title: Controlling Parkinson's disease with adaptive deep brain stimulation.
abstract: Adaptive deep brain stimulation (aDBS) has the potential to improve the treatment of Parkinson's disease by optimizing stimulation in real time according to fluctuating disease and medication state. In the present realization of adaptive DBS we record and stimulate from the DBS electrodes implanted in the subthalamic nucleus of patients with Parkinson's disease in the early post-operative period. Local field potentials are analogue filtered between 3 and 47 Hz before being passed to a data acquisition unit where they are digitally filtered again around the patient specific beta peak, rectified and smoothed to give an online reading of the beta amplitude. A threshold for beta amplitude is set heuristically, which, if crossed, passes a trigger signal to the stimulator. The stimulator then ramps up stimulation to a pre-determined clinically effective voltage over 250 msec and continues to stimulate until the beta amplitude again falls down below threshold. Stimulation continues in this manner with brief episodes of ramped DBS during periods of heightened beta power. Clinical efficacy is assessed after a minimum period of stabilization (5 min) through the unblinded and blinded video assessment of motor function using a selection of scores from the Unified Parkinson's Rating Scale (UPDRS). Recent work has demonstrated a reduction in power consumption with aDBS as well as an improvement in clinical scores compared to conventional DBS. Chronic aDBS could now be trialed in Parkinsonism.
authors: Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford.
authors: Simon
authors: S
authors: Little
authors: Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford.
authors: Alek
authors: A
authors: Pogosyan
authors: Sobell Department of Motor Neuroscience & Movement Disorders, Unit of Functional Neurosurgery, UCL Institute of Neurology.
authors: Spencer
authors: S
authors: Neal
authors: Sobell Department of Motor Neuroscience & Movement Disorders, Unit of Functional Neurosurgery, UCL Institute of Neurology.
authors: Ludvic
authors: L
authors: Zrinzo
authors: Sobell Department of Motor Neuroscience & Movement Disorders, Unit of Functional Neurosurgery, UCL Institute of Neurology.
authors: Marwan
authors: M
authors: Hariz
authors: Sobell Department of Motor Neuroscience & Movement Disorders, Unit of Functional Neurosurgery, UCL Institute of Neurology.
authors: Thomas
authors: T
authors: Foltynie
authors: Sobell Department of Motor Neuroscience & Movement Disorders, Unit of Functional Neurosurgery, UCL Institute of Neurology.
authors: Patricia
authors: P
authors: Limousin
authors: Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford; peter.brown@ndcn.ox.ac.uk.
authors: Peter
authors: P
authors: Brown
mesh_terms: D046690:Deep Brain Stimulation / Q000379:methods*; D006801:Humans; D010300:Parkinson Disease / Q000628:therapy*