Directional local field potential recordings for symptom‐specific optimization of deep brain stimulation

Fernández-García, Carla; Foffani, Guglielmo; Dileone, M.; Catalán-Alonso, María José; González-Hidalgo, Mercedes; Barcia, Juan A.; Alonso-Frech, Fernando

doi:10.1002/mds.26949

Cited by 28 publications

(18 citation statements)

References 7 publications

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“…Thus, the LFP can serve as a predictive and supportive tool for multicontact lead programming. This is in line with previous studies showing similar results for the ring contact electrode, as well as with an intraoperative trial and a single, early postoperative case report with directional stimulation …”

Section: Discussionsupporting

confidence: 93%

“…This is in line with previous studies showing similar results for the ring contact electrode, 11,[13][14][15] as well as with an intraoperative trial 17 and a single, early postoperative case report with directional stimulation. 18 Why should beta power in the LFP predict the clinical efficacy of stimulation fields of different orientation? It has been shown that the dorsal part of STN is the most effective site for STN stimulation in PD, 19,20 and that this is also the focus of beta activity.…”

Section: Discussionmentioning

confidence: 99%

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Directional local field potentials: A tool to optimize deep brain stimulation

et al. 2017

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BackgroundAlthough recently introduced directional DBS leads provide control of the stimulation field, programing is time-consuming.ObjectivesHere, we validate local field potentials recorded from directional contacts as a predictor of the most efficient contacts for stimulation in patients with PD.MethodsIntraoperative local field potentials were recorded from directional contacts in the STN of 12 patients and beta activity compared with the results of the clinical contact review performed after 4 to 7 months.ResultsNormalized beta activity was positively correlated with the contact’s clinical efficacy. The two contacts with the highest beta activity included the most efficient stimulation contact in up to 92% and that with the widest therapeutic window in 74% of cases.ConclusionLocal field potentials predict the most efficient stimulation contacts and may provide a useful tool to expedite the selection of the optimal contact for directional DBS.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Directional local field potentials: A tool to optimize deep brain stimulation

et al. 2017

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“…The practical usefulness of this technical advance however is currently limited by the time a specialized neurologist, together with the patient, must devote to conducting a thorough review of the effects of monopolar stimulation. Here, an automatic algorithm to determine the best contact combination could significantly advance the clinical adoption of directional stimulation [156][157][158].…”

Section: Electrode Designmentioning

confidence: 99%

Toward Electrophysiology-Based Intelligent Adaptive Deep Brain Stimulation for Movement Disorders

et al. 2019

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Deep brain stimulation (DBS) represents one of the major clinical breakthroughs in the age of translational neuroscience. In 1987, Benabid and colleagues demonstrated that high-frequency stimulation can mimic the effects of ablative neurosurgery in Parkinson's disease (PD), while offering two key advantages to previous procedures: adjustability and reversibility. Deep brain stimulation is now an established therapeutic approach that robustly alleviates symptoms in patients with movement disorders, such as Parkinson's disease, essential tremor, and dystonia, who present with inadequate or adverse responses to medication. Currently, stimulation electrodes are implanted in specific target regions of the basal ganglia-thalamic circuit and stimulation pulses are delivered chronically. To achieve optimal therapeutic effect, stimulation frequency, amplitude, and pulse width must be adjusted on a patient-specific basis by a movement disorders specialist. The finding that pathological neural activity can be sampled directly from the target region using the DBS electrode has inspired a novel DBS paradigm: closed-loop adaptive DBS (aDBS). The goal of this strategy is to identify pathological and physiologically normal patterns of neuronal activity that can be used to adapt stimulation parameters to the concurrent therapeutic demand. This review will give detailed insight into potential biomarkers and discuss next-generation strategies, implementing advances in artificial intelligence, to further elevate the therapeutic potential of DBS by capitalizing on its modifiable nature. Development of intelligent aDBS, with an ability to deliver highly personalized treatment regimens and to create symptom-specific therapeutic strategies in real-time, could allow for significant further improvements in the quality of life for movement disorders patients with DBS that ultimately could outperform traditional drug treatment.

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“…LFP recordings from basal ganglia in PD patients using dDBS technology have indicated that beta signal strength is not homogenously distributed around segmented leads (Fernández-García et al, 2017;Tinkhauser et al, 2018). Selective stimulation of these regions with high beta power was associated with greater therapeutic benefit (Tinkhauser et al, 2018) and could serve as a physiology-based tool to optimize DBS contact selection.…”

Section: Combining Directional Dbs and Physiologymentioning

confidence: 99%