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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...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Frontiers Media S.A.
2021
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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. |
format | Online Article Text |
id | pubmed-8716790 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
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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