Embedded adaptive deep brain stimulation for cervical dystonia controlled by motor cortex theta oscillations

Area of Science:

• Neuroscience and Neurology
• Biomedical Engineering

Background:

• Dystonia is a movement disorder with unclear pathophysiology and limited treatment options.
• Current deep brain stimulation (DBS) efficacy is constrained, necessitating innovative approaches.

Observation:

• A novel sensing-enabled deep brain stimulator recorded local field potentials from the sensorimotor cortex and subthalamic nuclei in a cervical dystonia patient.
• The device captured extensive neural data during unconstrained, at-home activities.
• Theta (3-7 Hz) oscillatory activity was identified as coherent throughout the cortico-subthalamic circuit.

Findings:

• High-frequency stimulation suppressed theta oscillations and reduced the duration, rate, and amplitude of theta bursts.
• An adaptive DBS strategy, triggered by motor cortex theta-burst activity, was developed.
• This adaptive approach demonstrated improved clinical ratings compared to continuous DBS, with increased stimulation amplitude and no induced dyskinesias, despite lower energy delivery.

Implications:

• These findings reinforce the pathophysiological role of low-frequency theta oscillations in dystonia.
• Novel adaptive stimulation strategies targeting cortico-basal theta bursts show promise for improved dystonia treatment.
• Sensing-enabled DBS devices offer a platform for real-world data collection and personalized neuromodulation.