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Review
. 2023 Jun;38(6):937-948.
doi: 10.1002/mds.29415. Epub 2023 May 6.

Adaptive Deep Brain Stimulation: From Experimental Evidence Toward Practical Implementation

Wolf-Julian Neumann  1 , Roee Gilron  2 , Simon Little  3 , Gerd Tinkhauser  4
Affiliations
Free article
Review

Adaptive Deep Brain Stimulation: From Experimental Evidence Toward Practical Implementation

Wolf-Julian Neumann et al. Mov Disord. 2023 Jun.
Free article

Abstract

Closed-loop adaptive deep brain stimulation (aDBS) can deliver individualized therapy at an unprecedented temporal precision for neurological disorders. This has the potential to lead to a breakthrough in neurotechnology, but the translation to clinical practice remains a significant challenge. Via bidirectional implantable brain-computer-interfaces that have become commercially available, aDBS can now sense and selectively modulate pathophysiological brain circuit activity. Pilot studies investigating different aDBS control strategies showed promising results, but the short experimental study designs have not yet supported individualized analyses of patient-specific factors in biomarker and therapeutic response dynamics. Notwithstanding the clear theoretical advantages of a patient-tailored approach, these new stimulation possibilities open a vast and mostly unexplored parameter space, leading to practical hurdles in the implementation and development of clinical trials. Therefore, a thorough understanding of the neurophysiological and neurotechnological aspects related to aDBS is crucial to develop evidence-based treatment regimens for clinical practice. Therapeutic success of aDBS will depend on the integrated development of strategies for feedback signal identification, artifact mitigation, signal processing, and control policy adjustment, for precise stimulation delivery tailored to individual patients. The present review introduces the reader to the neurophysiological foundation of aDBS for Parkinson's disease (PD) and other network disorders, explains currently available aDBS control policies, and highlights practical pitfalls and difficulties to be addressed in the upcoming years. Finally, it highlights the importance of interdisciplinary clinical neurotechnological research within and across DBS centers, toward an individualized patient-centered approach to invasive brain stimulation. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

Keywords: Parkinson's disease; adaptive DBS; basal ganglia; closed loop DBS; local field potentials.

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References

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    1. Neumann WJ, Staub F, Horn A, et al. Deep brain recordings using an implanted pulse generator in Parkinson's disease. Neuromodulation 2016;19(1):20-24.
    1. Steiner LA, Neumann WJ, Staub-Bartelt F, et al. Subthalamic beta dynamics mirror parkinsonian bradykinesia months after neurostimulator implantation. Mov Disord 2017;32(8):1183-1190.

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