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Practical Closed-Loop Strategies for Deep Brain Stimulation: Lessons From Chronic Pain.
Jordan Prosky1,2, Jackson Cagle3, Kristin K Sellers1,2
1Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States.
Frontiers in Neuroscience
|January 3, 2022
Summary
Closed-loop deep brain stimulation (DBS) offers personalized therapy by adjusting to neural signals, unlike older open-loop methods. This guide details practical programming for clinicians using new DBS devices, focusing on chronic pain management.
Area of Science:
- Neuroscience
- Biomedical Engineering
- Clinical Neurology
Background:
- Open-loop deep brain stimulation (DBS) has shown variable success in treating neuropsychiatric disorders due to its continuous, non-adaptive nature.
- Emerging DBS devices offer closed-loop capabilities, sensing neural signals to modulate stimulation in real-time.
- Closed-loop DBS holds promise for more personalized and effective therapeutic strategies, potentially overcoming limitations of traditional open-loop approaches.
Purpose of the Study:
- To provide a practical clinical guide for implementing closed-loop DBS systems.
- To detail the optimization of adjustable parameters for closed-loop DBS programming.
- To illustrate the application of closed-loop DBS in managing chronic pain.
Main Methods:
- Focus on Medtronic research devices (Activa PC+S and Summit RC+S) for practical implementation examples.
- Combine clinical understanding of chronic pain with data-driven heuristics for parameter tuning.
- Address key programming aspects: feature selection, state thresholding, and managing stimulation artifacts.
Main Results:
- Demonstrates a clinician-centric approach to programming closed-loop DBS devices.
- Provides actionable insights into optimizing parameter settings for specific patient needs, exemplified by chronic pain.
- Highlights the importance of empirical and clinical decision-making in closed-loop system calibration.
Conclusions:
- Closed-loop DBS programming requires careful parameter optimization based on physiological data and clinical expertise.
- This guide offers practical strategies for clinicians to effectively utilize advanced closed-loop DBS technology.
- Successful implementation of closed-loop DBS can lead to more personalized and potentially improved patient outcomes, particularly in chronic pain management.
