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Clinical applications of neurochemical and electrophysiological measurements for closed-loop neurostimulation.
Neurosurg Focus. 2020 Jul; 49(1):E6.NF

Abstract

The development of closed-loop deep brain stimulation (DBS) systems represents a significant opportunity for innovation in the clinical application of neurostimulation therapies. Despite the highly dynamic nature of neurological diseases, open-loop DBS applications are incapable of modifying parameters in real time to react to fluctuations in disease states. Thus, current practice for the designation of stimulation parameters, such as duration, amplitude, and pulse frequency, is an algorithmic process. Ideal stimulation parameters are highly individualized and must reflect both the specific disease presentation and the unique pathophysiology presented by the individual. Stimulation parameters currently require a lengthy trial-and-error process to achieve the maximal therapeutic effect and can only be modified during clinical visits. The major impediment to the development of automated, adaptive closed-loop systems involves the selection of highly specific disease-related biomarkers to provide feedback for the stimulation platform. This review explores the disease relevance of neurochemical and electrophysiological biomarkers for the development of closed-loop neurostimulation technologies. Electrophysiological biomarkers, such as local field potentials, have been used to monitor disease states. Real-time measurement of neurochemical substances may be similarly useful for disease characterization. Thus, the introduction of measurable neurochemical analytes has significantly expanded biomarker options for feedback-sensitive neuromodulation systems. The potential use of biomarker monitoring to advance neurostimulation approaches for treatment of Parkinson's disease, essential tremor, epilepsy, Tourette syndrome, obsessive-compulsive disorder, chronic pain, and depression is examined. Further, challenges and advances in the development of closed-loop neurostimulation technology are reviewed, as well as opportunities for next-generation closed-loop platforms.

Authors+Show Affiliations

1Department of Neurologic Surgery.1Department of Neurologic Surgery. 2Medical Scientist Training Program.1Department of Neurologic Surgery.1Department of Neurologic Surgery.1Department of Neurologic Surgery.1Department of Neurologic Surgery.3Division of Engineering, and.1Department of Neurologic Surgery. 3Division of Engineering, and.1Department of Neurologic Surgery.1Department of Neurologic Surgery. 4Department of Biomedical Engineering, Mayo Clinic, Rochester, Minnesota.1Department of Neurologic Surgery. 4Department of Biomedical Engineering, Mayo Clinic, Rochester, Minnesota.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32610297

Citation

Price, J Blair, et al. "Clinical Applications of Neurochemical and Electrophysiological Measurements for Closed-loop Neurostimulation." Neurosurgical Focus, vol. 49, no. 1, 2020, pp. E6.
Price JB, Rusheen AE, Barath AS, et al. Clinical applications of neurochemical and electrophysiological measurements for closed-loop neurostimulation. Neurosurg Focus. 2020;49(1):E6.
Price, J. B., Rusheen, A. E., Barath, A. S., Rojas Cabrera, J. M., Shin, H., Chang, S. Y., Kimble, C. J., Bennet, K. E., Blaha, C. D., Lee, K. H., & Oh, Y. (2020). Clinical applications of neurochemical and electrophysiological measurements for closed-loop neurostimulation. Neurosurgical Focus, 49(1), E6. https://doi.org/10.3171/2020.4.FOCUS20167
Price JB, et al. Clinical Applications of Neurochemical and Electrophysiological Measurements for Closed-loop Neurostimulation. Neurosurg Focus. 2020;49(1):E6. PubMed PMID: 32610297.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical applications of neurochemical and electrophysiological measurements for closed-loop neurostimulation. AU - Price,J Blair, AU - Rusheen,Aaron E, AU - Barath,Abhijeet S, AU - Rojas Cabrera,Juan M, AU - Shin,Hojin, AU - Chang,Su-Youne, AU - Kimble,Christopher J, AU - Bennet,Kevin E, AU - Blaha,Charles D, AU - Lee,Kendall H, AU - Oh,Yoonbae, PY - 2020/03/01/received PY - 2020/04/16/accepted PY - 2020/7/2/entrez PY - 2020/7/2/pubmed PY - 2020/7/2/medline KW - ACC = anterior cingulate cortex KW - ALIC = anterior limb of the internal capsule KW - CM-Pf = centromedian-parafascicular complex KW - DBS = deep brain stimulation KW - ET = essential tremor KW - FSCV = fast-scan cyclic voltammetry KW - GABA = gamma-aminobutyric acid KW - GPi = globus pallidus interna KW - LFP = local field potential KW - NAc = nucleus accumbens KW - OCD = obsessive-compulsive disorder KW - PAG = periaqueductal gray KW - PD = Parkinson’s disease KW - PVG = periventricular gray matter KW - SANTE = Stimulation of the Anterior Nucleus of the Thalamus for Epilepsy KW - STN = subthalamic nucleus KW - TS = Tourette syndrome KW - VC = ventral capsule KW - VPL = ventral posterolateral nucleus KW - VPM = ventral posteromedial nucleus KW - VS = ventral striatum KW - WINCS = Wireless Instantaneous Neurotransmitter Concentration Sensing KW - closed loop KW - deep brain stimulation KW - electrochemistry KW - electrophysiology KW - neurochemical measurement KW - open loop KW - vT = ventral thalamus SP - E6 EP - E6 JF - Neurosurgical focus JO - Neurosurg Focus VL - 49 IS - 1 N2 - The development of closed-loop deep brain stimulation (DBS) systems represents a significant opportunity for innovation in the clinical application of neurostimulation therapies. Despite the highly dynamic nature of neurological diseases, open-loop DBS applications are incapable of modifying parameters in real time to react to fluctuations in disease states. Thus, current practice for the designation of stimulation parameters, such as duration, amplitude, and pulse frequency, is an algorithmic process. Ideal stimulation parameters are highly individualized and must reflect both the specific disease presentation and the unique pathophysiology presented by the individual. Stimulation parameters currently require a lengthy trial-and-error process to achieve the maximal therapeutic effect and can only be modified during clinical visits. The major impediment to the development of automated, adaptive closed-loop systems involves the selection of highly specific disease-related biomarkers to provide feedback for the stimulation platform. This review explores the disease relevance of neurochemical and electrophysiological biomarkers for the development of closed-loop neurostimulation technologies. Electrophysiological biomarkers, such as local field potentials, have been used to monitor disease states. Real-time measurement of neurochemical substances may be similarly useful for disease characterization. Thus, the introduction of measurable neurochemical analytes has significantly expanded biomarker options for feedback-sensitive neuromodulation systems. The potential use of biomarker monitoring to advance neurostimulation approaches for treatment of Parkinson's disease, essential tremor, epilepsy, Tourette syndrome, obsessive-compulsive disorder, chronic pain, and depression is examined. Further, challenges and advances in the development of closed-loop neurostimulation technology are reviewed, as well as opportunities for next-generation closed-loop platforms. SN - 1092-0684 UR - https://www.unboundmedicine.com/medline/citation/32610297/Clinical_applications_of_neurochemical_and_electrophysiological_measurements_for_closed-loop_neurostimulation L2 - https://thejns.org/doi/10.3171/2020.4.FOCUS20167 DB - PRIME DP - Unbound Medicine ER -
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