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Dbs Essential Tremor Adaptive Dbs

Nivedita Khobragade, Daniela Tuninetti, Daniel Graupe
The results presented in this paper indicate that future on-demand Deep Brain Stimulation (DBS) systems for chronic use in patients with movement disorders should continuously and adaptively "learn" in order to maintain high symptom control efficacy. In this work, two machine learning algorithms-Decision Tree and LArge Memory STorage And Retrieval (LAMSTAR) neural network, both with surface Electromyography and accelerometry as control signals-are used to predict onset of tremor after DBS has been switched off in two patients, one suffering from Parkinson's disease and the other from essential tremor...
July 2018: Conference Proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society
Chao-Hung Kuo, Gabrielle A White-Dzuro, Andrew L Ko
OBJECTIVE Deep brain stimulation (DBS) is a safe and effective therapy for movement disorders, such as Parkinson's disease (PD), essential tremor (ET), and dystonia. There is considerable interest in developing "closed-loop" DBS devices capable of modulating stimulation in response to sensor feedback. In this paper, the authors review related literature and present selected approaches to signal sources and approaches to feedback being considered for deployment in closed-loop systems. METHODS A literature search using the keywords "closed-loop DBS" and "adaptive DBS" was performed in the PubMed database...
August 2018: Neurosurgical Focus
Andrew Haddock, Kyle T Mitchell, Andrew Miller, Jill L Ostrem, Howard J Chizeck, Svjetlana Miocinovic
Deep brain stimulation (DBS) programming, the systematic selection of fixed electrical stimulation parameters that deliver maximal therapeutic benefit while limiting side effects, poses several challenges in the treatment of movement disorders. DBS programming requires the expertise of trained neurologists or nurses who assess patient symptoms according to standardized clinical rating scales and use patient reports of DBS-related side effects to adjust stimulation parameters and optimize therapy. In this paper, we describe and validate an automated software platform for DBS programming for tremor associated with Parkinson's disease and essential tremor...
August 2018: IEEE Transactions on Neural Systems and Rehabilitation Engineering
Sabato Santaniello, John T Gale, Sridevi V Sarma
Over the last 30 years, deep brain stimulation (DBS) has been used to treat chronic neurological diseases like dystonia, obsessive-compulsive disorders, essential tremor, Parkinson's disease, and more recently, dementias, depression, cognitive disorders, and epilepsy. Despite its wide use, DBS presents numerous challenges for both clinicians and engineers. One challenge is the design of novel, more efficient DBS therapies, which are hampered by the lack of complete understanding about the cellular mechanisms of therapeutic DBS...
March 20, 2018: Wiley Interdisciplinary Reviews. Systems Biology and Medicine
Niels Allert, Binith Cheeran, Günther Deuschl, Michael T Barbe, Ilona Csoti, Markus Ebke, Martin Glaser, Jun-Suk Kang, Stefan Kelm, Paul Krack, Julia Kroth, Ulrich Jobst, Markus Leisse, Antonio Oliviero, Peter Nikolaus Nolte, Johanna Quick-Weller, Martin Strothjohann, Gertrúd Tamás, Michael Werner, Muthuraman Muthuraman, Jens Volkmann, Alfonso Fasano, Sergiu Groppa
Deep brain stimulation (DBS) is a highly efficient, evidence-based therapy for a set of neurological and psychiatric conditions and especially movement disorders such as Parkinson's disease, essential tremor and dystonia. Recent developments have improved the DBS technology. However, no unequivocal algorithms for an optimized postoperative care exist so far. The aim of this review is to provide a synopsis of the current clinical practice and to propose guidelines for postoperative and rehabilitative care of patients who undergo DBS...
March 2018: Clinical Neurophysiology: Official Journal of the International Federation of Clinical Neurophysiology
Martijn Beudel, Hayriye Cagnan, Simon Little
Deep brain stimulation (DBS) has markedly changed how we treat movement disorders including Parkinson's disease (PD), dystonia, and essential tremor (ET). However, despite its demonstrable clinical benefit, DBS is often limited by side effects and partial efficacy. These limitations may be due in part to the fact that DBS interferes with both pathological and physiological neural activities. DBS could, therefore, be potentially improved were it applied selectively and only at times of enhanced pathological activity...
2018: Progress in Neurological Surgery
Anders Christian Meidahl, Gerd Tinkhauser, Damian Marc Herz, Hayriye Cagnan, Jean Debarros, Peter Brown
Continuous high-frequency DBS is an established treatment for essential tremor and Parkinson's disease. Current developments focus on trying to widen the therapeutic window of DBS. Adaptive DBS (aDBS), where stimulation is dynamically controlled by feedback from biomarkers of pathological brain circuit activity, is one such development. Relevant biomarkers may be central, such as local field potential activity, or peripheral, such as inertial tremor data. Moreover, stimulation may be directed by the amplitude or the phase (timing) of the biomarker signal...
June 2017: Movement Disorders: Official Journal of the Movement Disorder Society
Oleksandr V Popovych, Borys Lysyansky, Michael Rosenblum, Arkady Pikovsky, Peter A Tass
High-frequency (HF) deep brain stimulation (DBS) is the gold standard for the treatment of medically refractory movement disorders like Parkinson's disease, essential tremor, and dystonia, with a significant potential for application to other neurological diseases. The standard setup of HF DBS utilizes an open-loop stimulation protocol, where a permanent HF electrical pulse train is administered to the brain target areas irrespectively of the ongoing neuronal dynamics. Recent experimental and clinical studies demonstrate that a closed-loop, adaptive DBS might be superior to the open-loop setup...
2017: PloS One
Arun Chockalingam, Hans Boggs, Julia Prusik, Adolfo Ramirez-Zamora, Paul Feustel, Abigail Belasen, Youngwon Youn, Chris Fama, Jessica Haller, Julie Pilitsis
BACKGROUND: Ventralis intermedius thalamic deep brain stimulation (VIM DBS) has shown to be safe and effective for medically refractory essential tremor (ET). We evaluate the use of quantitative tremor measurement methods for head tremor in ET using a "smart" hat and a smartphone application. METHODS: We enrolled 13 ET patients who previously underwent VIM DBS. Head and arm tremor was measured ON and OFF stimulation using the clinical gold standard Fahn-Tolosa-Marin Tremor Rating Scale (TRS)...
July 2017: Neuromodulation: Journal of the International Neuromodulation Society
Marina Picillo, Alfonso Fasano
While no real breakthrough in the medical treatment of Essential Tremor (ET) has recently emerged, surgical field is expanding exponentially. Purpose of this review is to examine the recent and future developments of the surgical treatments for ET. Technological advances are shaping the present and the future application of deep brain stimulation (DBS) in ET. New electrode configurations as well as new implantable pulse generators are now available. Application of closed-loop or adaptive stimulation in clinical practice will allow DBS to deliver stimulation in a truly physiological way to restore aberrant neurological circuits on demand, thus avoiding side effects, tolerance and also saving the battery life...
January 2016: Parkinsonism & related Disorders
Kaviraja Udupa, Robert Chen
Deep brain stimulation (DBS) has been used as a treatment of movement disorders such as Parkinson's disease, dystonia, and essential tremor for over twenty years, and is a promising treatment for depression and epilepsy. However, the exact mechanisms of action of DBS are still uncertain, although different theories have emerged. This review summarizes the current understanding in this field. Different modalities used to investigate DBS such as electrophysiological, imaging and biochemical studies have revealed different mechanisms of DBS...
October 2015: Progress in Neurobiology
Alfonso Fasano, Andres M Lozano
PURPOSE OF REVIEW: The purpose of this review was to review the recent and future developments of deep brain stimulation (DBS) for movement disorders. RECENT FINDINGS: In the last 2 years, we have gained a better understanding of established indications, particularly with respect to the debate on whether subthalamus or globus pallidus pars interna should be the target of choice for Parkinson's disease. In addition, the role of DBS for dystonia has been further defined in terms of patients' selection and outcome of surgery...
August 2015: Current Opinion in Neurology
Pitamber Shukla, Ishita Basu, Daniela Tuninetti, Daniel Graupe, Konstantin V Slavin
Mathematical models of the neuronal activity in the affected brain regions of Essential Tremor (ET) and Parkinson's Disease (PD) patients could shed light into the underlying pathophysiology of these diseases, which in turn could help develop personalized treatments including adaptive Deep Brain Stimulation (DBS). In this paper, we use an Ornstein Uhlenbeck Process (OUP) to model the neuronal spiking activity recorded from the brain of ET and PD patients during DBS stereotactic surgery. The parameters of the OUP are estimated based on Inter Spike Interval (ISI) measurements, i...
2014: Conference Proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society
Md Kamal Hosain, Abbas Kouzani, Susannah Tye
Deep brain stimulation is an effective and safe medical treatment for a variety of neurological and psychiatric disorders including Parkinson's disease, essential tremor, dystonia, and treatment resistant obsessive compulsive disorder. A closed loop deep brain stimulation (CLDBS) system automatically adjusts stimulation parameters by the brain response in real time. The CLDBS continues to evolve due to the advancement in the brain stimulation technologies. This paper provides a study on the existing systems developed for CLDBS...
December 2014: Australasian Physical & Engineering Sciences in Medicine
Brandon D Swan, Warren M Grill, Dennis A Turner
BACKGROUND: Direct testing of deep brain stimulation (DBS) mechanisms in humans is needed to assess therapy and to understand stimulation effects. OBJECTIVE: We developed an innovative paradigm for investigation of DBS on human movement disorders. Temporary connection to the DBS electrode during implantable pulse generator (IPG) replacement permitted analysis of novel patterns of stimulation on motor symptoms, which could enhance efficacy and improve battery life...
July 2014: Neuromodulation: Journal of the International Neuromodulation Society
Ishita Basu, Daniela Tuninetti, Daniel Graupe, Konstantin V Slavin
Entropy, as a measure of randomness in time-varying signals, is widely used in areas such as thermodynamics, statistical mechanics and information theory. This paper investigates the use of two commonly employed entropy measures, namely Wavelet Entropy and Approximate Entropy, as a predictor of tremor reappearance in Essential Tremor patients; the predictor input is a raw surface-electromyographic (sEMG) signal measured from tremor affected muscles of patients implanted with a Deep Brain Stimulator (DBS). A combination of both types of entropy measure is shown to successfully predict the occurrence of tremor few seconds before its visual manifestation...
2011: Conference Proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society
Alim Louis Benabid, Napoleon Torres
The specific effect of DBS at high frequency, discovered during a VIM thalamotomy, was extended to the older targets of ablative neurosurgery such as the pallidum, for tremor in Parkinson's disease (PD), dyskinesias, essential tremor, as well as the internal capsule to treat psychiatric disorders (OCD). A second wave of targets came from basic research, enabled by the low morbidity, reversibility, and adaptability of DBS. This was the case for the subthalamic nucleus (STN) which improves the triad of dopaminergic symptoms, and the pedunculopontine nucleus (PPN) for gait disorders in PD...
January 2012: Parkinsonism & related Disorders
Sabato Santaniello, Giovanni Fiengo, Luigi Glielmo, Warren M Grill
Deep brain stimulation (DBS) is an effective therapy to treat movement disorders including essential tremor, dystonia, and Parkinson's disease. Despite over a decade of clinical experience the mechanisms of DBS are still unclear, and this lack of understanding makes the selection of stimulation parameters quite challenging. The objective of this work was to develop a closed-loop control system that automatically adjusted the stimulation amplitude to reduce oscillatory neuronal activity, based on feedback of electrical signals recorded from the brain using the same electrode as implanted for stimulation...
February 2011: IEEE Transactions on Neural Systems and Rehabilitation Engineering
Daniel Graupe, Ishita Basu, Daniela Tuninetti, Prasad Vannemreddy, Konstantin V Slavin
OBJECTIVES: We present patient test outcomes to show that on-off control of deep brain stimulation sequences in essential tremor patients is achievable in a self-adaptive manner via non-invasive surface-electromyography, to prevent tremors in these patients. METHOD: In our study, an essential tremor patient, who underwent bilateral deep brain stimulation implantation 8 years earlier, was subjected to deep brain stimulation at 130 pulses/second, with a 90-microsecond pulse-width, in packets of durations from 20 to 73 seconds and was monitored with surface-electromyography...
November 2010: Neurological Research
Alexis M Kuncel, Scott E Cooper, Barbara R Wolgamuth, Warren M Grill
The mechanisms by which deep brain stimulation (DBS) alleviates tremor remain unclear, but successful treatment can be achieved with properly selected frequency and amplitude. The clinical tremor response to thalamic DBS for essential tremor is dependent on the stimulation frequency and amplitude, and for high frequencies (> or = 90 Hz), increasing amplitude suppressed tremor, whereas for low frequencies (< 60 Hz), increasing amplitude aggravated tremor. We studied the effects of stimulation frequency and amplitude on the output of a population of intrinsically active model neurons to test the hypothesis that regularization of neuronal firing patterns is responsible for the clinical effectiveness of DBS...
June 2007: IEEE Transactions on Neural Systems and Rehabilitation Engineering
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