Closed-Loop Deep Brain Stimulation for Essential Tremor Based on Thalamic Local Field Potentials

Background High-frequency thalamic stimulation is an effective therapy for essential tremor, which mainly affects voluntary movements and/or sustained postures. However, continuous stimulation may deliver unnecessary current to the brain due to the intermittent nature of the tremor. Objective We proposed to close the loop of thalamic stimulation by detecting tremor-provoking movement states using local field potentials recorded from the same electrodes implanted for stimulation, so that the stimulation is only delivered when necessary. Methods Eight patients with essential tremor participated in this study. Patient-specific support vector machine classifiers were first trained using data recorded while the patient performed tremor-provoking movements. Then, the trained models were applied in real-time to detect these movements and triggered the delivery of stimulation. Results Using the proposed method, stimulation was switched on for 80.37 +/- 7.06% of the time when tremor-evoking movements were present. In comparison, the stimulation was switched on for 12.71 +/- 7.06% of the time when the patients were at rest and tremor-free. Compared with continuous stimulation, a similar amount of tremor suppression was achieved while only delivering 36.62 +/- 13.49% of the energy used in continuous stimulation. Conclusions The results suggest that responsive thalamic stimulation for essential tremor based on tremor-provoking movement detection can be achieved without any requirement for external sensors or additional electrocorticography strips. Further research is required to investigate whether the decoding model is stable across time and generalizable to the variety of activities patients may engage with in everyday life. (c) 2021 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society

Automated summary

The study proposed an innovative approach for essential tremor treatment by detecting tremor-provoking movements and delivering stimulation in real-time, achieving effective therapeutic outcomes. Results showed a high percentage of stimulation time when tremors were triggered, with tremor suppression achieved while conserving energy.