Applying a Sensing-Enabled System for Ensuring Safe Anterior Cingulate Deep Brain Stimulation for Pain.
Yongzhi Huang1, Binith Cheeran1, Alexander L Green1
1Oxford Functional Neurosurgery Group, Nuffield Departments of Surgical Sciences, University of Oxford, Oxford OX3 9DU, UK.
Brain Sciences
|June 29, 2019
Summary
Deep brain stimulation (DBS) for chronic pain can cause seizures. Using sensing-enabled devices to monitor brain activity and adjust stimulation patterns, like ramping, can prevent seizures while providing pain relief.
Area of Science:
- Neuroscience
- Neurosurgery
- Biomedical Engineering
Background:
- Deep brain stimulation (DBS) of the anterior cingulate cortex (ACC) is a treatment option for chronic pain patients refractory to other therapies.
- Seizures have been reported as a complication in some patients undergoing ACC DBS.
Purpose of the Study:
- To investigate the relationship between ACC stimulation parameters and brain activity, specifically after-discharges (ADs).
- To develop safe DBS programming strategies to prevent seizures while maintaining therapeutic efficacy for chronic pain.
Main Methods:
- Utilized a sensing-enabled neurostimulator to record local field potentials (LFPs) from the ACC in three chronic pain patients.
- Tested various stimulation amplitudes and ramping rates to identify patterns that alleviate pain without inducing ADs.
- Correlated the absence of in-implant AD activity with the absence of clinical seizures.
Main Results:
- Stimulation without ramping induced ADs at amplitudes below therapeutic levels.
- Slowly ramping stimulation (8-s ramp duration) on and off prevented ADs at higher, effective pain-relieving amplitudes.
- Absence of detected ADs correlated with no clinical seizure events.
Conclusions:
- ACC stimulation-induced ADs may serve as a biomarker for seizure risk in DBS patients.
- Sensing-enabled DBS technology facilitates the identification of safe stimulation parameters.
- This approach holds promise for advancing the safety of DBS therapies, particularly for new targets.
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