Deep Brain Stimulation Treatment Research Articles

Effects of deep brain stimulation on dopamine D2 receptor binding in patients with treatment-refractory depression

BackgroundDepression is a chronic psychiatric disorder related to diminished dopaminergic neurotransmission. Deep brain stimulation (DBS) has shown effectiveness in treating patients with treatment-refractory depression (TRD). This study aimed to evaluate the effect of DBS on dopamine D2 receptor binding in patients with TRD. MethodsSix patients with TRD were treated with bed nucleus of the stria terminalis (BNST)-nucleus accumbens (NAc) DBS were recruited. Ultra-high sensitivity [11C]raclopride dynamic total-body positron emission tomography (PET) imaging was used to assess the brain D2 receptor binding. Each patient underwent a [11C]raclopride PET scan for 60-min under DBS OFF and DBS ON, respectively. A simplified reference tissue model was used to generate parametric images of binding potential (BPND) with the cerebellum as reference tissue. ResultsDepression and anxiety symptoms improved after 3–6 months of DBS treatment. Compared with two-day-nonstimulated conditions, one-day BNST-NAc DBS decreased [11C]raclopride BPND in the amygdala (15.9 %, p < 0.01), caudate nucleus (15.4 %, p < 0.0001) and substantia nigra (10.8 %, p < 0.01). LimitationsThis study was limited to the small sample size and lack of a healthy control group. ConclusionsChronic BNST-NAc DBS improved depression and anxiety symptoms, and short-term stimulation decreased D2 receptor binding in the amygdala, caudate nucleus, and substantia nigra. The findings suggest that DBS relieves depression and anxiety symptoms possibly by regulating the dopaminergic system.

Adolescent OCD Patient and Caregiver Perspectives on Identity, Authenticity, and Normalcy in Potential Deep Brain Stimulation Treatment.

The ongoing debate within neuroethics concerning the degree to which neuromodulation such as deep brain stimulation (DBS) changes the personality, identity, and agency (PIA) of patients has paid relatively little attention to the perspectives of prospective patients. Even less attention has been given to pediatric populations. To understand patients' views about identity changes due to DBS in obsessive-compulsive disorder (OCD), the authors conducted and analyzed semistructured interviews with adolescent patients with OCD and their parents/caregivers. Patients were asked about projected impacts to PIA generally due to DBS. All patient respondents and half of caregivers reported that DBS would impact patient self-identity in significant ways. For example, many patients expressed how DBS could positively impact identity by allowing them to explore their identities free from OCD. Others voiced concerns that DBS-related resolution of OCD might negatively impact patient agency and authenticity. Half of patients expressed that DBS may positively facilitate social access through relieving symptoms, while half indicated that DBS could increase social stigma. These views give insights into how to approach decision-making and informed consent if DBS for OCD becomes available for adolescents. They also offer insights into adolescent experiences of disability identity and "normalcy" in the context of OCD.

Modeling the volume of tissue activated in deep brain stimulation and its clinical influence: a review.

Deep brain stimulation (DBS) is a neuromodulatory therapy that has been FDA approved for the treatment of various disorders, including but not limited to, movement disorders (e.g., Parkinson's disease and essential tremor), epilepsy, and obsessive-compulsive disorder. Computational methods for estimating the volume of tissue activated (VTA), coupled with brain imaging techniques, form the basis of models that are being generated from retrospective clinical studies for predicting DBS patient outcomes. For instance, VTA models are used to generate target-and network-based probabilistic stimulation maps that play a crucial role in predicting DBS treatment outcomes. This review defines the methods for calculation of tissue activation (or modulation) including ones that use heuristic and clinically derived estimates and more computationally involved ones that rely on finite-element methods and biophysical axon models. We define model parameters and provide a comparison of commercial, open-source, and academic simulation platforms available for integrated neuroimaging and neural activation prediction. In addition, we review clinical studies that use these modeling methods as a function of disease. By describing the tissue-activation modeling methods and highlighting their application in clinical studies, we provide the neural engineering and clinical neuromodulation communities with perspectives that may influence the adoption of modeling methods for future DBS studies.

121 The Effectiveness of Deep Brain Stimulation in Patients With Disorders of Consciousness During Short- and Long-Term

INTRODUCTION: Disorders of consciousness (DoCs) impose heavy medical and economic burdens on families and society. Deep brain stimulation (DBS) has been preliminarily applied to treat patients with disorders of consciousness (DoCs). METHODS: Data from 365 patients with DoCs who were consecutively admitted from 15 July 2011 to 31 December 2021 were retrospectively analysed. Multivariate regression and subgroup analysis were performed to adjust for potential confounders. The primary outcome was improvement in consciousness at 1 year. The CRS-R was used to assess the level of consciousness of each patient. Scores on this scale may vary from 0 to 23, and six subscores are used to quantify auditory, visual, motor and verbal functions as well as communication and arousal. During the surgery, an electrode was implanted into the CM-Pf complex. RESULTS: An overall improvement in consciousness at 1 year was achieved in 32.4% (12/37) of the DBS group compared with 4.3% (14/328) of the conservative group. After full adjustment, DBS significantly improved consciousness at 1 year (adjusted OR 11.90, 95% CI 3.65–38.46, p &lt; 0.001). There was a significant treatment × follow-up interaction (H = 14.99, p &lt; 0.001). An priliminary improvement after DBS treatment could also be seen at 6 months. DBS had significantly better effects in patients with minimally conscious state (MCS) compared with patients with vegetative state/unresponsive wakefulness syndrome (p for interaction &lt;0.001). A nomogram based on age, state of consciousness, pathogeny and duration of DoCs indicated excellent predictive performance (c-index = 0.882). CONCLUSIONS: DBS was associated with better outcomes in patients with DoC, and the effect was likely to be significantly greater in patients with MCS. DBS should be cautiously evaluated by nomogram preoperatively, and randomised controlled trials are still needed.

Demographics of focused ultrasound thalamotomy for essential tremor and trends in deep brain stimulation surgery after its introduction in the USA

BackgroundEssential tremor (ET) is a movement disorder that affects 4%–5% of adults >65 years. For patients with medically refractory ET, neurosurgical interventions such as deep brain stimulation (DBS) and unilateral...

Deep Brain Stimulation Treatment for Genetic Parkinson's Disease: A Case Report

Parkinson's disease (PD) is the second most common neurodegenerative disease and its prevalence has been projected to double over the next 30 years. The diagnosis of PD is bradykinesia and resting tremor or rigidity. PD is a progressive neurodegenerative disease with both motor and nonmotor symptoms. There are many medical options for the treatment of PD but levodopa remains the mainstay. Deep brain stimulation (DBS) is a safe neurosurgical symptomatic treatment for eligible patients with advanced disease in whom medical therapy fails to provide adequate symptom control and a good quality of life or in whom dopaminergic drugs cause severe side effects such as dyskinesias. In this case report, a 44-year-old female patient with a history of tremor and genetic Parkinson's disease, who presented to the clinic with the complaint of excessive increase in tremor in recent years, firstly with drug treatment and then with DBS treatment is reported.

Machine learning-powered lead-free piezoelectric nanoparticle-based deep brain stimulation: A paradigm shift in Parkinson’s disease diagnosis and evaluation

Lead-based deep brain stimulation (DBS) electrodes have been employed to treat Parkinson’s disease (PD), but their limitations have led to the development of lead-free piezoelectric nanoparticle-based DBS (LF-PND-DBS). This novel approach utilizes non-invasive biocompatible piezoelectric nanoparticles to generate electrical stimulation, offering a promising alternative to traditional DBS. In this study, an innovative machine learning (ML)-optimized LF-PND-DBS system for diagnosing and evaluating PD is proposed. By leveraging ML algorithms, the optimized design of LF-PND electrodes and stimulation parameters is derived, ensuring precise and personalized treatment delivery. The ML-optimized LF-PND-DBS system was evaluated in a cohort of PD patients, demonstrating an exceptional diagnostic accuracy with a sensitivity of 99.1% and a specificity of 98.2%. It effectively assessed PD severity and response to DBS treatment, providing valuable guidance for treatment monitoring. The findings highlight the immense potential of the ML-optimized LF-PND-DBS system as a transformative tool for PD diagnosis and evaluation. This novel approach has the potential to enhance DBS efficacy, safety, and personalization, paving the way for improved patient outcomes and quality of life.

A retrospective, naturalistic study of deep brain stimulation and vagal nerve stimulation in young patients.

Invasive neuromodulation interventions such as deep brain stimulation (DBS) and vagal nerve stimulation (VNS) are important treatments for movement disorders and epilepsy, but literature focused on young patients treated with DBS and VNS is limited. This retrospective study aimed to examine naturalistic outcomes of VNS and DBS treatment of epilepsy and dystonia in children, adolescents, and young adults. We retrospectively assessed patient demographic and outcome data that were obtained from electronic health records. Two researchers used the Clinical Global Impression scale to retrospectively rate the severity of neurologic and psychiatric symptoms before and after patients underwent surgery to implant DBS electrodes or a VNS device. Descriptive and inferential statistics were used to examine clinical effects. Data from 73 patients were evaluated. Neurologic symptoms improved for patients treated with DBS and VNS (p<.001). Patients treated with DBS did not have a change in psychiatric symptoms, whereas psychiatric symptoms worsened for patients treated with VNS (p=.008). The frequency of postoperative complications did not differ between VNS and DBS groups. Young patients may have distinct vulnerabilities for increased psychiatric symptoms during treatment with invasive neuromodulation. Child and adolescent psychiatrists should consider a more proactive approach and greater engagement with DBS and VNS teams that treat younger patients.

Comprehensive characterization of intracranial hemorrhage in deep brain stimulation: a systematic review of literature from 1987 to 2023.

Deep brain stimulation (DBS) is an effective treatment for medically refractory movement disorders and other neurological conditions. To comprehensively characterize the prevalence, locations, timing of detection, clinical effects, and risk factors of DBS-related intracranial hemorrhage (ICH), the authors performed a systematic review of the published literature. PubMed, EMBASE, and Web of Science were searched using 2 concepts: cerebral hemorrhage and brain stimulation, with filters for English, human studies, and publication dates 1980-2023. The inclusion criteria were the use of DBS intervention for any human neurological condition, with documentation of hemorrhagic complications by location and clinical effect. Studies with non-DBS interventions, no documentation of hemorrhage outcome, patient cohorts of ≤ 10, and pediatric patients were excluded. The risk of bias was assessed using Centre for Evidence-Based Medicine Levels of Evidence. The authors performed proportional meta-analysis for ICH prevalence. A total of 63 studies, with 13,056 patients, met the inclusion criteria. The prevalence of ICH was 2.9% (fixed-effects model, 95% CI 2.62%-3.2%) per patient and 1.6% (random-effects model, 95% CI 1.34%-1.87%) per DBS lead, with 49.6% being symptomatic. The ICH rates did not change with time. ICH most commonly occurred around the DBS lead, with 16% at the entry point, 31% along the track, and 7% at the target. Microelectrode recording (MER) during DBS was associated with increased ICH rate compared to DBS without MER (3.5 ± 2.2 vs 2.1 ± 1.4; p[T ≤ t] 1-tail = 0.038). Other reported ICH risk factors include intraoperative systolic blood pressure > 140 mm Hg, sulcal DBS trajectories, and multiple microelectrode insertions. Sixty percent of ICH was detected at 24 hours postoperatively and 27% intraoperatively. The all-cause mortality rate of DBS was 0.4%, with ICH accounting for 22% of deaths. Single-surgeon DBS experience showed a weak inverse correlation (r = -0.27, p = 0.2189) between the rate of ICH per lead and the number of leads implanted per year. This study provides level III evidence that MER during DBS is a risk factor for ICH. Other risk factors include intraoperative systolic blood pressure > 140 mm Hg, sulcal trajectories, and multiple microelectrode insertions. Avoidance of these risk factors may decrease the rate of ICH.

Cortical signatures of sleep are altered following effective deep brain stimulation for depression

Deep brain stimulation (DBS) of the subcallosal cingulate cortex (SCC) is an experimental therapy for treatment-resistant depression (TRD). Chronic SCC DBS leads to long-term changes in the electrophysiological dynamics measured from local field potential (LFP) during wakefulness, but it is unclear how it impacts sleep-related brain activity. This is a crucial gap in knowledge, given the link between depression and sleep disturbances, and an emerging interest in the interaction between DBS, sleep, and circadian rhythms. We therefore sought to characterize changes in electrophysiological markers of sleep associated with DBS treatment for depression. We analyzed key electrophysiological signatures of sleep—slow-wave activity (SWA, 0.5–4.5 Hz) and sleep spindles—in LFPs recorded from the SCC of 9 patients who responded to DBS for TRD. This allowed us to compare the electrophysiological changes before and after 24 weeks of therapeutically effective SCC DBS. SWA power was highly correlated between hemispheres, consistent with a global sleep state. Furthermore, SWA occurred earlier in the night after chronic DBS and had a more prominent peak. While we found no evidence for changes to slow-wave power or stability, we found an increase in the density of sleep spindles. Our results represent a first-of-its-kind report on long-term electrophysiological markers of sleep recorded from the SCC in patients with TRD, and provides evidence of earlier NREM sleep and increased sleep spindle activity following clinically effective DBS treatment. Future work is needed to establish the causal relationship between long-term DBS and the neural mechanisms underlying sleep.

The Linguistic-Cognitive Profile in an Adult Population with Parkinson's Disease and Deep Brain Stimulation: A Comparative Study.

Introduction. Individuals with Parkinson's disease (PD) exhibit general impairments, particularly non-motor symptoms that are related to language, communication, and cognition processes. People with this disease may undergo a surgical intervention for the placement of a deep brain stimulation device, which improves their motor symptoms. However, this type of intervention leads to a decline in their linguistic and cognitive abilities that becomes increasingly noticeable as the disease progresses. Objective. The objective of this research was to compare the performance and linguistic-cognitive profile of individuals with Parkinson's disease who underwent deep brain stimulation treatment based on the stage of the disease. Method. A total of 60 participants who were diagnosed with PD by their reference hospital were selected. These participants were divided into three groups based on the stage of the disease that they were in, forming three groups: a Stage I group (n = 20), a Stage II group (n = 20), and a Stage III group (n = 20). The linguistic-cognitive profile was assessed using the MoCA, ACE-III, and MetAphas tests. The design of this study was established as a quasi-experimental, cross-sectional investigation, and statistical analysis was performed using MANOVA to compare the scores between the study groups. Results. The results indicate that individuals in Stage I exhibit better linguistic and cognitive performance compared to the other groups of participants in Stage II and Stage III, with statistically significant differences (p < 0.05). Conclusion. In conclusion, the progression of PD leads to significant linguistic and cognitive decline in individuals with this disease who have a deep brain stimulation device, greatly limiting the autonomy and quality of life for people with PD.

A review on Parkinson’s disease symptoms before and after deep brain stimulation treatment

Introduction: Parkinson’s disease (PD), followed by Alzheimer’s disease, is the most common progressive neurodegenerative disease. Tremors, rigidity, akinesia, and disorders are common PD symptoms. Over the last few decades, deep brain stimulation (DBS) of the subthalamic nucleus has become a standard treatment for advanced PD. The aim of this systematic review paper is to see the difference between the symptoms of PD before and after DBS. Methods: We conducted a literature search using PubMed and Google Scholar. We chose research from the past 10 years. We retrieved 64 papers, and seven duplicated papers were removed. We reviewed the abstract for the remaining 57 papers which led to the selection of 29 papers. After applying inclusion and exclusion criteria for the remaining 29 papers, 23 papers in the English language were chosen for our review. Results: Five Randomized Clinical Trials (RCTs) studied the outcomes of DBS and eight RCTs about effects on posture and motor function. Four RCTs investigated the effects on gait and balance, two on tremors, and the remaining two on posture. The effects of DBS on speech and language were compared in two RCTs. Three studies looked at cognitive performance. One RCT studied sleeping versus awake DBS on PD. These studies showed that with DBS treatment, there was significant improvement in posture, motor function, gait, balance, speech, and language. However, more studies are required for the further analysis on dysphagia and urinary dysfunction. Conclusion: Our study contributed to a better understanding of the advantages of DBS for a range of symptoms, but it concluded that additional RCT on dysphagia and urinary dysfunction was required to reach a reliable conclusion. More research is required to determine the effects of DBS on different motor and non-motor PD symptoms to standardize treatment.

Optimization of Patient Specific Stimulus for Deep Brain Stimulation Using Spatially Distributed Neural Sources

Deep brain stimulation (DBS) becomes the therapy of choice in the later stages of Parkinson's disease (PD) due to the medication's side effects. For effective DBS treatment, it is important to have a controlled dosage of DBS. DBS dosage is administered using the tuning of electrical parameters of the stimulus signal. Since this tuning process is tedious, time-consuming and patient-specific, there is a need to study the properties of DBS stimulation signal for proper dose administration. We propose a simulation framework to define an optimized DBS stimulus using Electroencephalogram (EEG) signals. The objective is to provide a simulation environment inspired by a realistic brain. The framework uses spiking neurons in a reservoir modelled after real brain anatomy and is trained using a biologically inspired spike-time-dependent-plasticity learning algorithm. This reservoir is initially set to OFF-medication state and forced to drift to the ON-medication state by optimizing the synaptic changes. In later testing, the generalization of this framework is verified with EEG-inverse solutions like sLORETA which utilize time-domain EEG signals to estimate neural activations. The stimulus signal is generated by accumulating the variations in synaptic weights in the neural reservoir in the target brain region. We analyze this signal and show that the application of this signal as stimulus results in decreased <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"><tex-math notation="LaTeX">$\beta$</tex-math></inline-formula> -band power in subthalamic-nucleus local-field-potential compared to OFF-medication local-field-potential without stimulation. Using SIM4LIFE simulation software, we show that the simulation increases chaos in the local-field-potential of subthalamic-nucleus neurons and shows that neuron weight variations follow specific trajectories in reconstructed state-space. <italic xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">Impact Statement:</i> The primary contribution of this paper is to present a framework that utilizes the association between target signals of any modality (EEG, MEG, fMRI) and their respective post-synaptic activations to optimize the deep brain stimulation (DBS) stimulus signal. This framework combines coordinates of neural sources with patients' EEG data to optimize the stimulus of DBS. While defining this framework, we initially proposed the usage of spiking neurons in a biological neural reservoir to estimate the internal activations for given EEG data. Later, we extended our testing to incorporate inverse EEG algorithms that estimate neural activations directly from EEG data without any conversion. This is a novel framework, and there are not many examples available in the literature for similar work. This framework is in its early stages, yet it provides an adequate starting point for an under-explored area of study. This framework can potentially evolve into a useful tool for doctors in assisting the DBS tuning process before the surgical procedure. This framework's accuracy depends on the underlying technique to estimate the neural activations from the target signals (like EEG etc.).

Disparities in the treatment of movement disorders using deep brain stimulation.

Deep brain stimulation (DBS) is a well-established treatment for Parkinson's disease (PD) and essential tremor (ET). Although the prevalence of PD and ET can vary by sex and race, little is known about the accessibility of neurosurgical treatments for these conditions. In this nationwide study, the authors aimed to characterize trends in the use of DBS for the treatment of PD and ET and to identify disparities in the neurosurgical treatment of these diseases based on ethnic, racial, sex, insurance, income, hospital, and geographic factors. Using the dates January 1, 2012, to December 31, 2019, the authors queried the National Inpatient Sample database for all discharges with an ICD-9 or ICD-10 diagnosis of PD or ET. Among these discharges, the DBS rates were reported for each subgroup of race, ethnicity, and sex. To develop national estimates, all analyses were weighted. Among 2,517,639 discharges with PD, 29,820 (1.2%) received DBS, and among 652,935 discharges with ET, 11,885 (1.8%) received DBS. Amid the PD cases, Black patients (n = 405 [0.2%], OR 0.16, 95% CI 0.12-0.20) were less likely than White patients (n = 23,975 [1.2%]) to receive DBS treatment, as were Hispanic patients (n = 1965 [1.1%], OR 0.76, 95% CI 0.65-0.88), whereas Asian/Pacific Islander patients (n = 855 [1.5%]) did not statistically differ from White patients. Amid the ET cases, Black (n = 230 [0.8%], OR 0.39, 95% CI 0.27-0.56), Hispanic (n = 215 [1.0%], OR 0.39, 95% CI 0.28-0.55), and Asian/Pacific Islander (n = 55 [1.0%], OR 0.51, 95% CI 0.28-0.93) patients were less likely than White patients (n = 10,440 [1.9%]) to receive DBS. Females were less likely than males to receive DBS for PD (OR 0.69, p < 0.0001) or ET (OR 0.70, p < 0.0001). The authors describe significant racial and sex-based differences in the utilization of DBS for the treatment of PD and ET. Further research is required to ascertain the causes of these disparities, as well as any differences in access to specialty neurosurgical care and referral for neuromodulation approaches.

Outcome differences between males and females undergoing deep brain stimulation for treatment-resistant depression: systematic review and individual patient data meta-analysis

BackgroundTreatment-resistant depression (TRD) occurs more commonly in women. Deep brain stimulation (DBS) is an emerging treatment for TRD, and its efficacy continues to be explored. However, differences in treatment outcomes between males and females have yet to be explored in formal analysis. MethodsA PRISMA-compliant systematic review of DBS for TRD studies was conducted. Patient-level data were independently extracted by two authors. Treatment response was defined as a 50 % or greater reduction in depression score. Percent change in depression scores by gender were evaluated using random-effects analyses. ResultsOf 737 records, 19 studies (129 patients) met inclusion criteria. The mean reduction in depression score for females was 57.7 % (95 % CI, 64.33 %–51.13 %), whereas for males it was 35.2 % (95 % CI, 45.12 %–25.23 %) (p < 0.0001). Females were more likely to respond to DBS for TRD when compared to males (OR = 2.44, 95 % CI 1.06, 1.95). These differences varied in significance when stratified by DBS anatomical target, age, and timeframe for responder classification. LimitationsStudies included were open-label trials with small sample sizes. ConclusionsOur findings suggest that females with TRD respond at higher rates to DBS treatment than males. Further research is needed to elucidate the implications of these results, which may include connectomic sexual dimorphism, depression phenotype variations, or unrecognized symptom reporting differences. Methodological standardization of outcome scales, granular demographic data, and individual subject outcomes would allow for more robust comparisons between trials.

Effect of deep brain stimulation compared with drug therapy alone on the progression of Parkinson's disease.

Parkinson's disease (PD) symptoms deteriorate with disease progression. Although deep brain stimulation (DBS) can effectively improve the motor signs of PD patients, it is not yet known whether DBS surgery, which is an invasive treatment modality, may change the progression of PD. The aim of this work was to compare the effect of DBS with that of drug treatment on the progression of PD. A total of 77 patients with PD with the Hoehn and Yahr scale (HY) stage of 2.5 or 3 were included, and were divided into 34 in the drug therapy alone group (Drug-G) and 43 in the DBS therapy group (DBS-G). All patients were subjected to a follow-up of 2 years, and disease severity was assessed by the Unified Parkinson's Disease Rating Scale part III (UPDRS-III), the Montreal Cognitive Assessment (MOCA), the Hamilton Anxiety Scale (HAMA), and the Hamilton Depression Scale (HAMD) scores. In addition, the quality of life of patients and the burden on their family were assessed by the 39-item PD questionnaire (PDQ-39) scores, daily levodopa equivalent dose (LED), patient's annual treatment-related costs, and the Zarit Caregiver Burden Scale (ZCBS) score. The changes in relevant scale scores between the two groups were compared at each follow-up stage. The UPDRS-III score of the patients in the "off" state increased from year to year in both groups, and the degree of increase of this score was greater in the DBS-G than in the Drug-G group. The MOCA score in both groups began to decline in the 2nd year of follow-up, and the decline was greater in the Drug-G than in the DBS-G group. DBS treatment did not affect patients' psychiatric disorders. The PDQ39, LED, costs, and ZCBS were negatively correlated with the follow-up time in patients in the DBS-G group, and positively correlated with the follow-up time in patients in the Drug-G. PD is progressive regardless of treatment. The findings from this follow-up study suggest that the disease progression of patients in DBS-G may be slightly faster compared to the drug-G, but the advantages of DBS are also evident. Indeed, DBS better improves patient's motor signs and quality of life and reduces the family burden. In addition, DBS has less impact on patients in terms of cognitive and mental effects.

Brain Temporal-Spectral Functional Variability Reveals Neural Improvements of DBS Treatment for Disorders of Consciousness.

Deep brain stimulation (DBS) is establishing itself as a promising treatment for disorders of consciousness (DOC). Measuring consciousness changes is crucial in the optimization of DBS therapy for DOC patients. However, conventional measures use subjective metrics that limit the investigations of treatment-induced neural improvements. The focus of this study is to analyze the regulatory effects of DBS and explain the regulatory mechanism at the brain functional level for DOC patients. Specifically, this paper proposed a dynamic brain temporal-spectral analysis method to quantify DBS-induced brain functional variations in DOC patients. Functional near-infrared spectroscopy (fNIRS) that promised to evaluate consciousness levels was used to monitor brain variations of DOC patients. Specifically, a fNIRS-based experimental procedure with auditory stimuli was developed, and the brain activities during the procedure from thirteen DOC patients before and after the DBS treatment were recorded. Then, dynamic brain functional networks were formulated with a sliding-window correlation analysis of phase lag index. Afterwards, with respect to the temporal variations of global and regional networks, the variability of global efficiency, local efficiency, and clustering coefficient were extracted. Further, dynamic networks were converted into spectral representations by graph Fourier transform, and graph energy and diversity were formulated to assess the spectral global and regional variability. The results showed that DOC patients under DBS treatment exhibited increased global and regional functional variability that was significantly associated with consciousness improvements. Moreover, the functional variability in the right brain regions had a stronger correlation with consciousness enhancements than that in the left brain regions. Therefore, the proposed method well signifies DBS-induced brain functional variations in DOC patients, and the functional variability may serve as promising biomarkers for consciousness evaluations in DOC patients.

Towards automated sleep-stage classification for adaptive deep brain stimulation targeting sleep in patients with Parkinson’s disease

Sleep dysfunction affects over 90% of Parkinson’s disease patients. Recently, subthalamic nucleus deep brain stimulation has shown promise for alleviating sleep dysfunction. We previously showed that a single-layer neural network could classify sleep stages from local field potential recordings in Parkinson’s disease patients. However, it was unable to categorise non-rapid eye movement into its different sub-stages. Here we employ a larger hidden layer network architecture to distinguish the substages of non-rapid eye movement with reasonable accuracy, up to 88% for the lightest substage and 92% for deeper substages. Using Shapley attribution analysis on local field potential frequency bands, we show that low gamma and high beta are more important to model decisions than other frequency bands. These results suggest that the proposed neural network-based classifier can be employed for deep brain stimulation treatment in commercially available devices with lower local field potential sampling frequencies.

A Comprehensive study on the application of deep brain stimulation in PTSD

Nowadays, with the rapid development of society, stress from all aspects promotes increasing rates of getting mental health issues or illness. Among them, Post Traumatic Stress Disorder (PTSD) is one of the famous mental problems that is noticed by people heavily in recent years. At the same time, great progress in the field of medical-surgical technology has also been made. Deep Brain Stimulation (DBS), a neurosurgical process that requires implanting electrodes in specific brain regions, can be used to treat PTSD to some extent. This reviewed the previous research and study conducted using DBS targeting PTSD, synthesized results and found that DBS treatment is currently mainly at the preclinical stage; Amygdala is the most common brain region that being targeted by DBS; The combination of several treatments is more effective than only DBS treatment; and most studies about the effects of DBS on PTSD were conducted on animal models. Whats more, the future study direction of this related topic including the Nonhuman Primate Research and DBS treatment with other disorders such as Parkinsons Disorder, and Obsessive-Compulsive Disorder(OCD) is also included.

[Pacemaker, organ or walking stick? Pre-op association with and post-op subjective perception of a deep brain stimulation device].

This study was conducted in a pre-post design with a survey of patients who had undergone deep brain stimulation (DBS) as treatment for a neurological movement disorder. The aim of the study was to compare patients' expectations and beliefs before a DBS intervention with patients' subjective experience of this intervention. The longitudinal study of patients (n=132) with an indication for DBS therapy was based on a written survey at the time points of preoperative screening (pre-op) and one-year follow-up (post-op). Preoperatively, a clear majority of respondents believed DSB to be similar to a pacemaker intervention, but one year after the intervention less than one third did so, as they compared DBS to using a walking stick or glasses. The experience of DBS in the patient's own body seems to be comparable by means of individually different associations, whereby the comparison with non-invasive aids predominates postoperatively. The discussion of these descriptions in the educational interview can contribute to a realistic horizon of patients' expectations before DBS.