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

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)611-616
Number of pages6
Issue number6
StatePublished - Aug 2018


  • 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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