Personalized chronic adaptive deep brain stimulation outperforms conventional stimulation in Parkinson's disease.

Autor: Oehrn CR; Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA., Cernera S; Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA., Hammer LH; Department of Neurology, University of California, San Francisco, San Francisco, California, USA., Shcherbakova M; Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA., Yao J; Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA.; University of California, Berkeley - University of California, San Francisco Graduate Program in Bioengineering, Berkeley, CA, USA., Hahn A; Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA., Wang S; Department of Neurology, University of California, San Francisco, San Francisco, California, USA.; Weill Institute for Neurosciences, University of California, San Francisco, CA, USA., Ostrem JL; Department of Neurology, University of California, San Francisco, San Francisco, California, USA.; Weill Institute for Neurosciences, University of California, San Francisco, CA, USA., Little S; Department of Neurology, University of California, San Francisco, San Francisco, California, USA.; University of California, Berkeley - University of California, San Francisco Graduate Program in Bioengineering, Berkeley, CA, USA.; Weill Institute for Neurosciences, University of California, San Francisco, CA, USA., Starr PA; Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA.; University of California, Berkeley - University of California, San Francisco Graduate Program in Bioengineering, Berkeley, CA, USA.; Weill Institute for Neurosciences, University of California, San Francisco, CA, USA.
Jazyk: angličtina
Zdroj: MedRxiv : the preprint server for health sciences [medRxiv] 2023 Aug 08. Date of Electronic Publication: 2023 Aug 08.
DOI: 10.1101/2023.08.03.23293450
Abstrakt: Deep brain stimulation is a widely used therapy for Parkinson's disease (PD) but currently lacks dynamic responsiveness to changing clinical and neural states. Feedback control has the potential to improve therapeutic effectiveness, but optimal control strategy and additional benefits of "adaptive" neurostimulation are unclear. We implemented adaptive subthalamic nucleus stimulation, controlled by subthalamic or cortical signals, in three PD patients (five hemispheres) during normal daily life. We identified neurophysiological biomarkers of residual motor fluctuations using data-driven analyses of field potentials over a wide frequency range and varying stimulation amplitudes. Narrowband gamma oscillations (65-70 Hz) at either site emerged as the best control signal for sensing during stimulation. A blinded, randomized trial demonstrated improved motor symptoms and quality of life compared to clinically optimized standard stimulation. Our approach highlights the promise of personalized adaptive neurostimulation based on data-driven selection of control signals and may be applied to other neurological disorders.
Databáze: MEDLINE
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