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ItemTowards guided and automated programming of subthalamic area stimulation in Parkinson's diseaseXu, SS ; Sinclair, NC ; Bulluss, KJ ; Perera, T ; Lee, W-L ; McDermott, HJ ; Thevathasan, W (OXFORD UNIV PRESS, 2022-01-04)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; r 2 = 0.50, Akaike information criterion 1039.9, beta; r 2 = 0.50, Akaike information criterion 1041.6, high-frequency oscillations; r 2 = 0.44, Akaike information criterion 1057.2 and anatomy; r 2 = 0.49, Akaike information criterion 1048.0. Combining evoked resonant neural activity, beta and high-frequency oscillations ranking data yielded the strongest predictive model (r 2 = 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.
ItemProceedings of the Seventh Annual Deep Brain Stimulation Think Tank: Advances in Neurophysiology, Adaptive DBS, Virtual Reality, Neuroethics and TechnologyRamirez-Zamora, A ; Giordano, J ; Gunduz, A ; Alcantara, J ; Cagle, JN ; Cernera, S ; Difuntorum, P ; Eisinger, RS ; Gomez, J ; Long, S ; Parks, B ; Wong, JK ; Chiu, S ; Patel, B ; Grill, WM ; Walker, HC ; Little, SJ ; Gilron, R ; Tinkhauser, G ; Thevathasan, W ; Sinclair, NC ; Lozano, AM ; Foltynie, T ; Fasano, A ; Sheth, SA ; Scangos, K ; Sanger, TD ; Miller, J ; Brumback, AC ; Rajasethupathy, P ; McIntyre, C ; Schlachter, L ; Suthana, N ; Kubu, C ; Sankary, LR ; Herrera-Ferra, K ; Goetz, S ; Cheeran, B ; Steinke, GK ; Hess, C ; Almeida, L ; Deeb, W ; Foote, KD ; Okun, MS (FRONTIERS MEDIA SA, 2020-03-27)The Seventh Annual Deep Brain Stimulation (DBS) Think Tank held on September 8th of 2019 addressed the most current: (1) use and utility of complex neurophysiological signals for development of adaptive neurostimulation to improve clinical outcomes; (2) Advancements in recent neuromodulation techniques to treat neuropsychiatric disorders; (3) New developments in optogenetics and DBS; (4) The use of augmented Virtual reality (VR) and neuromodulation; (5) commercially available technologies; and (6) ethical issues arising in and from research and use of DBS. These advances serve as both "markers of progress" and challenges and opportunities for ongoing address, engagement, and deliberation as we move to improve the functional capabilities and translational value of DBS. It is in this light that these proceedings are presented to inform the field and initiate ongoing discourse. As consistent with the intent, and spirit of this, and prior DBS Think Tanks, the overarching goal is to continue to develop multidisciplinary collaborations to rapidly advance the field and ultimately improve patient outcomes.
ItemTailoring Subthalamic Nucleus Deep Brain Stimulation for Parkinson's Disease Using Evoked Resonant Neural ActivityThevathasan, W ; Sinclair, NC ; Bulluss, KJ ; McDermott, HJ (FRONTIERS MEDIA SA, 2020-02-28)