TOWARDS ADAPTIVE DEEP BRAIN STIMULATION IN MOVEMENT DISORDERS
Movement Disorders (MDs) are neurological disorders characterised by a paucity of movements, involuntary movements or a combination of both. The most well-known MDs are Parkinson’s disease (PD) and essential tremor (ET) in which respectively a paucity of movements and involuntary (shaking) movements dominate. Most MDs can initially by treated medically but in their more progressed states medication often fails. In these disease stages advanced therapies, like deep brain stimulation (DBS), can become the treatment of choice. With DBS small electrical pulses are applied to deep brain nuclei. This is established by means of a stereotactic neurosurgical procedure by which one or more electrodes are implanted and connected to an internal pulse generator (IPG), usually placed under the clavicle. Although the exact working mechanism of DBS is not established yet, DBS has been successfully applied in PD, ET and dystonia for over 20 years. Nevertheless, there are still limitations in terms of efficacy, side-effects and efficiency. One of the most important reasons for this is that DBS not only influences pathological but also physiological neural activity. To overcome this, DBS might work better were it only to stimulate where and when necessary. In the last two decades, the knowledge of the neurophysiological basis of MDs has increased dramatically. One of the most important discoveries was that the (medication induced reduction of) the power of beta (13-30 Hz) oscillations in the subthalamic nucleus (STN) correlates with the contralateral stiff-and slowness. In very recent studies, this beta power has been used as a biomarker for titrating DBS, so called adaptive DBS (aDBS). At present, potential biomarkers for applying aDBS are also being developed for other MDs. Next to this, many companies are currently developing implantable IPG’s with closed-loop properties. With these simultaneous developments, DBS might be applied in a more intelligent way in the nearby future. This would not only lead to more efficacy, less side-effects and more efficiency but would also make it possible to implant DBS systems in patients that could not tolerate conventional (continuous) DBS due to side-effects. Finally, by automising DBS programming by means of adaptive algorithms DBS can act in synergy with concurrent medication and less hospital visits for titrating the stimulation parameters would be necessary. These potential advantages would not result in an increased quality of life for the patient but could also lead to a substantial cost reduction.
Wednesday 20 April 2016, 16:30 - 17:30 h
Building Carré - room CR 3.022