Who May Benefit From On-Demand Control of Deep Brain Stimulation? Noninvasive Evaluation of Parkinson Patients

Daniel Graupe; Nivedita Khobragade; Daniela Tuninetti; Ishita Basu; Konstantin V. Slavin; Leo Verhagen Metman

doi:10.1111/ner.12752

Who May Benefit From On-Demand Control of Deep Brain Stimulation? Noninvasive Evaluation of Parkinson Patients

Daniel Graupe, Nivedita Khobragade^*, Daniela Tuninetti, Ishita Basu, Konstantin V. Slavin, Leo Verhagen Metman

^*Corresponding author for this work

Neurology

Research output: Contribution to journal › Article › peer-review

6 Scopus citations

Abstract

Background: In closed-loop on-demand control (ODC) of deep brain stimulation (DBS), stimulation is applied only when symptoms appear. Following stimulation of a fixed duration, DBS is switched off until the symptoms reappear. By repeating these demand-driven cycles, the amount of stimulation delivered can be decreased, thereby reducing DBS side-effects and improving battery-life of the pulse-generator. This article introduces R_o metric for quantification of degree of benefit of ODC and explores candidate selection in tremor-dominant Parkinson's disease (PD). Method: The study was performed on nine PD patients previously implanted with Medtronic DBS systems. Accelerometer sensor was placed on the tremor-dominant hand to detect onset of tremor. Fixed duration of stimulation (DS) of 20–80 sec was applied. Once the tremor was observed, stimulation was switched on. These trials were repeated during resting, postural, and kinetic conditions. R_o metric was calculated as the ratio of stimulation-off tremor-free period to the DS. R_o calculated at different DS were compared for each patient. Results: We found that for each patient, R_o varied with DS and an optimal DS^* gave a higher percentage of stimulation-off time. Average R_o at DS^* varied from 0.554 to 4.24 for eight patients giving 35%–80% stimulation-off time. Conclusions: R_o values can be used for selection of optimal DS^* in ODC. Three of nine patients were found to be tremor-free without stimulation for >50% of total time with even up to 80% in one patient. Patients with low R_o may not benefit from ODC in DBS, where the trade-off between having side-effects and using ODC system will need to be assessed.

Original language	English (US)
Pages (from-to)	611-616
Number of pages	6
Journal	Neuromodulation
Volume	21
Issue number	6
DOIs	https://doi.org/10.1111/ner.12752
State	Published - Aug 2018

Funding

Source(s) of financial support: This work was supported by National Science Foundation (NSF) under award number 1134296. The data collection, patient payment was partially funded by National Institutes of Health (NIH) under award number R56 NS 040902-11 and the Parkinson’s Disease Foundation. The authors wish to thank Ahmed Rabie, MD, Fellow in Neurosurgery at the University of Illinois at Chicago, for his participation in the tests related to this article.

Keywords

Adaptive control
Parkinson's disease
benefit evaluation
closed-loop deep brain stimulation
on-demand control

ASJC Scopus subject areas

Clinical Neurology
Neurology
Anesthesiology and Pain Medicine

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10.1111/ner.12752

Cite this

@article{097dfb85896440cd94b52ffe00b0e6c0,

title = "Who May Benefit From On-Demand Control of Deep Brain Stimulation? Noninvasive Evaluation of Parkinson Patients",

abstract = "Background: In closed-loop on-demand control (ODC) of deep brain stimulation (DBS), stimulation is applied only when symptoms appear. Following stimulation of a fixed duration, DBS is switched off until the symptoms reappear. By repeating these demand-driven cycles, the amount of stimulation delivered can be decreased, thereby reducing DBS side-effects and improving battery-life of the pulse-generator. This article introduces Ro metric for quantification of degree of benefit of ODC and explores candidate selection in tremor-dominant Parkinson's disease (PD). Method: The study was performed on nine PD patients previously implanted with Medtronic DBS systems. Accelerometer sensor was placed on the tremor-dominant hand to detect onset of tremor. Fixed duration of stimulation (DS) of 20–80 sec was applied. Once the tremor was observed, stimulation was switched on. These trials were repeated during resting, postural, and kinetic conditions. Ro metric was calculated as the ratio of stimulation-off tremor-free period to the DS. Ro calculated at different DS were compared for each patient. Results: We found that for each patient, Ro varied with DS and an optimal DS* gave a higher percentage of stimulation-off time. Average Ro at DS* varied from 0.554 to 4.24 for eight patients giving 35%–80% stimulation-off time. Conclusions: Ro values can be used for selection of optimal DS* in ODC. Three of nine patients were found to be tremor-free without stimulation for >50% of total time with even up to 80% in one patient. Patients with low Ro may not benefit from ODC in DBS, where the trade-off between having side-effects and using ODC system will need to be assessed.",

keywords = "Adaptive control, Parkinson's disease, benefit evaluation, closed-loop deep brain stimulation, on-demand control",

author = "Daniel Graupe and Nivedita Khobragade and Daniela Tuninetti and Ishita Basu and Slavin, {Konstantin V.} and {Verhagen Metman}, Leo",

note = "Funding Information: Source(s) of financial support: This work was supported by National Science Foundation (NSF) under award number 1134296. The data collection, patient payment was partially funded by National Institutes of Health (NIH) under award number R56 NS 040902-11 and the Parkinson{\textquoteright}s Disease Foundation. Funding Information: The authors wish to thank Ahmed Rabie, MD, Fellow in Neurosurgery at the University of Illinois at Chicago, for his participation in the tests related to this article. Publisher Copyright: {\textcopyright} 2018 International Neuromodulation Society",

year = "2018",

month = aug,

doi = "10.1111/ner.12752",

language = "English (US)",

volume = "21",

pages = "611--616",

journal = "Neuromodulation",

issn = "1094-7159",

publisher = "International Neuromodulation Society",

number = "6",

}

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T1 - Who May Benefit From On-Demand Control of Deep Brain Stimulation? Noninvasive Evaluation of Parkinson Patients

AU - Graupe, Daniel

AU - Khobragade, Nivedita

AU - Tuninetti, Daniela

AU - Basu, Ishita

AU - Slavin, Konstantin V.

AU - Verhagen Metman, Leo

N1 - Funding Information: Source(s) of financial support: This work was supported by National Science Foundation (NSF) under award number 1134296. The data collection, patient payment was partially funded by National Institutes of Health (NIH) under award number R56 NS 040902-11 and the Parkinson’s Disease Foundation. Funding Information: The authors wish to thank Ahmed Rabie, MD, Fellow in Neurosurgery at the University of Illinois at Chicago, for his participation in the tests related to this article. Publisher Copyright: © 2018 International Neuromodulation Society

PY - 2018/8

Y1 - 2018/8

N2 - Background: In closed-loop on-demand control (ODC) of deep brain stimulation (DBS), stimulation is applied only when symptoms appear. Following stimulation of a fixed duration, DBS is switched off until the symptoms reappear. By repeating these demand-driven cycles, the amount of stimulation delivered can be decreased, thereby reducing DBS side-effects and improving battery-life of the pulse-generator. This article introduces Ro metric for quantification of degree of benefit of ODC and explores candidate selection in tremor-dominant Parkinson's disease (PD). Method: The study was performed on nine PD patients previously implanted with Medtronic DBS systems. Accelerometer sensor was placed on the tremor-dominant hand to detect onset of tremor. Fixed duration of stimulation (DS) of 20–80 sec was applied. Once the tremor was observed, stimulation was switched on. These trials were repeated during resting, postural, and kinetic conditions. Ro metric was calculated as the ratio of stimulation-off tremor-free period to the DS. Ro calculated at different DS were compared for each patient. Results: We found that for each patient, Ro varied with DS and an optimal DS* gave a higher percentage of stimulation-off time. Average Ro at DS* varied from 0.554 to 4.24 for eight patients giving 35%–80% stimulation-off time. Conclusions: Ro values can be used for selection of optimal DS* in ODC. Three of nine patients were found to be tremor-free without stimulation for >50% of total time with even up to 80% in one patient. Patients with low Ro may not benefit from ODC in DBS, where the trade-off between having side-effects and using ODC system will need to be assessed.

AB - Background: In closed-loop on-demand control (ODC) of deep brain stimulation (DBS), stimulation is applied only when symptoms appear. Following stimulation of a fixed duration, DBS is switched off until the symptoms reappear. By repeating these demand-driven cycles, the amount of stimulation delivered can be decreased, thereby reducing DBS side-effects and improving battery-life of the pulse-generator. This article introduces Ro metric for quantification of degree of benefit of ODC and explores candidate selection in tremor-dominant Parkinson's disease (PD). Method: The study was performed on nine PD patients previously implanted with Medtronic DBS systems. Accelerometer sensor was placed on the tremor-dominant hand to detect onset of tremor. Fixed duration of stimulation (DS) of 20–80 sec was applied. Once the tremor was observed, stimulation was switched on. These trials were repeated during resting, postural, and kinetic conditions. Ro metric was calculated as the ratio of stimulation-off tremor-free period to the DS. Ro calculated at different DS were compared for each patient. Results: We found that for each patient, Ro varied with DS and an optimal DS* gave a higher percentage of stimulation-off time. Average Ro at DS* varied from 0.554 to 4.24 for eight patients giving 35%–80% stimulation-off time. Conclusions: Ro values can be used for selection of optimal DS* in ODC. Three of nine patients were found to be tremor-free without stimulation for >50% of total time with even up to 80% in one patient. Patients with low Ro may not benefit from ODC in DBS, where the trade-off between having side-effects and using ODC system will need to be assessed.

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Who May Benefit From On-Demand Control of Deep Brain Stimulation? Noninvasive Evaluation of Parkinson Patients

Abstract

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Keywords

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