Deep Brain Stimulation System Research Articles

ID: 197424 Improvement in Quality-of-Life and Motor Function: Real-World, Prospective Study of Directional DBS Systems

Early Deep Brain Stimulation (DBS) systems used ring-shaped electrodes to achieve axial selectivity in stimulation of target tissue. However, directional current steering allows for rotational selectivity (in addition to axial) and has the potential to further improve patient outcomes by avoiding off-target stimulation due to the ability to create a well-defined field around the intended target. Several pilot studies have corroborated the use of directionality and its impact on therapeutic window and adverse effects.1-3 In this report, real-world outcomes using Directional DBS Systems with multiple independent current source control (MIC() for use in managing symptoms of levodopa responsive Parkinson's disease (PD) are reported.

ID: 198132 Tremor Reduction Using DBS: Outcomes of a Real-World, Prospective, Multicenter Essential Tremor Registry

Essential Tremor (ET) is one of the most common neurological diseases affecting about 0.9% of the world population.1 ET treatment is focused on medical management of motor symptoms and includes pharmacotherapy and ventral intermediate nucleus (VIM) thalamotomy, which is being largely replaced by thalamic Deep Brain Stimulation (DBS) as the surgical treatment of choice. DBS of the VIM thalamus is recommended as a therapeutic option for appropriate subjects with ET.2 New insights regarding the real-world, clinical use of VIM DBS may be acquired through the implementation of large, multi-center patient registries. Here, we describe the initiation of a new ET patient registry for patients implanted with a multiple-source, constant- current DBS system capable of providing directionality for use in the management of Essential Tremor motor symptoms.

ID: 209013 Combining Remote Programming and Remote Monitoring Towards a Closed-Loop DBS System

Deep Brain Stimulation (DBS) is an effective therapy for Parkinson’s Disease (PD). However, it is currently applied in an open-loop fashion and symptom management relies on iterative programming. The field is trending towards closed-loop solutions that enable stimulation parameters to be adjusted in real-time in response to patient-specific feedback signals. Identifying reliable and robust feedback signals is a challenge in developing closed-loop DBS solutions. As such, in this study, we aim to combine remote monitoring and remote programming to identify specific sensor signals that correlate with DBS programming and symptom profile changes.

ID: 197707 Quality-of-Life Improvement and Patient's Impression of Change With Use of Directional DBS Therapy for PD

Deep Brain Stimulation (DBS) is an established treatment for motor signs and fluctuations associated with Parkinson's disease (PD). Retrospective studies can provide a relatively quick and cost-effective means to obtain data regarding various types of patient outcomes when devices are being used per standard-of-care in the real world clinical setting, thereby contributing to real-world evidence (RWE). Here, we report clinical outcomes associated with the use of DBS systems capable of directionality and Multiple Independent Current Control (MICC) used in the management of PD motor symptoms.

Pallidal activities during sleep and sleep decoding in dystonia, Huntington's, and Parkinson's disease

BackgroundSleep disturbances are highly prevalent in movement disorders, potentially due to the malfunctioning of basal ganglia structures. Pallidal deep brain stimulation (DBS) has been widely used for multiple movement disorders and been reported to improve sleep. We aimed to investigate the oscillatory pattern of pallidum during sleep and explore whether pallidal activities can be utilized to differentiate sleep stages, which could pave the way for sleep-aware adaptive DBS. MethodsWe directly recorded over 500 h of pallidal local field potentials during sleep from 39 subjects with movement disorders (20 dystonia, 8 Huntington's disease, and 11 Parkinson's disease). Pallidal spectrum and cortical-pallidal coherence were computed and compared across sleep stages. Machine learning approaches were utilized to build sleep decoders for different diseases to classify sleep stages through pallidal oscillatory features. Decoding accuracy was further associated with the spatial localization of the pallidum. ResultsPallidal power spectra and cortical-pallidal coherence were significantly modulated by sleep-stage transitions in three movement disorders. Differences in sleep-related activities between diseases were identified in non-rapid eye movement (NREM) and REM sleep. Machine learning models using pallidal oscillatory features can decode sleep-wake states with over 90% accuracy. Decoding accuracies were higher in recording sites within the internus-pallidum than the external-pallidum, and can be precited using structural (P < 0.0001) and functional (P < 0.0001) whole-brain neuroimaging connectomics. ConclusionOur findings revealed strong sleep-stage dependent distinctions in pallidal oscillations in multiple movement disorders. Pallidal oscillatory features were sufficient for sleep stage decoding. These data may facilitate the development of adaptive DBS systems targeting sleep problems that have broad translational prospects.

Closed-Loop Deep Brain Stimulation for Psychiatric Disorders.

Deep brain stimulation (DBS) is a well-established approach to treating medication-refractory neurological disorders and holds promise for treating psychiatric disorders. Despite strong open-label results in extremely refractory patients, DBS has struggled to meet endpoints in randomized controlled trials. A major challenge is stimulation "dosing"-DBS systems have many adjustable parameters, and clinicians receive little feedback on whether they have chosen the correct parameters for an individual patient. Multiple groups have proposed closed loop technologies as a solution. These systems sense electrical activity, identify markers of an (un)desired state, then automatically deliver or adjust stimulation to alter that electrical state. Closed loop DBS has been successfully deployed in movement disorders and epilepsy. The availability of that technology, as well as advances in opportunities for invasive research with neurosurgical patients, has yielded multiple pilot demonstrations in psychiatric illness. Those demonstrations split into two schools of thought, one rooted in well-established diagnoses and symptom scales, the other in the more experimental Research Domain Criteria (RDoC) framework. Both are promising, and both are limited by the boundaries of current stimulation technology. They are in turn driving advances in implantable recording hardware, signal processing, and stimulation paradigms. The combination of these advances is likely to change both our understanding of psychiatric neurobiology and our treatment toolbox, though the timeframe may be limited by the realities of implantable device development.

Improvement in Quality of Life and Motor Function during Daily Clinical Practice using Directional DBS Systems (P4-11.010)

<h3>Objective:</h3> To understand the benefits of Deep Brain Stimulation (DBS) systems with Multiple Independent Current Control (MICC) in daily clinical practice in patients with Parkinson’s disease (PD). <h3>Background:</h3> The main goal of DBS therapy is to achieve optimal outcomes while avoiding side effects. The challenging anatomy surrounding DBS targets requires precise control of neurostimulation. Directional DBS systems can deliver specific amounts of current to each contact using MICC, and this capability has been shown to increase therapeutic window under controlled study conditions (Dembek 2017; Schnitzler 2022). In so doing, vertical and horizontal steering of cathodic and/or anodic current can be achieved, thereby providing flexible programming options to deliver stimulation while minimizing side effects (Steigerwald 2016) (Kirsch 2018). <h3>Design/Methods:</h3> This is a prospective, multicenter (International), registry of up to 1500-patients implanted with directional MICC-based DBS systems (Vercise, Boston Scientific), per standard-of-care. Participants are being followed up to 3-years post-implantation whereby quality-of-life, motor symptoms improvement, overall satisfaction, and other disease aspects are measured. Adverse events and device-related complications are collected. <h3>Results:</h3> A total of 815-patients have been evaluated. Quality-of-life as assessed by PDQ-39 out to 2-years demonstrated sustained clinically significant improvement (minimal clinically important difference [MCID] &gt;4.7-points) despite an expected 5-point worsening due to disease progression (p&lt;0.001) (Horvath 2017; Reuther 2007). Improvement in motor function (MDS-UPDRS III Meds-OFF ) versus baseline were also noted (35% reduction at 2-year; p&lt;0.0001). To date, with &gt;1500 directional leads implanted, no lead breakages have been reported. <h3>Conclusions:</h3> This on-going registry represents the first large-scale collection of real-world, long-term outcomes using MICC-based directional DBS systems. Use of directional DBS systems in clinical practice has been demonstrated to be beneficial per increases in therapeutic window and associated positive outcomes. Results from this on-going evaluation demonstrate sustained improvement in overall outcomes with the use of directional DBS systems. <b>Disclosure:</b> Dr. Deuschl has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Boston Scientific Cavion Functional Neuromodulation. The institution of Dr. Deuschl has received research support from Medtronic. Dr. Deuschl has received publishing royalties from a publication relating to health care. Roshini Jain has received personal compensation for serving as an employee of Boston Scientific. Roshini Jain has received stock or an ownership interest from Boston Scientific. Heleen Scholtes has received personal compensation for serving as an employee of Boston Scientific. Lilly Chen has received personal compensation for serving as an employee of Boston Scientific . Michael Barbe, MD has nothing to disclose. Steffen Paschen has nothing to disclose. Andrea Kuehn has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Medtronic. Andrea Kuehn has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Boston Scientific. Dr. Lee has nothing to disclose. Jan Vesper has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Boston Scientific . Jan Vesper has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Medtronic . Jan Vesper has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Abbott . Jan Vesper has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Abbott . Jan Vesper has received research support from German Research Council.

Tremor Reduction using DBS: Outcomes of a Real-world, Prospective, Multicenter Essential Tremor Registry (P7-11.004)

<h3>Objective:</h3> To evaluate outcomes of directional DBS systems with Multiple Independent Current Control (MICC) technology when implanted in patients with Essential Tremor (ET) as standard of care. <h3>Background:</h3> ET is one of the most common neurological diseases affecting about 0.9% of the world population. Medical treatment is focused on management of motor symptoms, and therapeutic options include pharmacotherapy, ventral intermediate nucleus (Vim) thalamotomy, and/or thalamic Deep Brain Stimulation (DBS). Currently, Vim DBS is recommended as a therapeutic option for appropriate subjects with ET (Wharen 2017, Zesiewicz 2005). <h3>Design/Methods:</h3> In this prospective, on-label, multi-center, international DBS registry, enrolled patients are implanted with a directional MICC-based DBS system (Vercise, Boston Scientific). Patients are followed up to 3-years where overall improvement in quality of life and ET symptoms are evaluated. Adverse events are also being collected. <h3>Results:</h3> To date, 30-patients have been implanted (age = 64.8 ± 15.1 years [Mean (SD)], 53.1% male) with a mean disease duration of 19.3-years. A 17.3-point change in QUEST Summary Index was noted at 12-months representing a clinically significant difference (&gt;4.47-point change) (Pinter 2019). In addition, a mean 9-hours of tremor reduction in a typical day was noted (14.7-hours at Baseline versus 6.5-hours at 12-months). Moreover, based on the severity scale of FTMTRS, when comparing disability at 12-months (vs Baseline), no patient reported experiencing marked disability (vs. 9.4% at Baseline), 16.7% reported moderate disability (vs. 81.3% at Baseline) and 83.3% reported mild disability (vs 9.4% at Baseline). <h3>Conclusions:</h3> Preliminary results from this ongoing registry show clinically important outcomes in quality of life, as well as motor function, thereby reflecting improvement in overall disability among patients (i.e., a disability profile moving from moderate/severe to more mild/moderate disability). This registry represents the first comprehensive, large-scale collection of real-world outcomes with MICC-based DBS systems for ET. <b>Disclosure:</b> Dr. Deuschl has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Boston Scientific Cavion Functional Neuromodulation. The institution of Dr. Deuschl has received research support from Medtronic. Dr. Deuschl has received publishing royalties from a publication relating to health care. Dr. Loret has nothing to disclose. The institution of Norbert Kovacs has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Abbvie. The institution of Norbert Kovacs has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Abbott. The institution of Norbert Kovacs has received personal compensation in the range of $500-$4,999 for serving as a Consultant for boston Scientific. Norbert Kovacs has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Abbvie. Norbert Kovacs has received personal compensation in the range of $500-$4,999 for serving as an officer or member of the Board of Directors for Hungarian Scientific Parkinson’s Disease Society. The institution of Norbert Kovacs has received research support from Abbott. The institution of Norbert Kovacs has received research support from Hungarian National Research Board. Dr. Clement has nothing to disclose. P.R. Schuurman has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Boston Scientific. P.R. Schuurman has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Medtronic.

Ictal Thalamic Recordings in Patients with Deep Brain Stimulation Targeting Thalamic NucleiIdentify whether ictal thalamic EEG signals could be derived from ambulatory recordings in patients with pharmacoresistant epilepsy treated with deep brain stimulation (DBS) targeting either bilateral anterior thalamic nuclei (ATN) or centromedian nuclei (CMN). (P5-1.008)

<h3>Objective:</h3> Identify whether ictal thalamic EEG signals could be derived from ambulatory recordings in patients with pharmacoresistant epilepsy treated with deep brain stimulation (DBS) targeting bilateral anterior thalamic nuclei (ATN) or centromedian nuclei (CMN). <h3>Background:</h3> The DBS system is one modality that can target thalamic nuclei for neuromodulation. The most recently available model features the capability to record live streamed intracranial EEG (local field potentials, or LFP). <h3>Design/Methods:</h3> We selected four patients who had habitual electroclinical and electrographic seizures during live streaming (based on the simultaneous scalp EEG). All the devices were Percept^™ PC (by Medtronic^®), utilizing the BrainSense^® feature to record bipolar LFP signals between two contacts of each of the bilateral four-contact leads. LFP time series were extracted using MATLAB and exported as EEG for review and visualization. <h3>Results:</h3> Three patients were adults (mean age 43, median age 37), and one was a child (10 years). Two had generalized forms of epilepsy (acquired Lennox-Gastaut Syndrome due to diffuse bilateral polymicrogyria; generalized non-lesional epilepsy characterized by absence and myoclonic seizures). One patient had unilateral hemispheric epilepsy due to dual pathology (adult-onset Rasmussen’s encephalitis and focal cortical dysplasia) and prior frontal topectomy. The last patient presented with non-lesional multifocal epilepsy and a history of left parietal topectomy. The DBS for two types of generalized epilepsy targeted bilateral CMN, while the other two targeted bilateral ATN. Generalized ictal patterns involving the four contacts of both thalamic nuclei have been identified as ictal patterns. In contrast, in hemispheric or multifocal epilepsies, only unilateral thalamic nuclei exhibited ictal EEG changes. Ictal EEG alterations consisted of a combination of rhythmic activity and sharp waves or rhythmic spiking activity. Our figures depict the ictal thalamic recordings with the corresponding ictal thalamic waves. <h3>Conclusions:</h3> Our observations call for a more systematic investigation of ictal thalamic signature in various types of epilepsy. <b>Disclosure:</b> Miss Saab has nothing to disclose. Ms. Jiang has nothing to disclose. The institution of Dr. Quraishi has received research support from NeuroPace. The institution of Dr. Quraishi has received research support from Biogen. The institution of Dr. Quraishi has received research support from Praxis Precision Medicines. Dr. Herlopian has nothing to disclose.

Real-World Outcomes in USA using DBS Systems with Directionality and Multiple Independent Current Control (P5-11.017)

Real-World Outcomes in USA using DBS Systems with Directionality and Multiple Independent Current Control (P5-11.017)

Improvement in Cervical Dystonia – Outcomes of a Prospective, Multicenter, International Registry of Deep Brain Stimulation (DBS) (P11-11.002)

<h3>Objective:</h3> To report real-world outcomes of Dystonia patients implanted with a Multiple Independent Current Control (MICC)-based Directional DBS system. <h3>Background:</h3> Management of dystonia using Deep Brain Stimulation (DBS) is a well-established therapeutic approach. However, optimal DBS target sites in patients with cervical (focal) versus generalized dystonia are thought to diverge and be specific for particular connections (Horn 2022). DBS devices equipped with capabilities such as directionality and Multiple Independent Current Control (MICC) may offer potential for improved clinical outcomes. Here, we report a sub-analysis of patients with cervical dystonia only or dystonia with cervical involvement from an on-going, multicenter registry. <h3>Design/Methods:</h3> In this prospective, on-label, multi-center, international registry (ClinicalTrials.gov Identifier: NCT02686125) of dystonia, enrolled subjects received MICC-based directional DBS systems (Vercise, Boston Scientific). Subjects were followed up to 3 years (post-implant). Several study assessments evaluating their dystonia symptoms (e.g., TWSTRS), quality of life (GIC) and overall satisfaction were administered. Adverse Events were also collected. <h3>Results:</h3> A total of 43-patients (mean age 56.9-years, 58% females) with focal (cervical) dystonia only and 83-patients (mean 41.95-years, 61% females) with generalized or segmental dystonia with cervical involvement who underwent pallidal DBS were prospectively evaluated. Both groups reported significant improvement in overall TWSTRS scores – however the extent varied. In the cervical only cohort, a 19.9-point improvement was noted at 6-months (n=25) and sustained up to 1-year (23.2-point improvement, n=20). In those with generalized or segmental dystonia (with cervical involvement), a 9.7-point. and 7.3-improvement in overall TWSTRS scores was noted at 6- (n = 50) and 12-months (n = 38), respectively. <h3>Conclusions:</h3> This registry represents the first comprehensive, large-scale collection of real-world outcomes associated with dystonia patients implanted with a directional DBS system capable of MICC. Preliminary results demonstrate significant improvement in patients with cervical dystonia (either alone or with other regions involved) following DBS. <b>Disclosure:</b> Dr. Albanese has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Boston Scientific. Dr. Albanese has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Frontiers Publishing Group. Dr. Albanese has a non-compensated relationship as a President-Elect with International Association on Parkinsonism and Related Disorders that is relevant to AAN interests or activities. Roshini Jain has received personal compensation for serving as an employee of Boston Scientific. Roshini Jain has received stock or an ownership interest from Boston Scientific. Lilly Chen has received personal compensation for serving as an employee of Boston Scientific . Joachim Krauss has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Inomed. Joachim Krauss has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for aleva. Joachim Krauss has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Boston.

Utilization of intraoperative Subthalamic Nucleus local field potential recordings to guide postoperative Deep Brain Stimulation programming in Parkinson’s disease (P5-11.013)

<h3>Objective:</h3> To investigate whether intraoperative recordings of subthalamic nucleus (STN) local field potentials (LFPs) during awake deep brain stimulation (DBS) surgery for Parkinson’s disease can provide valuable information for postoperative DBS programming. <h3>Background:</h3> DBS is a well-established treatment of Parkinson’s disease. Intraoperative LFP recordings during awake DBS surgery are used to confirm accurate targeting. Postoperative DBS programming is usually based on clinical response. It is unclear whether the intraoperative LFP recordings can guide postoperative DBS programming. <h3>Design/Methods:</h3> All patients with Parkinson’s disease who had awake placement of STN DBS electrodes with intraoperative STN LFP recordings (Alpha Omega LeadConfirm®) at the University of Utah since August 2021 were identified. The peak beta band power for each individual electrode contact was identified. For directional electrodes, the LFP beta peaks were averaged across the three directional contacts for each level. Postoperatively the DBS systems were programmed based on symptom response. The activated DBS levels were compared to the levels with the highest and lowest LFP beta band peaks. <h3>Results:</h3> 13 DBS STN electrodes, from 8 patients (all males, mean age=60±10 years, mean UPDRS score=40±14) were analyzed. The grand average peak beta band frequency was 21Hz with power of 2.3. In 2 out of 13 electrodes the level with the highest beta band peak was activated postoperatively. In 8 electrodes the active levels and the levels with the highest peaks were adjacent. In one electrode the contact with the highest peaks provided best benefit but the contact with the lowest beta peak was activated to avoid dyskinesias. <h3>Conclusions:</h3> In the majority of the electrodes (11 out of 13 electrodes) the levels that were post-operatively activated based on best clinical response coincided or were adjacent to the levels with the highest intraoperative STN LFP beta power peaks. The intraoperative LFP recordings can potentially provide valuable information for programming guidance postoperatively. <b>Disclosure:</b> An immediate family member of Dr. Anwer has received personal compensation for serving as an employee of Southwest Airlines. Dr. Anwer has stock in Boeing. Mr. PAXTON has nothing to disclose. Dr. Rahimpour has nothing to disclose. Dr. Alshaikh has nothing to disclose. D. James Ballard has nothing to disclose. Dr. Steffens has nothing to disclose. Ms. Zorn has nothing to disclose. Dr. Kassavetis has nothing to disclose.

Image-Guided Programming Tool for DBS Programming Used with a Multiple-Source, Constant-Current System Reduces Initial Programming Time (P4-11.012)

Image-Guided Programming Tool for DBS Programming Used with a Multiple-Source, Constant-Current System Reduces Initial Programming Time (P4-11.012)

510 Prospective, Multicenter, International Outcomes Study of Deep Brain Stimulation for Essential Tremor

INTRODUCTION: Essential Tremor (ET) treatment is focused on medical management of motor symptoms and includes pharmacotherapy and ventral intermediate nucleus (VIM) thalamotomy, which is being largely replaced by thalamic Deep Brain Stimulation (DBS) as the surgical treatment of choice. DBS of the VIM thalamus is recommended as a therapeutic option for appropriate subjects with ET (Elble RJ., et al. Expert Rev Neurother. 2018). METHODS: This is a prospective, on-label, multi-center, international DBS outcomes study conducted at up to 50 implanting centers. All participants are implanted with a multiple-source, constant-current directional DBS system (Vercise, Boston Scientific). Subjects are followed for up to 3-years post implantation where their overall improvement in quality of life and ET symptoms are evaluated. Clinical endpoints evaluated at baseline and follow-up timepoints include: The Essential Tremor Rating Assessment Scale (TETRAS), Quality of Life in Essential Tremor Questionnaire (QUEST), Fahn-Tolosa-Marin Rating Scale (TRS), and Global Impression of Change. Adverse events also collected. RESULTS: To date, 18-implanted subjects with a mean disease duration of 15.1 ± 14.6-years and a baseline QUEST Summary Index score of 35.0 ± 12.4. At 6-months post-DBS, a clinically significant improvement in quality of life (∆ = 19.5-point change in QUEST SI score) was reported. In addition, a mean 9-hours of tremor reduction was noted (14-hours at Baseline, 6.9-hours at 6-months) in a typical day at 6-months. All subjects (100%) reported mild disability, and no subject reported moderate or marked disability (89% at baseline) as reported by TRS at 6 months. CONCLUSIONS: This work represents the first comprehensive, large scale collection of real-world outcomes and evaluation of safety and effectiveness of a multiple-source, constant-current DBS system capable of providing directionality for use in treatment of Essential Tremor.

Brain abscess in a patient with generalized dystonia after deep brain stimulation: illustrative case.

Infections related to deep brain stimulation (DBS) devices are not rare, but abscess formation in brain parenchyma is extremely rare. A 50-year-old man with generalized dystonia had undergone DBS of bilateral globus pallidus internus. The authors attempted to remove the bilateral DBS system due to repeated device infections caused by metal allergies. However, the intracranial lead had to be left in place, because the lead was strongly adherent to brain parenchyma. Five years later, magnetic resonance imaging showed ring-like enhancement localized around the tip of the intracranial lead, suggesting brain abscess. In response to the symptoms, the remaining left intracranial electrode was removed. Brain abscesses require several months of treatment with appropriate antibiotics, but good outcomes can be achieved with appropriate treatment. Brain abscess is a rare complication of DBS. In the present case, the infection spread from the subcutaneous infected foci to the intracranial area through the lead, resulting in the formation of a brain abscess. Removing as much of the device as possible from the body is therefore important, even if adhesions with brain parenchyma or other tissues are present, because of the risk of serious complications, as seen in this case.

Glioblastoma, IDH-Wildtype, CNS WHO Grade 4, Associated with Deep Brain Stimulation in a Patient with Essential Tremor: Report of a Case with Molecular Characterization, and Review of the Literature.

Table S1. Summary of prior literature of Glioma post DBS placement. Figure S1. MRI: (A) FLAIR sequence showing normal brain at different levels pre-implantation of the deep brain stimulator system. (B) FLAIR sequences showing development of an ill-defined mildly expansile FLAIR hyperintensity in the high right frontoparietal lobe involving the cortex and white mater, body of the corpus callosum and extending to the left side. (C) T1 post-contrast images showing enhancement in the right frontal lobe white matter anterior and medial to the right DBS lead. (D) FLAIR and (E) T1 post-contrast images following radiation therapy showing a 5 mm rim enhancing lesion anterior to the right DBS lead. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Advanced non-linear control based on artificial intelligence tuner for hand tremor suppression

One of the most common symptoms among diverse patients (e.g. Parkinson’s disease, essential tremor) is hand tremor. Deep brain stimulation (DBS) has been a popular method of controlling hand tremor in recent years. Although recent advancements in the DBS system have enabled DBS applications in the context of various neurodegenerative disorders, the deployment of such interface tactics in DBS applications is seriously threatened by un-adaptability concerns and a lack of an accurate model. In response to these issues, the current letter discusses the construction of an intelligent technique for minimizing hand tremor and self-adaptive DBS settings without requiring a proper hand tremor system modeling setup. For this purpose, the hand tremor is suppressed using an intelligent proportional–integral (iPI) as the main controller and the sliding mode (SM) as an observer. Furthermore, as an auxiliary controller, a deep reinforcement learning (DRL) method with the Actor-Critic structure is adaptively incorporated. The feedback parameters of the ultra-local model (ULM) controller will be adaptively modified utilizing the DRL method by online neural network (NN) updating in the proposed strategy. The advantages of the ULM based on DRL structure over state-of-the-art approaches are demonstrated by a complete assessment.

Real-Time Adjustment of Impulse Stimulation Parameters Using a Closed-Loop Deep Brain Stimulation System

The closed-loop deep brain stimulation system is a new research that provides real-time adjustment of impulse stimulation parameters. This system belongs to the implantation medical equipment technical field, which is designed for gathering physiological signals of patients. It includes a host computer that displays data in real-time, data storage, design optimization algorithms, and renewal embedded programs. The system has two modes of operation: one is where the embedded nerve stimulator carries out the formation closed-loop control of Embedded algorithm processing data, and the other is where the data collection reaches the host computer by wireless communication module. The stimulation parameter is controlled by the wireless communication module after host computer algorithm process, forming a closed loop. This research aimed to investigate the feasibility of using the closed-loop deep brain stimulation system for electronic stimulation of the nervous system disease and its potential for clinical research or zooscopy for closed-loop stimulation methods. The study provides a good platform for the research of closed-loop stimulation methods.

Septum Pellucidum Cyst in Patient with Parkinson’s Disease-minimally Invasive Staged Therapy

Background: The aim of the case report is to present the minimally invasive staged treatment of a patient with motor complications of Parkinson’s disease with a large septum pellucidum cyst.&#x0D; Material and Method: A two-stage surgical strategy was proposed by the movement disorders team: neuroendoscopic cyst fenestration with subsequent implantation of deep brain stimulation electrodes (subthalamic nucleus) depending on the effect of neuroendoscopic treatment.&#x0D; Results: Despite the technical success of a neuroendoscopic cyst fenestration, as evidenced by a reduction in cyst volume, intraoperative ventriculocystography and postoperative CT showing free communication between the cyst and the ventricular system the motor symptoms caused by Parkinson’s disease remained unchanged. A bilateral subthalamic deep brain stimulation system was implanted with good functional results as documented by her UPRDS III score in the off-medication state (52 points preoperative and 34 point after 6 years postoperative) and reduction of L-DOPA equivalent dose (60% of the pre-deep brain stimulation level). &#x0D; Conclusion: Minimally invasive therapy-neuroendoscopic cyst fenestration, followed by a bilateral subthalamic stimulation implantation-led to the substantial and lasting improvement of the patient’s symptoms.&#x0D;

Artificial neural network-based rapid predictor of biological nerve fiber activation for DBS applications

Objective. Computational models are powerful tools that can enable the optimization of deep brain stimulation (DBS). To enhance the clinical practicality of these models, their computational expense and required technical expertise must be minimized. An important aspect of DBS models is the prediction of neural activation in response to electrical stimulation. Existing rapid predictors of activation simplify implementation and reduce prediction runtime, but at the expense of accuracy. We sought to address this issue by leveraging the speed and generalization abilities of artificial neural networks (ANNs) to create a novel predictor of neural fiber activation in response to DBS. Approach. We developed six variations of an ANN-based predictor to predict the response of individual, myelinated axons to extracellular electrical stimulation. ANNs were trained using datasets generated from a finite-element model of an implanted DBS system together with multi-compartment cable models of axons. We evaluated the ANN-based predictors using three white matter pathways derived from group-averaged connectome data within a patient-specific tissue conductivity field, comparing both predicted stimulus activation thresholds and pathway recruitment across a clinically relevant range of stimulus amplitudes and pulse widths. Main results. The top-performing ANN could predict the thresholds of axons with a mean absolute error (MAE) of 0.037 V, and pathway recruitment with an MAE of 0.079%, across all parameters. The ANNs reduced the time required to predict the thresholds of 288 axons by four to five orders of magnitude when compared to multi-compartment cable models. Significance. We demonstrated that ANNs can be fast, accurate, and robust predictors of neural activation in response to DBS.