期刊
BRAIN STIMULATION
卷 14, 期 6, 页码 1434-1443出版社
ELSEVIER SCIENCE INC
DOI: 10.1016/j.brs.2021.09.002
关键词
Deep brain stimulation; Responsive stimulation; Essential tremor; Wearable sensors; Electromyography
资金
- National Institute of Neurological Disorders And Stroke of the National Institutes of Health [T32 NS082168, F31NS115363, UH3NS095553]
- Fixel Institute for Neurological Diseases
- Parkinson's Foundation Center of Excellence
- Tyler's Hope for a Dystonia Cure
The study aimed to establish a physiology-driven responsive DBS system for personalized therapy in ET based on EMG signals. Results showed that EMG-driven rDBS provides clinically equivalent tremor suppression compared to traditional cDBS, while delivering less total electrical energy, leading to increased battery life of the INS.
Background: Deep brain stimulation (DBS) is an effective surgical therapy for individuals with essential tremor (ET). However, DBS operates continuously, resulting in adverse effects such as postural instability or dysarthria. Continuous DBS (cDBS) also presents important practical issues including limited battery life of the implantable neurostimulator (INS). Collectively, these shortcomings impact optimal therapeutic benefit in ET. Objective: The goal of the study was to establish a physiology-driven responsive DBS (rDBS) system to provide targeted and personalized therapy based on electromyography (EMG) signals. Methods: Ten participants with ET underwent rDBS using Nexus-D, a Medtronic telemetry wand that acts as a direct conduit to the INS by modulating stimulation voltage. Two different rDBS paradigms were tested: one driven by one EMG (single-sensor) and another driven by two or more EMGs (multi-sensor). The feature(s) used in the rDBS algorithms was the pow2er in the participant's tremor frequency band derived from the sensors controlling stimulation. Both algorithms were trained on kinetic and postural data collected during DBS off and cDBS states. Results: Using established clinical scales and objective measurements of tremor severity, we confirm that both rDBS paradigms deliver equivalent clinical benefit as cDBS. Moreover, both EMG-driven rDBS paradigms delivered less total electrical energy translating to an increase in the battery life of the INS. Conclusions: The results of this study verify that EMG-driven rDBS provides clinically equivalent tremor suppression compared to cDBS, while delivering less total electrical energy. Controlling stimulation using a dynamic rDBS paradigm can mitigate limitations of traditional cDBS systems. (c) 2021 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
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