Abstract
Deep brain stimulation (DBS) serves as a treatment for neurological and psychiatric disorders, such as Parkinson's disease (PD), essential tremor, dystonia, Tourette Syndrome (GTS), Huntington's disease, and obsessive-compulsive disorder (OCD). There is broad experience with the short-term effects of DBS in individual diseases and their signs/symptoms. However, even in acute treatment and for the same disorder or a given disorder, a prediction of effect is not perfect. Even further, the factors that influence the long-term effect of DBS and its withdrawal are hardly characterized. In this work, we aim to shed light on an important topic, the question of “DBS dependency.” To address this, we make use of the Kuramoto model of phase synchronization (oscillation feature) endowed with neuroplasticity to study the effects of DBS under successive withdrawals and renewals of neuromodulation as well as influence of treatment duration in de novo DBS “patients.” The results of our simulation show that the characteristics of neuroplasticity have a profound effect on the stability and mutability of oscillation synchronization patterns across successive withdrawal and renewal of DBS in chronic “patients” and also in de novo DBS “patients” with varying duration of treatment (here referred to as the “number of iterations”). Importantly, the results demonstrate the strong effect of the individual neuroplasticity makeup on the behavior of synchrony of oscillatory activity that promotes certain disorder/disease states or symptoms. The effect of DBS-mediated neuromodulation and withdrawal is highly dependent on the makeup of the neuroplastic signature of a disorder or an individual.
Highlights
Deep brain stimulation (DBS) is a neuromodulation technique that is effective as a treatment for severe neurological and psychiatric disorders [1,2,3,4]
It is noticeable that for the high levels of potentiation and depotentiation (8.0 and 8.0), phase locking value (PLV) tended to decrease under successive DBS withdrawal and renewals (Figures 1C, 2C); in the case of middle levels of potentiation and depotentiation (4.0 and 4.0), PLV showed a stable trend without fluctuations (Figures 1D, 2D); in the case of low values of potentiation and depotentiation (0.7 and 0.7), PLV fluctuated between increased and decreased low values with a consistent increase during the successive DBS OFF states (Figures 1E, 2E)
When a powerful treatment, such as deep brain stimulation gets introduced in a new patient, questions arise as to “Why there is no effect? Will there be an effect when I stimulate for a longer time? What happens when the DBS machinery fails or a planned interruption of the stimulation occurs?” In long-term patients on this neuromodulation treatment, the question comes up whether a break or time off the intervention could be planned, or whether a life-long dependence on this input is likely
Summary
Deep brain stimulation (DBS) is a neuromodulation technique that is effective as a treatment for severe neurological and psychiatric disorders [1,2,3,4]. Personalized Neuromodulation and DBS Dependency in terms of variability in efficacy and clinical adverse features, such as stimulation-related side effects or stimulation-independent effects. Long-term neuromodulation with deep brain stimulation reorganizes the brain, changes the inherent patterns of cortical excitability typical of a particular disorder or symptom, and causes different individual clinical responses of a patient upon withdrawal of the stimulation input. In patients in vivo it would be impossible to characterize the complex multifactorial patterns of neuroplasticity in a specific state (e.g., “ON DBS,” “OFF DBS,” and “symptom status”) the patient is in. The reasons for this are technical in nature. It allows consideration of an input as a function of complex patterns, supposedly reflecting an electrophysiological signature of a patient
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