, Oxford, UK; Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK.
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Deflating the Deep Brain Stimulation Causes Personality Changes Bubble: the Authors Reply. NEUROETHICS-NETH 2020. [DOI: 10.1007/s12152-020-09437-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Thevathasan W, Sinclair NC, Bulluss KJ, McDermott HJ. Tailoring Subthalamic Nucleus Deep Brain Stimulation for Parkinson's Disease Using Evoked Resonant Neural Activity. Front Hum Neurosci 2020; 14:71. [PMID: 32180711 PMCID: PMC7059818 DOI: 10.3389/fnhum.2020.00071] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 02/18/2020] [Indexed: 01/15/2023] Open
Affiliation(s)
- Wesley Thevathasan
- Bionics Institute, East Melbourne, VIC, Australia
- Department of Neurology, The Royal Melbourne and Austin Hospitals, Melbourne, VIC, Australia
- Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
| | - Nicholas C. Sinclair
- Bionics Institute, East Melbourne, VIC, Australia
- Medical Bionics Department, The University of Melbourne, East Melbourne, VIC, Australia
| | - Kristian J. Bulluss
- Bionics Institute, East Melbourne, VIC, Australia
- Department of Neurosurgery, St Vincent's and Austin Hospitals, Melbourne, VIC, Australia
- Department of Surgery, The University of Melbourne, Melbourne, VIC, Australia
| | - Hugh J. McDermott
- Bionics Institute, East Melbourne, VIC, Australia
- Medical Bionics Department, The University of Melbourne, East Melbourne, VIC, Australia
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