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Toward Electrophysiology-Based Intelligent Adaptive Deep Brain Stimulation for Movement Disorders

  • Wolf-Julian Neumann
  • Robert S. Turner
  • Benjamin Blankertz
  • Tom Mitchell
  • Andrea A. Kühn
  • R. Mark Richardson
Review

Abstract

Deep brain stimulation (DBS) represents one of the major clinical breakthroughs in the age of translational neuroscience. In 1987, Benabid and colleagues demonstrated that high-frequency stimulation can mimic the effects of ablative neurosurgery in Parkinson’s disease (PD), while offering two key advantages to previous procedures: adjustability and reversibility. Deep brain stimulation is now an established therapeutic approach that robustly alleviates symptoms in patients with movement disorders, such as Parkinson’s disease, essential tremor, and dystonia, who present with inadequate or adverse responses to medication. Currently, stimulation electrodes are implanted in specific target regions of the basal ganglia–thalamic circuit and stimulation pulses are delivered chronically. To achieve optimal therapeutic effect, stimulation frequency, amplitude, and pulse width must be adjusted on a patient-specific basis by a movement disorders specialist. The finding that pathological neural activity can be sampled directly from the target region using the DBS electrode has inspired a novel DBS paradigm: closed-loop adaptive DBS (aDBS). The goal of this strategy is to identify pathological and physiologically normal patterns of neuronal activity that can be used to adapt stimulation parameters to the concurrent therapeutic demand. This review will give detailed insight into potential biomarkers and discuss next-generation strategies, implementing advances in artificial intelligence, to further elevate the therapeutic potential of DBS by capitalizing on its modifiable nature. Development of intelligent aDBS, with an ability to deliver highly personalized treatment regimens and to create symptom-specific therapeutic strategies in real-time, could allow for significant further improvements in the quality of life for movement disorders patients with DBS that ultimately could outperform traditional drug treatment.

Keywords

Deep brain stimulation Closed-loop DBS Basal ganglia Parkinson’s disease Dystonia Tourette syndrome 

Notes

Required Author Forms

Disclosure forms provided by the authors are available with the online version of this article.

Funding information

This review article was supported through the joint funding initiative of the United States National Institutes of Health (NIH 1 R01 NS110424) and the German Ministry for Education and Research (BMBF) “Collaborative Research in Computational Neuroscience (CRCNS)” to all authors of the manuscript.

Supplementary material

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Copyright information

© The American Society for Experimental NeuroTherapeutics, Inc. 2019

Authors and Affiliations

  1. 1.Movement Disorder and Neuromodulation Unit, Department of NeurologyCharité – Universitätsmedizin BerlinBerlinGermany
  2. 2.Department of NeurobiologyUniversity of PittsburghPittsburghUSA
  3. 3.Department of Computer ScienceTechnische Universität BerlinBerlinGermany
  4. 4.Machine Learning DepartmentCarnegie Mellon UniversityPittsburghUSA
  5. 5.Berlin School of Mind and BrainCharité – Universitätsmedizin BerlinBerlinGermany
  6. 6.Neurocure, Centre of ExcellenceCharité – Universitätsmedizin BerlinBerlinGermany
  7. 7.Department of Neurological SurgeryUniversity of PittsburghPittsburghUSA

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