Adaptive deep brain stimulation

Last updated
Adaptive Deep Brain Stimulation.png

Adaptive deep brain stimulation (aDBS), also known as closed-loop deep brain stimulation (clDBS), is a neuro-modulatory technique currently under investigation for the treatment of neurodegenerative diseases. [1]

Contents

Conventional DBS delivers constant electrical stimulation to regions of the brain that control movement through a surgically implanted wire, or lead, that is connected to an implantable pulse generator (IPG). Programming adjustments to the pulse generator are frequently made by the treating neurologist based on what the patient is doing and the medication they take over time to optimize the patient's symptoms. [2] However, it can lead to side effects. [3] aDBS and differs from conventional DBS systems (that provide constant stimulation) in that it can both sense the brain activity and deliver the appropriate stimulation in real time. Of note, in the early days of deep brain stimulation, closed loop applications were carried out by multiple pioneers, such as José Delgado, [4] Robert Heath, [5] Natalia Bechtereva [6] and Carl Wilhelm Sem-Jacobsen long before the advent of 'modern' DBS. Perhaps the earliest closed-loop experiment in an animal model was performed by Delgado and colleagues in 1969. [4] [7] In the modern era of DBS following the introduction of the method by Alim Louis Benabid, after a demonstration of efficacy of aDBS in the macaque by the team of Hagai Bergman in 2011, [8] the first in-human application of aDBS was carried out by the team of Peter Brown in 2013, [9] followed by the team of Alberto Priori in the same year. [10]

History in Parkinson's disease

After being developed in the 1950s, and modern versions introduced by the team of Alim Louis Benabid in the 1980s, DBS received recognition as a treatment method for tremor and later Parkinson's disease, dystonia, obsessive–compulsive disorder and epilepsy. [11] However, the working mechanism of conventional DBS involved the continuous stimulation of the target structure, which is an approach that cannot adapt to patients' changing symptoms or functional status in real-time. [12]

Keeping in view this unwanted side effect of DBS, concepts that have the capability to sense brain activity and automatically adjust the stimulation in response to fluctuating biomarkers, were re-introduced by multiple teams, with a first peer-reviewed publication in modern times by the teams of Hagai Bergman (in primates) [8] and Peter Brown (in humans), [9] followed by the team of Alberto Priori in the same year. [10] The study, followed by others testing more patients in longer time windows (up to 24 hours) supported the hypothesis that aDBS is effective in controlling PD symptoms while reducing side effects of constant stimulation. [13] [14]

The device used in these studies was the external component of the AlphaDBS system developed by Newronika. [15] While these advancements were ongoing, Medtronic published the architecture of an implantable aDBS device for application in humans. [16] [17] This design was embedded in Medtronic's Activa PC + S research device, allowing LFP sensing and recording while delivering targeted DBS therapy. This device was used in 2018 by a research team led by Philip A. Starr at the University of California, San Francisco, in a public-private partnership with Medtronic. The researchers inserted the device into two patients with Parkinson's disease who had traditional DBS but continued to experience dyskinesia after adjustment by a neurologist. Later on, they compared the results of the adaptive stimulation system with traditional stimulation set manually on two patients, and found that the adaptive approach was as effective at controlling symptoms as constant stimulation. [18] [19] The AlphaDBS implantable system by Newronika was developed and CE-marked in 2021. A systematic study was also conducted to highlight safety and efficacy of aDBS vs cDBS using this new generation of DBS IPG in PD. [20]

The AlphaDBS represents a new generation commercially available DBS implantable pulse generator (IPG) for DBS and sensing, with aDBS capabilities. A systematic multicentre international study consisted of six investigational sites (in Italy, Poland and the Netherlands) was also conducted to highlight safety and efficacy of aDBS vs cDBS using this a new generation of DBS IPG in PD (AlphaDBS system by Newronika SpA, Milan, Italy).[10] The Medtronic PC+S device was also developed in a commercial IPG allowing stimulation and sensing, the Percept PC, which is approved for aDBS delivery in Japan. Nobutaka Hattori and the group performed a research study, focused on exploring the case of a 51-year-old man with Parkinson's disease (PD) presenting with motor fluctuations, who received bilateral subthalamic deep brain stimulation (DBS) the Percept PC device, showing the feasibility of the approach. While these new devices seem to have various applications in terms of facilitating condition-dependent stimulation, and providing new insights into the pathophysiological mechanisms of PD, they are currently under investigation in larger clinical studies, to definitely allow their use in clinical practice

Mechanism of action

To adapt to the stimulation parameters, adaptive DBS (aDBS) employs the local field potential (LFP) of the target structure recorded through the implanted electrodes that deliver stimulation. [21] The present application of adaptive DBS (aDBS) technique is primarily based on the detection of increased beta oscillations in the subthalamic nucleus (STN), [22] on account of which it has the capability to change the current depending on the strength of the beta band oscillation, and can, therefore, overcome conventional DBS (cDBS) therapy limitations, including stimulation-induced long term side effects, such as dyskinesia [13] or speech deterioration. [23]

Medical use

Adaptive deep brain stimulation (aDBS) is a treatment modality that is being studied for the treatment of multiple neuropsychiatric and movement disorders.

Parkinson's disease (PD)

Since 2015, several experiments were carried out to assess the efficacy of aDBS, that uses beta-band power of the subthalamic local field potentials (LFPs) as target to adapt DBS parameters to motor fluctuations. Results of the experiments proved that aDBS is highly effective in controlling the patients PD symptoms in addition to the normal Levodopa therapy, reducing dyskinesias. [24]

Tourette syndrome (TS)

Adaptive deep brain stimulation (aDBS) is currently being studied to be used as a potential treatment for TS. A 2017 research study presented a review on the available literature supporting the feasibility of an LFP-based aDBS approach in patients with TS. In addition to that, researchers have put forward several explorative findings regarding LFP data recently acquired and analysed in patients with TS after DBS electrode implantation at rest, during voluntary and involuntary movements (tics), and during ongoing DBS. It was found out that LFPs recorded from DBS targets can be used to control new aDBS devices capable of adaptive stimulation responsive to the symptoms of TS. [25] [26]

Dystonia

The applications of aDBS in the treatment of dystonia have significantly evolved over the past few years. Low-frequency oscillations (LFO) detected in the internal globus pallidus of dystonia patients have been identified as a physiomarker for adaptive Deep Brain Stimulation (aDBS).[22] Moreover, the characteristics of pallidal low-frequency and beta bursts can be helpful in implementing adaptive brain stimulation in the context of parkinsonian and dystonic internal globus pallidus.[23] A significant amount of scientific research to date on pathological oscillations in dystonia has been focused to address potential biomarkers that might be used as a feedback signal for controlling aDBS in patients with dystonia.[24]

Essential tremor (ET)

Adaptive deep brain stimulation (aDBS) may be an effective tool in the treatment of essential tremor (ET), which is one of the most common neurological movement disorders. aDBS for ET is however more focused on a closed-loop technology based on external sensors. [27] [28] In a recent study, H J Chizeck presented the first translation-ready training procedure for a fully embedded aDBS control system for MDs and one of the first examples of such a system in ET. [29]

Comparison with conventional DBS (cDBS)

In a 2021 research study conducted by Alberto Priori, a comparative analysis was presented between the impacts on motor symptoms between conventional deep brain stimulation (cDBS) and closed-loop adaptive deep brain stimulation (aDBS) in patients with Parkinson's disease. This work highlighted the safety and effectiveness of aDBS stimulation compared to cDBS in a daily session, both in terms of motor performance and TEED to the patient. [2] Simon Little has regarded aDBS approach to be superior to conventional DBS in PD in primates using cortical neuronal spike triggering and in humans employing local field potential biomarkers. [3] While presenting a protocol for a pseudo-randomised clinical study for adaptive deep brain stimulation as advanced Parkinson's disease treatment, it was shown that aDBS do not induce dysarthria, in contrast to cDBS. [22] Also it has been suggested that aDBS and cDBS can improve patient's axial symptoms to a similar extent, but compared with cDBS, aDBS significantly improves its main symptom, bradykinesia. [30]

Related Research Articles

<span class="mw-page-title-main">Tremor</span> Involuntary muscle contraction

A tremor is an involuntary, somewhat rhythmic muscle contraction and relaxation involving oscillations or twitching movements of one or more body parts. It is the most common of all involuntary movements and can affect the hands, arms, eyes, face, head, vocal folds, trunk, and legs. Most tremors occur in the hands. In some people, a tremor is a symptom of another neurological disorder.

<span class="mw-page-title-main">Deep brain stimulation</span> Neurosurgical treatment

Deep brain stimulation (DBS) is a surgical procedure that implants a neurostimulator and electrodes which sends electrical impulses to specified targets in the brain responsible for movement control. The treatment is designed for a range of movement disorders such as Parkinson's disease, essential tremor, and dystonia, as well as for certain neuropsychiatric conditions like obsessive-compulsive disorder (OCD) or neurological disorders like epilepsy. The exact mechanisms of DBS are complex and not entirely clear, but it is known to modify brain activity in a structured way.

<span class="mw-page-title-main">Dystonia</span> Neurological movement disorder

Dystonia is a neurological hyperkinetic movement disorder in which sustained or repetitive muscle contractions occur involuntarily, resulting in twisting and repetitive movements or abnormal fixed postures. The movements may resemble a tremor. Dystonia is often intensified or exacerbated by physical activity, and symptoms may progress into adjacent muscles.

Neurotechnology encompasses any method or electronic device which interfaces with the nervous system to monitor or modulate neural activity.

<span class="mw-page-title-main">Thalamotomy</span> Surgical procedure

Thalamotomy is a surgical procedure in which a functional lesion is made into the thalamus to improve the overall brain function in patients. First introduced in the 1950s, it is primarily effective for tremors such as those associated with Parkinson's disease, where a selected portion of the thalamus is surgically destroyed (ablated). Neurosurgeons use specialized equipment to precisely locate an area of the thalamus, usually choosing to work on only one side. Bilateral procedures are poorly tolerated because of increased complications and risk, including vision and speech problems. The positive effects on tremors are immediate. Other less destructive procedures are sometimes preferred, such as subthalamic deep brain stimulation, since this procedure can also improve tremors and other symptoms of PD.

<span class="mw-page-title-main">Hypokinesia</span> Decreased movement due to basal ganglia dysfunction

Hypokinesia is one of the classifications of movement disorders, and refers to decreased bodily movement. Hypokinesia is characterized by a partial or complete loss of muscle movement due to a disruption in the basal ganglia. Hypokinesia is a symptom of Parkinson's disease shown as muscle rigidity and an inability to produce movement. It is also associated with mental health disorders and prolonged inactivity due to illness, amongst other diseases.

<span class="mw-page-title-main">Spasmodic torticollis</span> Medical condition

Spasmodic torticollis is an extremely painful chronic neurological movement disorder causing the neck to involuntarily turn to the left, right, upwards, and/or downwards. The condition is also referred to as "cervical dystonia". Both agonist and antagonist muscles contract simultaneously during dystonic movement. Causes of the disorder are predominantly idiopathic. A small number of patients develop the disorder as a result of another disorder or disease. Most patients first experience symptoms midlife. The most common treatment for spasmodic torticollis is the use of botulinum toxin type A.

In the management of Parkinson's disease, due to the chronic nature of Parkinson's disease (PD), a broad-based program is needed that includes patient and family education, support-group services, general wellness maintenance, exercise, and nutrition. At present, no cure for the disease is known, but medications or surgery can provide relief from the symptoms.

<span class="mw-page-title-main">Responsive neurostimulation device</span> Category of medical devices that respond to signals in a patients body to treat disease

Responsive neurostimulation device is a medical device that senses changes in a person's body and uses neurostimulation to respond in the treatment of disease. The FDA has approved devices for use in the United States in the treatment of epileptic seizures and chronic pain conditions. Devices are being studied for use in the treatment of essential tremor, Parkinson's disease, Tourette's syndrome, depression, obesity, and post-traumatic stress disorder.

Ablative brain surgery is the surgical ablation by various methods of brain tissue to treat neurological or psychological disorders. The word "Ablation" stems from the Latin word Ablatus meaning "carried away". In most cases, however, ablative brain surgery does not involve removing brain tissue, but rather destroying tissue and leaving it in place. The lesions it causes are irreversible. There are some target nuclei for ablative surgery and deep brain stimulation. Those nuclei are the motor thalamus, the globus pallidus, and the subthalamic nucleus.

Myoclonic dystonia or Myoclonus dystonia syndrome is a rare movement disorder that induces spontaneous muscle contraction causing abnormal posture. The prevalence of myoclonus dystonia has not been reported, however, this disorder falls under the umbrella of movement disorders which affect thousands worldwide. Myoclonus dystonia results from mutations in the SGCE gene coding for an integral membrane protein found in both neurons and muscle fibers. Those suffering from this disease exhibit symptoms of rapid, jerky movements of the upper limbs (myoclonus), as well as distortion of the body's orientation due to simultaneous activation of agonist and antagonist muscles (dystonia).

<span class="mw-page-title-main">Basal ganglia disease</span> Group of physical problems resulting from basal ganglia dysfunction

Basal ganglia disease is a group of physical problems that occur when the group of nuclei in the brain known as the basal ganglia fail to properly suppress unwanted movements or to properly prime upper motor neuron circuits to initiate motor function. Research indicates that increased output of the basal ganglia inhibits thalamocortical projection neurons. Proper activation or deactivation of these neurons is an integral component for proper movement. If something causes too much basal ganglia output, then the ventral anterior (VA) and ventral lateral (VL) thalamocortical projection neurons become too inhibited, and one cannot initiate voluntary movement. These disorders are known as hypokinetic disorders. However, a disorder leading to abnormally low output of the basal ganglia leads to reduced inhibition, and thus excitation, of the thalamocortical projection neurons which synapse onto the cortex. This situation leads to an inability to suppress unwanted movements. These disorders are known as hyperkinetic disorders.

David Charles is an American neurologist, professor and vice-chair of neurology, and the medical director of Telehealth at Vanderbilt University Medical Center.

Neuromodulation is "the alteration of nerve activity through targeted delivery of a stimulus, such as electrical stimulation or chemical agents, to specific neurological sites in the body". It is carried out to normalize – or modulate – nervous tissue function. Neuromodulation is an evolving therapy that can involve a range of electromagnetic stimuli such as a magnetic field (rTMS), an electric current, or a drug instilled directly in the subdural space. Emerging applications involve targeted introduction of genes or gene regulators and light (optogenetics), and by 2014, these had been at minimum demonstrated in mammalian models, or first-in-human data had been acquired. The most clinical experience has been with electrical stimulation.

<span class="mw-page-title-main">Alim Louis Benabid</span> French neurosurgeon

Alim Louis Benabid is a French-Algerian emeritus professor, neurosurgeon and member of the French Academy of Sciences, who has had a global impact in the development of deep brain stimulation (DBS) for Parkinson's disease and other movement disorders. He became emeritus professor of biophysics at the Joseph Fourier University in Grenoble in September 2007, and chairman of the board of the Edmond J. Safra Biomedical Research Center in 2009 at Clinatec, a multidisciplinary institute he co-founded in Grenoble that applies nanotechnologies to neurosciences.

<span class="mw-page-title-main">Mesencephalic locomotor region</span>

The mesencephalic locomotor region (MLR) is a functionally defined area of the midbrain that is associated with the initiation and control of locomotor movements in vertebrate species.

Sridevi Sarma is an American biomedical and electrical engineer known for her work in applying control theory to improve therapies for neurological disorders such as Parkinson's disease and epilepsy. She is vice dean for graduate education of the Johns Hopkins University Whiting School of Engineering, associate director of the Johns Hopkins Institute for Computational Medicine, and an associate professor in the Johns Hopkins Department of Biomedical Engineering.

<span class="mw-page-title-main">Alberto Priori</span> Italian neurologist

Alberto Priori is an Italian neurologist, academic, and author. He is a Professor of Neurology at the University of Milan, Director of Neurology 1 Unit at San Paolo Hospital, and the Founder and Coordinator of Aldo Ravelli Center of the University of Milan. He also serves as President of the Neurophysiopatology Techniques Course, and Professor of Postgraduate Schools - Medicine, Healthcare, Dental Medicine at the same University.

<span class="mw-page-title-main">Andreas Horn</span> German neuroscientist

Andreas Horn is a German neuroscientist and Associate Professor of Neurology at Harvard Medical School and Mass General Brigham. His research has focused on mapping deep brain stimulation outcomes onto networks of the human brain. Horn's work has been featured by media outlets such as CNN, Newsweek or Fox News and he has been considered among the 'World's Highly Cited Researchers' by Clarivate.

Patricia Limousin is a French neurologist recognized for her contributions to the treatment of movement disorders, particularly through deep brain stimulation (DBS). She earned her medical degree from the University of Grenoble and completed her PhD in neuroscience at the University of Lyon I in 1998, focusing on DBS of the subthalamic nucleus as a treatment for Parkinson's disease.

References

  1. ↑ Marceglia, Sara; Guidetti, Matteo; Harmsen, Irene E; Loh, Aaron; Meoni, Sara; Foffani, Guglielmo; Lozano, Andres M; Volkmann, Jens; Moro, Elena; Priori, Alberto (December 2021). "Deep brain stimulation: is it time to change gears by closing the loop?". Journal of Neural Engineering. 18 (6): 061001. Bibcode:2021JNEng..18f1001M. doi:10.1088/1741-2552/ac3267. hdl: 2434/877893 . PMID   34678794. S2CID   239472558.
  2. 1 2 Bocci, Tommaso; Prenassi, Marco; Arlotti, Mattia; Cogiamanian, Filippo Maria; Borellini, Linda; Moro, Elena; Lozano, Andres M.; Volkmann, Jens; Barbieri, Sergio; Priori, Alberto; Marceglia, Sara (September 28, 2021). "Eight-hours conventional versus adaptive deep brain stimulation of the subthalamic nucleus in Parkinson's disease". npj Parkinson's Disease. 7 (1): 88. doi:10.1038/s41531-021-00229-z. PMC   8478873 . PMID   34584095.
  3. 1 2 Beudel, Martijn; Cagnan, Hayriye; Little, Simon (2018). "Adaptive Brain Stimulation for Movement Disorders". Current Concepts in Movement Disorder Management. Progress in Neurological Surgery. Vol. 33. pp. 230–242. doi:10.1159/000481107. ISBN   978-3-318-06201-4.
  4. 1 2 Delgado, J. M.; Johnston, V. S.; Wallace, J. D.; Bradley, R. J. (September 1969). "Operant conditioning of EEG in the unrestrained chimpanzee". Electroencephalography and Clinical Neurophysiology. 27 (7): 701–702. doi:10.1016/0013-4694(69)91347-9. PMID   4187397.
  5. ↑ Heath, Robert G.; Cox, Aris W.; Lustick, Leonard S. (August 1974). "Brain Activity During Emotional States". American Journal of Psychiatry. 131 (8): 858–862. doi:10.1176/ajp.131.8.858. PMID   4209918.
  6. ↑ Bechtereva, N.P.; Bondartchuk, A.N.; Smirnov, V.M.; Meliutcheva, L.A.; Shandurina, A.N. (1975). "Method of Electrostimulation of the Deep Brain Structures in Treatment of Some Chronic Diseases". Stereotactic and Functional Neurosurgery. 37 (1–3): 136–140. doi:10.1159/000102727.
  7. ↑ Krook-Magnuson, Esther; Gelinas, Jennifer N.; Soltesz, Ivan; Buzsáki, György (July 2015). "Neuroelectronics and Biooptics: Closed-Loop Technologies in Neurological Disorders". JAMA Neurology. 72 (7): 823–829. doi:10.1001/jamaneurol.2015.0608. PMC   4501886 . PMID   25961887.
  8. 1 2 Rosin, Boris; Slovik, Maya; Mitelman, Rea; Rivlin-Etzion, Michal; Haber, Suzanne N.; Israel, Zvi; Vaadia, Eilon; Bergman, Hagai (October 2011). "Closed-Loop Deep Brain Stimulation Is Superior in Ameliorating Parkinsonism". Neuron. 72 (2): 370–384. doi:10.1016/j.neuron.2011.08.023. PMID   22017994.
  9. 1 2 Little, Simon; Pogosyan, Alex; Neal, Spencer; Zavala, Baltazar; Zrinzo, Ludvic; Hariz, Marwan; Foltynie, Thomas; Limousin, Patricia; Ashkan, Keyoumars; FitzGerald, James; Green, Alexander L.; Aziz, Tipu Z.; Brown, Peter (September 2013). "Adaptive deep brain stimulation in advanced Parkinson disease". Annals of Neurology. 74 (3): 449–457. doi:10.1002/ana.23951. PMC   3886292 . PMID   23852650.
  10. 1 2 Priori, Alberto; Foffani, Guglielmo; Rossi, Lorenzo; Marceglia, Sara (July 2013). "Adaptive deep brain stimulation (aDBS) controlled by local field potential oscillations". Experimental Neurology. 245: 77–86. doi:10.1016/j.expneurol.2012.09.013. PMID   23022916.
  11. ↑ Speelman, J. D. Hans; Schuurman, Rick (2020). "The History of Deep Brain Stimulation". Fundamentals and Clinics of Deep Brain Stimulation. pp. 3–13. doi:10.1007/978-3-030-36346-8_1. ISBN   978-3-030-36345-1.
  12. ↑ Guidetti, Matteo; Marceglia, Sara; Loh, Aaron; Harmsen, Irene E.; Meoni, Sara; Foffani, Guglielmo; Lozano, Andres M.; Moro, Elena; Volkmann, Jens; Priori, Alberto (September 1, 2021). "Clinical perspectives of adaptive deep brain stimulation". Brain Stimulation. 14 (5): 1238–1247. doi: 10.1016/j.brs.2021.07.063 . hdl: 2434/865610 . PMID   34371211. S2CID   236949013.
  13. 1 2 Arlotti, Mattia; Marceglia, Sara; Foffani, Guglielmo; Volkmann, Jens; Lozano, Andres M.; Moro, Elena; Cogiamanian, Filippo; Prenassi, Marco; Bocci, Tommaso; Cortese, Francesca; Rampini, Paolo; Barbieri, Sergio; Priori, Alberto (March 13, 2018). "Eight-hours adaptive deep brain stimulation in patients with Parkinson disease". Neurology. 90 (11): e971 –e976. doi:10.1212/WNL.0000000000005121. PMC   5858949 . PMID   29444973.
  14. ↑ Rosa, Manuela; Arlotti, Mattia; Marceglia, Sara; Cogiamanian, Filippo; Ardolino, Gianluca; Fonzo, Alessio Di; Lopiano, Leonardo; Scelzo, Emma; Merola, Aristide; Locatelli, Marco; Rampini, Paolo M.; Priori, Alberto (April 18, 2017). "Adaptive deep brain stimulation controls levodopa-induced side effects in Parkinsonian patients". Movement Disorders. 32 (4): 628–629. doi:10.1002/mds.26953. PMC   5412843 . PMID   28211585.
  15. ↑ Prenassi, Marco; Arlotti, Mattia; Borellini, Linda; Bocci, Tommaso; Cogiamanian, Filippo; Locatelli, Marco; Rampini, Paolo; Barbieri, Sergio; Priori, Alberto; Marceglia, Sara (May 31, 2021). "The Relationship Between Electrical Energy Delivered by Deep Brain Stimulation and Levodopa-Induced Dyskinesias in Parkinson's Disease: A Retrospective Preliminary Analysis". Frontiers in Neurology. 12: 643841. doi: 10.3389/fneur.2021.643841 . PMC   8200487 . PMID   34135846.
  16. ↑ Carvalho, Joana (18 January 2021). "Medtronic Trial Assessing Safety, Efficacy of New Parkinson's DBS Feature". Parkinson's News Today.
  17. ↑ "Deep Brain Stimulation Systems - Activa Platform". Medtronic.
  18. ↑ "Adaptive deep brain stimulation for Parkinson's disease". National Institutes of Health (NIH). June 4, 2018.
  19. ↑ Swann, Nicole C.; de Hemptinne, Coralie; Thompson, Margaret C.; Miocinovic, Svjetlana; Miller, Andrew M.; Gilron, Ro'ee; Ostrem, Jill L.; Chizeck, Howard J.; Starr, Philip A. (August 18, 2018). "Adaptive deep brain stimulation for Parkinson's disease using motor cortex sensing". Journal of Neural Engineering. 15 (4): 046006. Bibcode:2018JNEng..15d6006S. doi:10.1088/1741-2552/aabc9b. PMC   6021210 . PMID   29741160.
  20. ↑ Arlotti, Mattia; Colombo, Matteo; Bonfanti, Andrea; Mandat, Tomasz; Lanotte, Michele Maria; Pirola, Elena; Borellini, Linda; Rampini, Paolo; Eleopra, Roberto; Rinaldo, Sara; Romito, Luigi; Janssen, Marcus L. F.; Priori, Alberto; Marceglia, Sara (November 18, 2021). "A New Implantable Closed-Loop Clinical Neural Interface: First Application in Parkinson's Disease". Frontiers in Neuroscience. 15: 763235. doi: 10.3389/fnins.2021.763235 . PMC   8689059 . PMID   34949982.
  21. ↑ Nakajima, Asuka; Shimo, Yasushi; Fuse, Atsuhito; Tokugawa, Joji; Hishii, Makoto; Iwamuro, Hirokazu; Umemura, Atsushi; Hattori, Nobutaka (November 18, 2021). "Case Report: Chronic Adaptive Deep Brain Stimulation Personalizing Therapy Based on Parkinsonian State". Frontiers in Human Neuroscience. 15: 702961. doi: 10.3389/fnhum.2021.702961 . PMC   8414587 . PMID   34483867.
  22. 1 2 Piña-Fuentes, Dan; Beudel, Martijn; Little, Simon; Brown, Peter; Oterdoom, D L Marinus; van Dijk, J Marc C (June 2019). "Adaptive deep brain stimulation as advanced Parkinson's disease treatment (ADAPT study): protocol for a pseudo-randomised clinical study". BMJ Open. 9 (6): e029652. doi:10.1136/bmjopen-2019-029652. PMC   6575861 . PMID   31201193.
  23. ↑ Little, Simon; Tripoliti, Elina; Beudel, Martijn; Pogosyan, Alek; Cagnan, Hayriye; Herz, Damian; Bestmann, Sven; Aziz, Tipu; Cheeran, Binith; Zrinzo, Ludvic; Hariz, Marwan; Hyam, Jonathan; Limousin, Patricia; Foltynie, Tom; Brown, Peter (December 18, 2016). "Adaptive deep brain stimulation for Parkinson's disease demonstrates reduced speech side effects compared to conventional stimulation in the acute setting". Journal of Neurology, Neurosurgery, and Psychiatry. 87 (12): 1388–1389. doi:10.1136/jnnp-2016-313518. PMC   5136720 . PMID   27530809.
  24. ↑ Bocci, T.; Arlotti, M.; Marceglia, S.; Prenassi, M.; Ardolino, G.; Cogiamanian, F.; Borrellini, L.; Rampini, P.; Locatelli, M.; Barbieri, S.; Priori, A. (January 2019). "Adaptive Deep Brain Stimulation for Parkinson's disease: Safety and effectiveness". Clinical Neurophysiology. 130 (1): e17. doi:10.1016/j.clinph.2018.09.098. S2CID   56569946.
  25. ↑ Marceglia, Sara; Rosa, Manuela; Servello, Domenico; Porta, Mauro; Barbieri, Sergio; Moro, Elena; Priori, Alberto (January 18, 2018). "Adaptive Deep Brain Stimulation (aDBS) for Tourette Syndrome". Brain Sciences. 8 (1): 4. doi: 10.3390/brainsci8010004 . PMC   5789335 . PMID   29295486.
  26. ↑ Molina, Rene; Okun, Michael S.; Shute, Jonathan B.; Opri, Enrico; Rossi, P. Justin; Martinez-Ramirez, Daniel; Foote, Kelly D.; Gunduz, Aysegul (August 18, 2018). "Report of a patient undergoing chronic responsive deep brain stimulation for Tourette syndrome: proof of concept". Journal of Neurosurgery. 129 (2): 308–314. doi:10.3171/2017.6.JNS17626. PMC   7007215 . PMID   28960154.
  27. ↑ Fra̧czek, Tomasz M.; Ferleger, Benjamin I.; Brown, Timothy E.; Thompson, Margaret C.; Haddock, Andrew J.; Houston, Brady C.; Ojemann, Jeffrey G.; Ko, Andrew L.; Herron, Jeffrey A.; Chizeck, Howard J. (November 18, 2021). "Closing the Loop With Cortical Sensing: The Development of Adaptive Deep Brain Stimulation for Essential Tremor Using the Activa PC+S". Frontiers in Neuroscience. 15: 749705. doi: 10.3389/fnins.2021.749705 . PMC   8695120 . PMID   34955714.
  28. ↑ Priori, Alberto; Maiorana, Natale; Dini, Michelangelo; Guidetti, Matteo; Marceglia, Sara; Ferrucci, Roberta (2021). "Adaptive deep brain stimulation (ADBS)". Emerging Horizons in Neuromodulation: New Frontiers in Brain and Spine Stimulation. International Review of Neurobiology. Vol. 159. pp. 111–127. doi:10.1016/bs.irn.2021.06.006. ISBN   978-0-12-822298-0. PMID   34446243.
  29. ↑ Ferleger, B I; Houston, B; Thompson, M C; Cooper, S S; Sonnet, K S; Ko, A L; Herron, J A; Chizeck, H J (October 2020). "Fully implanted adaptive deep brain stimulation in freely moving essential tremor patients". Journal of Neural Engineering. 17 (5): 056026. Bibcode:2020JNEng..17e6026F. doi:10.1088/1741-2552/abb416. PMID   33055369. S2CID   219166717.
  30. ↑ Rosa, Manuela; Arlotti, Mattia; Ardolino, Gianluca; Cogiamanian, Filippo; Marceglia, Sara; Di Fonzo, Alessio; Cortese, Francesca; Rampini, Paolo M.; Priori, Alberto (June 18, 2015). "Adaptive deep brain stimulation in a freely moving parkinsonian patient". Movement Disorders. 30 (7): 1003–1005. doi:10.1002/mds.26241. PMC   5032989 . PMID   25999288.
This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.