title: Adaptive deep brain stimulation in advanced Parkinson disease.
abstract: OBJECTIVE
  Brain-computer interfaces (BCIs) could potentially be used to interact with pathological brain signals to intervene and ameliorate their effects in disease states. Here, we provide proof-of-principle of this approach by using a BCI to interpret pathological brain activity in patients with advanced Parkinson disease (PD) and to use this feedback to control when therapeutic deep brain stimulation (DBS) is delivered. Our goal was to demonstrate that by personalizing and optimizing stimulation in real time, we could improve on both the efficacy and efficiency of conventional continuous DBS.
  
  
  METHODS
  We tested BCI-controlled adaptive DBS (aDBS) of the subthalamic nucleus in 8 PD patients. Feedback was provided by processing of the local field potentials recorded directly from the stimulation electrodes. The results were compared to no stimulation, conventional continuous stimulation (cDBS), and random intermittent stimulation. Both unblinded and blinded clinical assessments of motor effect were performed using the Unified Parkinson's Disease Rating Scale.
  
  
  RESULTS
  Motor scores improved by 66% (unblinded) and 50% (blinded) during aDBS, which were 29% (p = 0.03) and 27% (p = 0.005) better than cDBS, respectively. These improvements were achieved with a 56% reduction in stimulation time compared to cDBS, and a corresponding reduction in energy requirements (p < 0.001). aDBS was also more effective than no stimulation and random intermittent stimulation.
  
  
  CONCLUSIONS
  BCI-controlled DBS is tractable and can be more efficient and efficacious than conventional continuous neuromodulation for PD.
authors.affiliation: Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford.
authors.forename: Simon
authors.initials: S
authors.lastname: Little
authors.forename: Alex
authors.initials: A
authors.lastname: Pogosyan
authors.forename: Spencer
authors.initials: S
authors.lastname: Neal
authors.forename: Baltazar
authors.initials: B
authors.lastname: Zavala
authors.forename: Ludvic
authors.initials: L
authors.lastname: Zrinzo
authors.forename: Marwan
authors.initials: M
authors.lastname: Hariz
authors.forename: Thomas
authors.initials: T
authors.lastname: Foltynie
authors.forename: Patricia
authors.initials: P
authors.lastname: Limousin
authors.forename: Keyoumars
authors.initials: K
authors.lastname: Ashkan
authors.forename: James
authors.initials: J
authors.lastname: FitzGerald
authors.forename: Alexander L
authors.initials: AL
authors.lastname: Green
authors.forename: Tipu Z
authors.initials: TZ
authors.lastname: Aziz
authors.forename: Peter
authors.initials: P
authors.lastname: Brown
mesh_terms: D000368:Aged; D000978:Antiparkinson Agents / Q000627:therapeutic use; D062207:Brain-Computer Interfaces; D046690:Deep Brain Stimulation; D006801:Humans; D008875:Middle Aged; D010300:Parkinson Disease / Q000188:drug therapy / Q000503:physiopathology / Q000628:therapy*; D020531:Subthalamic Nucleus / Q000503:physiopathology*; D016896:Treatment Outcome
chemical_list: D000978:Antiparkinson Agents