Fully implanted adaptive deep brain stimulation in freely moving essential tremor patients

Area of Science:

• Neuroscience
• Biomedical Engineering
• Neurological Surgery

Background:

• Deep brain stimulation (DBS) is an established treatment for essential tremor (ET) and other movement disorders.
• Adaptive DBS (aDBS) offers improved therapy by real-time modulation of stimulation based on biofeedback.
• Previous aDBS systems faced limitations in translational applicability due to external hardware and privacy concerns.

Purpose of the Study:

• To design and implement a translation-ready training data collection system for fully implanted adaptive deep brain stimulation (aDBS).
• To evaluate the efficacy and feasibility of a fully embedded aDBS system for essential tremor treatment.

Main Methods:

• Recruited two patients with essential tremor chronically implanted with electrocorticography strips and DBS probes.
• Utilized a translation-ready distributed training procedure for data collection and classifier training.
• Trained a linear classifier biased towards clinical considerations for stimulation activation.

Main Results:

• Achieved a clinically relevant average false negative rate of 0.036.
• Demonstrated 33.2% greater tremor suppression with aDBS compared to continuous DBS.
• Patients reported no significant difference in treatment efficacy, with one experiencing mild paresthesia.

Conclusions:

• Presented the first translation-ready training procedure for a fully embedded aDBS control system for movement disorders.
• This study provides one of the first examples of such a system in essential tremor.
• Fully implanted aDBS systems are mature for broader deployment in treating movement disorders.