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Practical Closed-Loop Strategies for Deep Brain Stimulation: Lessons From Chronic Pain

Deep brain stimulation (DBS) is a plausible therapy for various neuropsychiatric disorders, though continuous tonic stimulation without regard to underlying physiology (open-loop) has had variable success. Recently available DBS devices can sense neural signals which, in turn, can be used to control...

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Autores principales: Prosky, Jordan, Cagle, Jackson, Sellers, Kristin K., Gilron, Ro’ee, de Hemptinne, Cora, Schmitgen, Ashlyn, Starr, Philip A., Chang, Edward F., Shirvalkar, Prasad
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8716790/
https://www.ncbi.nlm.nih.gov/pubmed/34975374
http://dx.doi.org/10.3389/fnins.2021.762097
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author Prosky, Jordan
Cagle, Jackson
Sellers, Kristin K.
Gilron, Ro’ee
de Hemptinne, Cora
Schmitgen, Ashlyn
Starr, Philip A.
Chang, Edward F.
Shirvalkar, Prasad
author_facet Prosky, Jordan
Cagle, Jackson
Sellers, Kristin K.
Gilron, Ro’ee
de Hemptinne, Cora
Schmitgen, Ashlyn
Starr, Philip A.
Chang, Edward F.
Shirvalkar, Prasad
author_sort Prosky, Jordan
collection PubMed
description Deep brain stimulation (DBS) is a plausible therapy for various neuropsychiatric disorders, though continuous tonic stimulation without regard to underlying physiology (open-loop) has had variable success. Recently available DBS devices can sense neural signals which, in turn, can be used to control stimulation in a closed-loop mode. Closed-loop DBS strategies may mitigate many drawbacks of open-loop stimulation and provide more personalized therapy. These devices contain many adjustable parameters that control how the closed-loop system operates, which need to be optimized using a combination of empirically and clinically informed decision making. We offer a practical guide for the implementation of a closed-loop DBS system, using examples from patients with chronic pain. Focusing on two research devices from Medtronic, the Activa PC+S and Summit RC+S, we provide pragmatic details on implementing closed- loop programming from a clinician’s perspective. Specifically, by combining our understanding of chronic pain with data-driven heuristics, we describe how to tune key parameters to handle feature selection, state thresholding, and stimulation artifacts. Finally, we discuss logistical and practical considerations that clinicians must be aware of when programming closed-loop devices.
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spelling pubmed-87167902021-12-31 Practical Closed-Loop Strategies for Deep Brain Stimulation: Lessons From Chronic Pain Prosky, Jordan Cagle, Jackson Sellers, Kristin K. Gilron, Ro’ee de Hemptinne, Cora Schmitgen, Ashlyn Starr, Philip A. Chang, Edward F. Shirvalkar, Prasad Front Neurosci Neuroscience Deep brain stimulation (DBS) is a plausible therapy for various neuropsychiatric disorders, though continuous tonic stimulation without regard to underlying physiology (open-loop) has had variable success. Recently available DBS devices can sense neural signals which, in turn, can be used to control stimulation in a closed-loop mode. Closed-loop DBS strategies may mitigate many drawbacks of open-loop stimulation and provide more personalized therapy. These devices contain many adjustable parameters that control how the closed-loop system operates, which need to be optimized using a combination of empirically and clinically informed decision making. We offer a practical guide for the implementation of a closed-loop DBS system, using examples from patients with chronic pain. Focusing on two research devices from Medtronic, the Activa PC+S and Summit RC+S, we provide pragmatic details on implementing closed- loop programming from a clinician’s perspective. Specifically, by combining our understanding of chronic pain with data-driven heuristics, we describe how to tune key parameters to handle feature selection, state thresholding, and stimulation artifacts. Finally, we discuss logistical and practical considerations that clinicians must be aware of when programming closed-loop devices. Frontiers Media S.A. 2021-12-16 /pmc/articles/PMC8716790/ /pubmed/34975374 http://dx.doi.org/10.3389/fnins.2021.762097 Text en Copyright © 2021 Prosky, Cagle, Sellers, Gilron, de Hemptinne, Schmitgen, Starr, Chang and Shirvalkar. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Neuroscience
Prosky, Jordan
Cagle, Jackson
Sellers, Kristin K.
Gilron, Ro’ee
de Hemptinne, Cora
Schmitgen, Ashlyn
Starr, Philip A.
Chang, Edward F.
Shirvalkar, Prasad
Practical Closed-Loop Strategies for Deep Brain Stimulation: Lessons From Chronic Pain
title Practical Closed-Loop Strategies for Deep Brain Stimulation: Lessons From Chronic Pain
title_full Practical Closed-Loop Strategies for Deep Brain Stimulation: Lessons From Chronic Pain
title_fullStr Practical Closed-Loop Strategies for Deep Brain Stimulation: Lessons From Chronic Pain
title_full_unstemmed Practical Closed-Loop Strategies for Deep Brain Stimulation: Lessons From Chronic Pain
title_short Practical Closed-Loop Strategies for Deep Brain Stimulation: Lessons From Chronic Pain
title_sort practical closed-loop strategies for deep brain stimulation: lessons from chronic pain
topic Neuroscience
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8716790/
https://www.ncbi.nlm.nih.gov/pubmed/34975374
http://dx.doi.org/10.3389/fnins.2021.762097
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