Objective: To provide a proof of principle implementation of closed loop DBS in an office setting using narrowband γ and β power as modulatory signals for DBS therapy.

Background: Deep brain stimulation (DBS) therapy is a common treatment for Parkinson’s disease (PD) and other movement disorders, but suffers from several limitations. Existing DBS devices continuously stimulate target structures regardless of changes in motor function, often resulting in stimulation-induced adverse effects, short battery life, and the need for labor-intensive programming by a clinician. DBS treatment could be improved by automatically adjusting stimulation parameters based on brain signals that reflect the patient’s clinical state (closed loop DBS). We and others have identified brain signals related to motor impairments of PD in both motor cortex and subthalamic nucleus (STN). Dyskinesia is associated with a narrowband γ oscillation at 60-90 Hz. Akinesia is associated with excessive neuronal synchronization in the β band (13-30 Hz).

Methods: Closed loop DBS in two patients (both male, 59 and 62 years old at time of surgery) implanted with a novel bidirectional neural interface for at least a year were studied. This device allows chronic recording and stimulation. We utilized electrocorticography (ECoG) over motor cortex as a signal to adjust DBS voltage, delivered in STN, within a neurologist-specified range. Short sessions (less than 10 minutes) were performed with either data streaming to an external computer to perform calculations and update DBS, or algorithms directly uploaded to the internal pulse generator for totally implanted control.

Results: We showed that stimulation updates were appropriately triggered based on ECoG power for both sessions utilizing external streaming or totally implanted approaches. Patients and investigators did not report any adverse stimulation effects.

Conclusions: We have demonstrated the feasibility of implementing closed loop DBS in clinic based on cortical narrowband γ and β power. This approach has the potential to trigger DBS updates based on changes in dyskinesia and akinesia/rigidity and represents the first step towards closed loop DBS to improve treatment efficacy, reduce side effects and reduce battery consumption. The next step will be to assess potential clinical benefit during a longer closed loop DBS session (1 week) before undertaking a long-term trial of closed loop DBS.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/feedback-controlled-dbs-in-parkinsons-disease-using-electrocorticography/