Coordinated reset vibrotactile stimulation shows prolonged improvement in Parkinson's disease

Syrkin-Nikolau, Judy; Neuville, Raumin S.; O’Day, Johanna J.; Anidi, Chioma; Koop, Mandy Miller; Martin, Talora; Tass, Peter A.; Brontë‐Stewart, Helen

doi:10.1002/mds.27223

Cited by 37 publications

(52 citation statements)

References 6 publications

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“…This therapeutic approach was inspired by the observation that peripheral stimulation evokes central activity in brain regions such as the VIM, a target that when effectively stimulated with DBS can improve tremor . While the success of the patterned peripheral nerve stimulation tested here is consistent with this hypothesis, other potential mechanisms are possible, including circuitry modulated in previous studies demonstrating tremor reduction by manipulation of sensory input, including with topical anesthesia, cooling, vibration, and electrical stimulation . It is also possible that alternative stimulation methods may improve tremor in patients with ET, and determination of optimal treatment for each patient requires further research.…”

Section: Discussionsupporting

confidence: 57%

An Acute Randomized Controlled Trial of Noninvasive Peripheral Nerve Stimulation in Essential Tremor

Pahwa

Dhall

Ostrem

et al. 2019

Neuromodulation: Technology at the Neural Interface

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Objective To evaluate the safety and effectiveness of a wrist‐worn peripheral nerve stimulation device in patients with essential tremor (ET) in a single in‐office session. Methods This was a randomized controlled study of 77 ET patients who received either treatment stimulation (N = 40) or sham stimulation (N = 37) on the wrist of the hand with more severe tremor. Tremor was evaluated before and immediately after the end of a single 40‐minute stimulation session. The primary endpoint compared spiral drawing in the stimulated hand using the Tremor Research Group Essential Tremor Rating Assessment Scale (TETRAS) Archimedes spiral scores in treatment and sham groups. Additional endpoints included TETRAS upper limb tremor scores, subject‐rated tasks from the Bain and Findley activities of daily living (ADL) scale before and after stimulation as well as clinical global impression‐improvement (CGI‐I) rating after stimulation. Results Subjects who received peripheral nerve stimulation did not show significantly larger improvement in the Archimedes spiral task compared to sham but did show significantly greater improvement in upper limb TETRAS tremor scores (p = 0.017) compared to sham. Subject‐rated improvements in ADLs were significantly greater with treatment (49% reduction) than with sham (27% reduction; p = 0.001). A greater percentage of ET patients (88%) reported improvement in the stimulation group as compared to the sham group (62%) according to CGI‐I ratings (p = 0.019). No significant adverse events were reported; 3% of subjects experienced mild adverse events. Conclusions Peripheral nerve stimulation in ET may provide a safe, well‐tolerated, and effective treatment for transient relief of hand tremor symptoms.

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Section: Discussionsupporting

confidence: 57%

An Acute Randomized Controlled Trial of Noninvasive Peripheral Nerve Stimulation in Essential Tremor

Pahwa

Dhall

Ostrem

et al. 2019

Neuromodulation: Technology at the Neural Interface

View full text Add to dashboard Cite

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“…Specific interventions to target specific problems is logical; however, as highlighted in the optogenetics section, less targeted manipulations well outside the seizure focus are also capable of seizure control. Stimulation of a relay structure, such as the thalamus (e.g., SANTE trial; see Salanova et al, 2015), or even sensory inputs to the thalamus (e.g., tactile stimulation in Parkinson's disease; see Syrkin-Nikolau et al, 2018) could potentially control many epilepsies. Specific and non-specific therapies both have merit, and it will be interesting to understand how advancements in these domains will ultimately lead to more effective treatments for epilepsy.…”

Section: Resultsmentioning

confidence: 99%

Resolving the Micro-Macro Disconnect to Address Core Features of Seizure Networks

Farrell

Nguyen

Soltész

2019

Neuron

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Current drug treatments for epilepsy attempt to broadly restrict excitability to mask a symptom, seizures, with little regard for the heterogeneous mechanisms that underlie disease manifestation across individuals. Here, we discuss the need for a more complete view of epilepsy, outlining how key features at the cellular and microcircuit level can significantly impact disease mechanisms that are not captured by the most common methodology to study epilepsy, electroencephalography (EEG). We highlight how major advances in neuroscience tool development now enable multi-scale investigation of fundamental questions to resolve the currently controversial understanding of seizure networks. These findings will provide essential insight into what has emerged as a disconnect between the different levels of investigation and identify new targets and treatment options.

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“…In accordance with these theoretical predictions, long-lasting therapeutic effects were demonstrated in pre-clinical studies in MPTP monkeys with CR-DBS (Tass et al, 2012b ; Wang et al, 2016 ) as well as in a clinical proof of concept study with CR-DBS in Parkinson's patients (Adamchic et al, 2014 ). Analogously, long-lasting therapeutic effects were observed in a proof of concept study with acoustic CR stimulation in tinnitus patients (Tass et al, 2012a ) as well as in a first in man study with vibrotactile CR stimulation in patients with Parkinson's disease (Syrkin-Nikolau et al, 2018 ).…”

Section: Discussionmentioning

confidence: 72%

Multisite Delayed Feedback for Electrical Brain Stimulation

Popovych¹,

Tass²

2018

Front. Physiol.

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Demand-controlled deep brain stimulation (DBS) appears to be a promising approach for the treatment of Parkinson's disease (PD) as revealed by computational, pre-clinical and clinical studies. Stimulation delivery is adapted to brain activity, for example, to the amount of neuronal activity considered to be abnormal. Such a closed-loop stimulation setup might help to reduce the amount of stimulation current, thereby maintaining therapeutic efficacy. In the context of the development of stimulation techniques that aim to restore desynchronized neuronal activity on a long-term basis, specific closed-loop stimulation protocols were designed computationally. These feedback techniques, e.g., pulsatile linear delayed feedback (LDF) or pulsatile nonlinear delayed feedback (NDF), were computationally developed to counteract abnormal neuronal synchronization characteristic for PD and other neurological disorders. By design, these techniques are intrinsically demand-controlled methods, where the amplitude of the stimulation signal is reduced when the desired desynchronized regime is reached. We here introduce a novel demand-controlled stimulation method, pulsatile multisite linear delayed feedback (MLDF), by employing MLDF to modulate the pulse amplitude of high-frequency (HF) DBS, in this way aiming at a specific, MLDF-related desynchronizing impact, while maintaining safety requirements with the charge-balanced HF DBS. Previously, MLDF was computationally developed for the control of spatio-temporal synchronized patterns and cluster states in neuronal populations. Here, in a physiologically motivated model network comprising neurons from subthalamic nucleus (STN) and external globus pallidus (GPe), we compare pulsatile MLDF to pulsatile LDF for the case where the smooth feedback signals are used to modulate the amplitude of charge-balanced HF DBS and suggest a modification of pulsatile MLDF which enables a pronounced desynchronizing impact. Our results may contribute to further clinical development of closed-loop DBS techniques.

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Coordinated reset vibrotactile stimulation shows prolonged improvement in Parkinson's disease

Cited by 37 publications

References 6 publications

An Acute Randomized Controlled Trial of Noninvasive Peripheral Nerve Stimulation in Essential Tremor

An Acute Randomized Controlled Trial of Noninvasive Peripheral Nerve Stimulation in Essential Tremor

Resolving the Micro-Macro Disconnect to Address Core Features of Seizure Networks

Multisite Delayed Feedback for Electrical Brain Stimulation

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