Wearable sensor-driven responsive deep brain stimulation for essential tremor

Abstract

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Milestones in Tremor Research: 10 Years Later

“…This likely explains the failure in detecting tremor progression using sensor‐based measures rather than what would be obtained by clinical ratings alone 24 . Nonetheless, detailed characterization of tremor features by means of sensors may be helpful in the differential diagnosis between tremor syndromes, 25,26 to predict therapeutic outcomes, 27 and to adapt deep‐brain stimulation (DBS) paradigms to individual tremor physiology 28,29 . It is, therefore, expected that transducers will be increasingly used in both clinical and research settings, also because they enable more frequent and/or longer tremor assessments, and they can be used almost anywhere without clinician raters and/or might be exploited to substantiate clinical ratings 23 …”

“…24 Nonetheless, detailed characterization of tremor features by means of sensors may be helpful in the differential diagnosis between tremor syndromes, 25,26 to predict therapeutic outcomes, 27 and to adapt deep-brain stimulation (DBS) paradigms to individual tremor physiology. 28,29 It is, therefore, expected that transducers will be increasingly used in both clinical and research settings, also because they enable more frequent and/or longer tremor assessments, and they can be used almost anywhere without clinician raters and/or might be exploited to substantiate clinical ratings. 23 The advances in the instrumental measurement of tremor reflect on the possibility of developing novel treatment strategies based on tremor characteristics, which can be sensitively measured only by means of sensors, which is why they are discussed in this section.…”

Which one is the superior target? A comparison and pooled analysis between posterior subthalamic area and ventral intermediate nucleus deep brain stimulation for essential tremor

“…To improve tremor symptoms, many patients were even willing to tolerate mild SRCs, such as mild dysarthria and gait ataxia 72–74 . With the increasing understanding of DBS programming, adaptive and/or sensing closed‐loop DBS, delivering stimulation only when necessary to reduce SRCs and prolong clinical efficacy, is considered as a promising ET‐DBS treatment, when compared with conventional continuous DBS 75,76 . While conventional DBS electrode contacts stimulate the ring‐shaped area around the electrode, directional electrodes achieve stimulation in different directions by dividing the ring electrode into segmented electrodes.…”

Phase-specific Deep Brain Stimulation revisited: effects of stimulation on postural and kinetic tremor

“…To achieve this, experimental closed-loop DBS protocols seek to adjust stimulation delivery and parametrisation in a symptom-responsive manner. In ET, different experimental control algorithms for closed-loop DBS have been successful in supressing tremor -either guided by tremor episodes (detected via accelerometery [22,33] or decoded from thalamic local field potentials [34]); or by voluntary movements (sensed via EMG of the upper limb [35,36] or decoded from cortical [37] or thalamic local field potentials [34]). The main difference between the stimulation strategy used in this study (phase-specific DBS) and the aforementioned studies lies in the pattern of stimulation during stimulation periods.…”