Adaptive Deep Brain Stimulation for Movement Disorders: The Long Road to Clinical Therapy.
Although electrical stimulation of nerve cells lying deep in the brain is an important treatment for people affected by Parkinson’s, we are only just beginning to understand how to make such stimulation more effective and ‘intelligent’ by timing its delivery according to ongoing symptoms. In this review, we discuss what is needed to translate intelligent stimulation into clinical practice.
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. In this review, we evaluate existing aDBS studies as proof-of-principle, discuss their limitations, most of which stem from their acute nature, and propose what is needed to take aDBS into a chronic setting. © 2017 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.
2017.Mov. Disord., 32(6):810-819.