MAR 13, 2019 2:40 PM PDT

Clinical Updates: Closed Loop Deep Brain Stimulation in Parkinson's Disease Using Patient Specific Biomarkers and Therapeutic Windows

Presented at: Neuroscience 2019
C.E. Credits: P.A.C.E. CE Florida CE
  • John E Cahill Family Professor in the department of Neurology and Neurological Sciences, Stanford
      Dr. Helen Bronte-Stewart is the John E Cahill Family Professor in the department of Neurology and Neurological Sciences. She is a neurologist, neurophysiologist and movement disorders specialist, who has used her training in mathematics and physics, bioengineering, neurology, movement disorders, and single unit electrophysiology in primates to develop a rigorous translational program in motor control research in human subjects with movement disorders. Dr. Bronte-Stewart is the Director of the Stanford Comprehensive Movement Disorders Center, the Co-Director of the Stanford Balance Center, and the Division Chief of Movement Disorders in the department of Neurology and Neurological Sciences. She directs the Stanford Human Motor Control and Balance Laboratory, where she has developed computerized, quantitative measurements of motor behavior, which are being implemented in a wide range of Movement Disorders. Her research investigates the brain's contribution to abnormal movement in human subjects, using synchronous brain recordings and quantitative kinematics, and how these are modulated with different frequencies and patterns of neurostimulation. Dr. Bronte-Stewart's team was the first in the United States to implant a sensing neurostimulator, from which they can record brain signals directly, and use the patient's own neural activity to drive the first closed loop neurostimulation studies in Parkinson's disease. This work has led to the first multicenter international clinical trial in closed loop deep brain stimulation for people with Parkinson's disease, which Dr. Bronte-Stewart will lead.


    Deep brain stimulation (DBS) is an established therapy for cardinal motor signs and medication-related complications in Parkinson’s disease (PD). Current DBS therapy is limited to “open-loop” neurostimulation: the neurostimulator cannot sense the brain signals nor the behavior it is modulating. It applies continuous pulse trains of fixed frequency, amplitude, pulse width, and pattern, and cannot adjust such parameters in response to neural activity, or the patient’s state of activity or behavior. It applies a one size fits all set of stimulation parameters no matter what the dominant symptom of the patient. Adaptive or closed-loop (cl)DBS uses real time physiological signals to inform the neurostimulator when and how to change stimulation, to provide optimal therapy and minimize adverse effects.  Successful subthalamic (STN) clDBS in PD will require discovery of patient specific neural and behavioral features (control variables) that reflect the disease, state of activity and/or dominant symptom, along with control policy algorithms that will change stimulation parameters in a manner that modulates the variable and improves motor function in a patient specific manner.  In this talk I will discuss our research into relevant neural and physiological signals that may be useful for clDBS for specific PD motor symptoms, and how we have used a dual threshold control policy algorithm based on patient specific therapeutic windows in the first feasibility studies on clDBS for PD using a fully implanted neurostimulator.

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