Parkinsons disease (PD) is a prevalent neurodegenerative disorder that poses significant healthcare challenges worldwide. Deep brain stimulation (DBS) has proven effective for managing PD, particularly for patients with inadequate medication response. However, traditional high-frequency DBS systems lack the capability to adjust stimulation patterns in real time based on patient responses. In contrast, closed-loop DBS systems, which adjust stimulation based on recorded biomarkers, present a promising alternative that allows more flexible, on-demand electrical pulses delivery, offering possibility of achieving better therapeutic outcomes with less invasive stimulus. This review article explored various strategies for real-time adjustment of stimulation parameters in closed-loop DBS primarily based on electrophysiological biomarkers, particularly local field potentials (LFPs). We categorize these strategies into four categories: simple on-demand methods, control methods in systems theory, optimization or machine learning algorithms, and desynchronization approaches. By synthesizing existing literature, we provide a comprehensive overview of these strategies, highlighting contributions from multiple disciplines and the prospect of optimizing treatment for Parkinsons disease using closed-loop approach.
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