Scalar Closed-Loop STN/GPi DBS Based on Evoked and Spontaneous Potentials
基于诱发电位和自发电位的标量闭环 STN/GPi DBS
基本信息
- 批准号:9564229
- 负责人:
- 金额:$ 54.38万
- 依托单位:
- 依托单位国家:美国
- 项目类别:
- 财政年份:2017
- 资助国家:美国
- 起止时间:2017-09-15 至 2022-07-31
- 项目状态:已结题
- 来源:
- 关键词:AffectAlgorithmsAxonBasal GangliaBilateralBiological MarkersBradykinesiaBrainChronicClinicalClinical MarkersClinical ResearchComplexDeep Brain StimulationDevelopmentDevicesDisease ProgressionDopamineDyskinetic syndromeEarly InterventionElectrodesEvaluationEvoked PotentialsEvolutionFDA approvedFeedbackHumanImplantLeadLocationManualsMedical DeviceMorphologic artifactsMotorNatureOnset of illnessOperative Surgical ProceduresOutcomeParkinson DiseasePatientsPatternPersonsPharmaceutical PreparationsPhysiologicalPostoperative PeriodPublic HealthResearchSignal TransductionSiteSurrogate MarkersSymptomsSynapsesSystemTechnologyTestingThalamic structureTimeTremorbaseclinical efficacyexperienceexperimental studyfirst-in-humanimprovedmotor symptomnovelnovel strategiesprogramsreduce symptomsrelating to nervous systemresponsesynergismsystems researchtreatment effect
项目摘要
Abstract
DBS therapy for Parkinson's disease is now the primary surgical approach for Parkinson's disease, recently
FDA approved at 4 years after onset of disease. However, this therapy is still limited to treatment of a subset
of motor symptoms (ie, tremor, rigidity, bradykinesia and dyskinesias) and requires considerable postoperative
clinical adjustment to program and maintain function. A number of improvements to DBS for PD are being
tested, including changes in patterns of stimulation and specific targets. However, a major new approach
involves internal parameter adjustment using a surrogate physiological marker of clinical symptoms, useful for
confirming initial electrode placement, programming, and also long-term optimization of parameters. Several
research systems have been suggested and are in testing for development of closed loop systems, including
systems based on recording beta-band oscillations. Closed loop control involving recording a surrogate signal
relevant to PD could improve DBS therapy on several time scales, including short-term dynamics (ie, over
minutes), initial programming (over weeks to months), and long-term, depending on the time course of
response to STN DBS. In addition to spontaneous beta band recording we have also implemented direct
evoked potential recording using the stimulating DBS electrode, requiring suppression of the DBS-induced
artifact. These intraoperative DBS recordings during STN DBS implants have revealed a complex evoked
potential likely reflecting GPe/GPi activation, which may provide an excellent surrogate marker. This complex
evoked potential changes over a short-term time period as the treatment effect of STN DBS comes on,
indicating that the evoked potential likely reflects DBS effects on a larger motor circuit as the circuit
dynamically is altered to an improved state. We hypothesize that this surrogate marker (in addition to beta
band oscillations) may provide a key feedback signal for scalar, graded (proportional) closed loop DBS control,
highly relevant to DBS effects on PD circuitry. To test this hypothesis we will perform long-term recording of
this signal from humans (in either STN or GPe/GPi) together with DBS stimulation (in STN and/or GPi), using a
novel DBS recording/stimulation device (Medtronics RC+S).
These clinical experiments will focus on a small, pilot clinical study (n = 6 patients) to implant bilateral STN +
GPe/GPi DBS electrodes in Parkinson's patients eligible for DBS using conventional stereotactic localization,
connecting to Medtronics RC+S IPGs. Patients will benefit from either ordinary STN or GPi DBS stimulation
and then we will also test the possibility of synergism between the two electrodes for clinical efficacy.
Additionally, we will analyze the motor efficacy of both an external (using recording and modifying the
parameters manually) and internal (using an algorithm for providing parameters automatically) scalar, closed
loop response to these recorded surrogate markers. We will take advantage of the graded nature of the
spontaneous and evoked responses to construct a proportional control feedback system, and to specifically
delineate the time constants of the closed loop system to be able to define optimally damped control of PD
symptoms. These experiments will provide a number of novel outcomes, including a direct, within-person
comparison of STN and GPe/GPi DBS efficacy, development of an optimal surrogate parameter for detecting
DBS efficacy using spontaneous and evoked physiological responses in direct comparison to clinical
symptoms, and defining an optimal, scalar feedback, proportional control system for treatment on various time
scales.
摘要
项目成果
期刊论文数量(0)
专著数量(0)
科研奖励数量(0)
会议论文数量(0)
专利数量(0)
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DENNIS Alan TURNER其他文献
DENNIS Alan TURNER的其他文献
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{{ truncateString('DENNIS Alan TURNER', 18)}}的其他基金
Hypoperfusion, Hemodynamic Control Domains and Neurovascular Dysregulation in AD brain pathology
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10588544 - 财政年份:2022
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Scalar Closed-Loop STN/GPi DBS Based on Evoked and Spontaneous Potentials
基于诱发电位和自发电位的标量闭环 STN/GPi DBS
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9404120 - 财政年份:2017
- 资助金额:
$ 54.38万 - 项目类别:
Scalar Closed-Loop STN/GPi DBS Based on Evoked and Spontaneous Potentials
基于诱发电位和自发电位的标量闭环 STN/GPi DBS
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10219364 - 财政年份:2017
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