Adaptive deep brain stimulation in advanced Parkinson disease.
Open accessAbstract
OBJECTIVE: Brain-computer interfaces (BCIs) could potentially be used to interact with pathological brain signals to intervene and ameliorate their effects in disease states. Here, we provide proof-of-principle of this approach by using a BCI to interpret pathological brain activity in patients with advanced Parkinson disease (PD) and to use this feedback to control when therapeutic deep brain stimulation (DBS) is delivered. Our goal was to demonstrate that by personalizing and optimizing stimulation in real time, we could improve on both the efficacy and efficiency of conventional continuous DBS. METHODS: We tested BCI-controlled adaptive DBS (aDBS) of the subthalamic nucleus in 8 PD patients. Feedback was provided by processing of the local field potentials recorded directly from the stimulation electrodes. The results were compared to no stimulation, conventional continuous stimulation (cDBS), and random intermittent stimulation. Both unblinded and blinded clinical assessments of motor effect were performed using the Unified Parkinson's Disease Rating Scale. RESULTS: Motor scores improved by 66% (unblinded) and 50% (blinded) during aDBS, which were 29% (p = 0.03) and 27% (p = 0.005) better than cDBS, respectively. These improvements were achieved with a 56% reduction in stimulation time compared to cDBS, and a corresponding reduction in energy requirements (p < 0.001). aDBS was also more effective than no stimulation and random intermittent stimulation. INTERPRETATION: BCI-controlled DBS is tractable and can be more efficient and efficacious than conventional continuous neuromodulation for PD.
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The outcome of brain stimulation to treat Parkinson's disease can be improved by recording brain activity and stimulating only when the local field potentials collected by electrodes inserted in the subthalamic nucleus exceed a certain threshold.
“Furthermore, it has been shown that the outcome of brain stimulation to treat Parkinson’s disease can be improved by recording brain activity and stimulating only when the local field potentials collected by electrodes inserted in the subthalamic nucleus exceed a certain threshold (Little et al., 2013)”
From Toward a personalized closed-loop stimulation of the visual cortex: Advances and challenges (2022) · cites this paper as Little et al., 2013
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- Authors
- Little, S., Pogosyan, A., Neal, S., Zavala, B., Zrinzo, L., Hariz, M., Foltynie, T., Limousin, P., Ashkan, K., FitzGerald, J., Green, A. L., Aziz, T. Z., & Brown, P.
- Affiliations
- John Radcliffe Hospital (GB)
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital University of Oxford Oxford
- UCL Queen Square Institute of Neurology (GB)
- King's College Hospital (GB)
- ORCID
- Venue
- Annals of Neurology
- Publisher
- Wiley
- Published
- 2013-07-12
- Volume
- 74
- Issue
- 3
- Pages
- 449-457
- ISSN
- 0364-5134 (ISSN-L)
- 1531-8249
- PMC
- PMC3886292
- OpenAlex
- W2143685192
- Cited by
- 1,374
- References
- 40
- Citations by year
- 2026: 131 · 2025: 123 · 2024: 113 · 2023: 114 · 2022: 106 · 2021: 116 · 2020: 118 · 2019: 92 · 2018: 111 · 2017: 103 · 2016: 93 · 2015: 76 · 2014: 64 · 2013: 11 · 2012: 1
- FWCI
- 51.61
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Annals of Neurology (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- UCL Discovery (University College London) (submittedVersion)
- eScholarship (California Digital Library) (submittedVersion, cc-by-nc-nd)
- Funders
- Medical Research Council
- Wellcome Trust
- Topics
- Health Sciences › Medicine › Neurology › Neurological disorders and treatments
- Social Sciences › Psychology › Clinical Psychology › Obsessive-Compulsive Spectrum Disorders
- Life Sciences › Neuroscience › Neurology › Transcranial Magnetic Stimulation Studies
- Keywords
- adaptive deep brain stimulation, Parkinson's disease, brain-computer interface, subthalamic nucleus, local field potentials, intermittent stimulation, stimulation efficiency, energy consumption reduction, motor symptoms, neuromodulation
- MeSH terms
- Aged, Antiparkinson Agents, Humans, Middle Aged, Parkinson Disease, Treatment Outcome, Subthalamic Nucleus, Deep Brain Stimulation, Brain-Computer Interfaces
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