Abstract
Abstract Programming in deep brain stimulation (DBS) is often a labour-intensive process. Although automatic closed-loop stimulation has recently been receiving considerable attention, it is still far from clinical settings. Testing in-loop stimulation in a clinical setting is extremely challenging due to manual programming and the lack of synchronisation between stimulation and monitoring devices. In this work, we present a simple rulebased expert system to test feedback-controlled DBS in a clinical setting. The new application operates in closed-loop with the physician as acting person and real-time feedback from an accelerometer. Patients with movement disorders such as in essential tremor announce an individually acceptable level of tremor as a boundary condition for control. As a proof-of-concept, the expert system provides continuous recommendations of stimulation parameters and guides the physician to increase or decrease DBS amplitude by capturing tremor acceleration power on the patients’ forearms. The introduced application considers the technical and practical aspects in a clinical setting. Data obtained from test subjects provide insight into tremor dynamics. We demonstrate the clinical applicability of the rule-based control system for future research focusing on tremor dynamics and inloop stimulation. Finally, a telemetry streaming system could provide the interface for the application of automatic tremor control without the physician as acting person.
Highlights
deep brain stimulation (DBS) is an established method for the treatment of movement disorders such as in Parkinson’s disease (PD) and essential tremor (ET)
The proposed control strategy in this work mainly uses the insights gained from previous examinations and forms it into a number of IF- rules as logical implication for the rule-based expert system
A total number of 5 linguistic variables were defined for 5 inputs with rectangle membership functions
Summary
DBS is an established method for the treatment of movement disorders such as in Parkinson’s disease (PD) and essential tremor (ET). The device-based therapy, is associated with a time-consuming programming including frequent patients’ visits, involvement of movement disorder experts and sometimes non-optimal therapeutic effects [1]. These time- and resource consuming procedures further increase the socio-economic burden [2]. The literature has reported a large amount of theoretical and simulation works related to closedloop DBS for movement disorders, which are, typically far from a real-world clinical setting [3]. An exception is a commercially available and approved closedloop neuro-stimulation system for cortical stimulation in epilepsy [4]
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