A New Implantable Closed-Loop Clinical Neural Interface: First Application in Parkinson’s Disease

Arlotti, Mattia; Colombo, Matteo; Bonfanti, Andrea; Mandat, Tomasz; Lanotte, Michele; Pirola, Elena; Borellini, Linda; Rampini, Paolo; Eleopra, Roberto; Rinaldo, Sara; Romito, Luigi; Janssen, Mark; Priori, Alberto; Marceglia, Sara

doi:10.3389/fnins.2021.763235

Cited by 35 publications

(23 citation statements)

References 58 publications

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“…In this direction, future works should investigate whether the additional and more prominent information provided by FM over AM may extend from the binary definition of dopaminergic states to a more continuous mapping of some clinical/behavioral features. This issue seems particularly feasible to be addressed with the newer sensing devices that are becoming progressively available 60 – 62 . In any case, the partial redundancy of the AM-FM code seems appealing for increasing the robustness of decoding algorithms, possibly favoring the transition of closed-loop brain stimulation from controlled lab conditions to noisy real-life applications.…”

Section: Discussionmentioning

confidence: 99%

Amplitude and frequency modulation of subthalamic beta oscillations jointly encode the dopaminergic state in Parkinson’s disease

Averna

Marceglia

Priori

et al. 2022

npj Parkinsons Dis.

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Brain states in health and disease are classically defined by the power or the spontaneous amplitude modulation (AM) of neuronal oscillations in specific frequency bands. Conversely, the possible role of the spontaneous frequency modulation (FM) in defining pathophysiological brain states remains unclear. As a paradigmatic example of pathophysiological resting states, here we assessed the spontaneous AM and FM dynamics of subthalamic beta oscillations recorded in patients with Parkinson’s disease before and after levodopa administration. Even though AM and FM are mathematically independent, they displayed negatively correlated dynamics. First, AM decreased while FM increased with levodopa. Second, instantaneous amplitude and instantaneous frequency were negatively cross-correlated within dopaminergic states, with FM following AM by approximately one beta cycle. Third, AM and FM changes were also negatively correlated between dopaminergic states. Both the slow component of the FM and the fast component (i.e. the phase slips) increased after levodopa, but they differently contributed to the AM-FM correlations within and between states. Finally, AM and FM provided information about whether the patients were OFF vs. ON levodopa, with partial redundancy and with FM being more informative than AM. AM and FM of spontaneous beta oscillations can thus both separately and jointly encode the dopaminergic state in patients with Parkinson’s disease. These results suggest that resting brain states are defined not only by AM dynamics but also, and possibly more prominently, by FM dynamics of neuronal oscillations.

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Section: Discussionmentioning

confidence: 99%

Amplitude and frequency modulation of subthalamic beta oscillations jointly encode the dopaminergic state in Parkinson’s disease

Averna

Marceglia

Priori

et al. 2022

npj Parkinsons Dis.

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“…In future applications, neurophysiology could guide adaptive DBS. Indeed, LFP recorded in GPi could be used as input signals to modulate stimulation parameters as currently used for Parkinson’s disease [ 104 ].…”

Section: Discussionmentioning

confidence: 99%

Dystonia Diagnosis: Clinical Neurophysiology and Genetics

Biase

Santo

Caminiti

et al. 2022

JCM

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Dystonia diagnosis is based on clinical examination performed by a neurologist with expertise in movement disorders. Clues that indicate the diagnosis of a movement disorder such as dystonia are dystonic movements, dystonic postures, and three additional physical signs (mirror dystonia, overflow dystonia, and geste antagonists/sensory tricks). Despite advances in research, there is no diagnostic test with a high level of accuracy for the dystonia diagnosis. Clinical neurophysiology and genetics might support the clinician in the diagnostic process. Neurophysiology played a role in untangling dystonia pathophysiology, demonstrating characteristic reduction in inhibition of central motor circuits and alterations in the somatosensory system. The neurophysiologic measure with the greatest evidence in identifying patients affected by dystonia is the somatosensory temporal discrimination threshold (STDT). Other parameters need further confirmations and more solid evidence to be considered as support for the dystonia diagnosis. Genetic testing should be guided by characteristics such as age at onset, body distribution, associated features, and coexistence of other movement disorders (parkinsonism, myoclonus, and other hyperkinesia). The aim of the present review is to summarize the state of the art regarding dystonia diagnosis focusing on the role of neurophysiology and genetic testing.

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“…Given the complexity of the pathology and the limitations that underline a correct neuropsychiatric evaluation, further studies with a more extensive series are needed, perhaps collecting data from multicenter studies. We believe that, with the widespread use of directional leads and of closed-loop systems that adjust the stimulation parameters according to biomarkers, which reflect the patients’ clinical state (e.g., BrainSense technology or AlphaDBS technology), it will be possible to further personalize the stimulation therapy and lower the incidence of stimulation-related adverse effects [ 52 , 53 ].…”

Section: Discussionmentioning

confidence: 99%

Psychiatric Symptoms in Parkinson’s Disease Patients before and One Year after Subthalamic Nucleus Deep Brain Stimulation Therapy: Role of Lead Positioning and Not of Total Electrical Energy Delivered

Somma

Esposito

Scala

et al. 2022

JPM

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Parkinson’s disease (PD) patients may experience neuropsychiatric symptoms, including depression, anxiety, sleep disturbances, psychosis, as well as behavioral and cognitive symptoms during all the different stages of the illness. Deep Brain Stimulation (DBS) therapy has proven to be successful in controlling the motor symptoms of PD and its possible correlation with the occurrence or worsening of neuropsychiatric symptoms has been reported. We aimed to assess the neuropsychiatric symptoms of 14 PD patients before and after one year of Subthalamic Nucleus (STN)-DBS and to correlate the possible changes to the lead placement and to the total electrical energy delivered. We assessed PD motor symptoms, depression, anxiety, apathy, impulsivity, and suicidality using clinician- and/or self-administered rating scales and correlated the results to the lead position using the Medtronic SuretuneTM software and to the total electrical energy delivered (TEED). At the 12-month follow-up, the patients showed a significant improvement in PD symptoms on the UPDRS (Unified Parkinson’s Disease Rating Scale) (−38.5%; p < 0.001) and in anxiety on the Hamilton Anxiety Rating Scale (HAM-A) (−29%; p = 0.041), with the most significant reduction in the physiological anxiety subscore (−36.26%; p < 0.001). A mild worsening of impulsivity was detected on the Barratt Impulsiveness Scale (BIS-11) (+9%; p = 0.048), with the greatest increase in the attentional impulsiveness subscore (+13.60%; p = 0.050). No statistically significant differences were found for the other scales. No correlation was found between TEED and scales’ scores, while the positioning of the stimulating electrodes in the different portions of the STN was shown to considerably influence the outcome, with more anterior and/or medial lead position negatively influencing psychiatric symptoms.

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A New Implantable Closed-Loop Clinical Neural Interface: First Application in Parkinson’s Disease

Cited by 35 publications

References 58 publications

Amplitude and frequency modulation of subthalamic beta oscillations jointly encode the dopaminergic state in Parkinson’s disease

Amplitude and frequency modulation of subthalamic beta oscillations jointly encode the dopaminergic state in Parkinson’s disease

Dystonia Diagnosis: Clinical Neurophysiology and Genetics

Psychiatric Symptoms in Parkinson’s Disease Patients before and One Year after Subthalamic Nucleus Deep Brain Stimulation Therapy: Role of Lead Positioning and Not of Total Electrical Energy Delivered

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