Deep brain stimulation (DBS) has become a widespread and valuable treatment for patients with movement disorders such as essential tremor (ET). However, current DBS treatment constantly delivers stimulation in an open loop, which can be inefficient. Closing the loop with sensors to provide feedback may increase power efficiency and reduce side effects for patients. New implantable neuromodulation platforms, such as the Medtronic Activa PC+S DBS system, offer important data sources by providing chronic neural sensing capabilities and a means of investigating dynamic stimulation based on symptom measurements. The authors implanted in a single patient with ET an Activa PC+S system, a cortical strip of electrodes on the hand sensorimotor cortex, and therapeutic electrodes in the ventral intermediate nucleus of the thalamus. In this paper they describe the effectiveness of the platform when sensing cortical movement intentions while the patient actually performed and imagined performing movements. Additionally, they demonstrate dynamic closed-loop DBS based on several wearable sensor measurements of tremor intensity.
Keywords: CLDBS = closed-loop DBS; DBS = deep brain stimulation; ECoG; ECoG = electrocorticography; EMG = electromyography; ET = essential tremor; IMU = inertial measuring unit; PD = Parkinson disease; PSD = power spectral density; TRS = Fahn-Tolosa-Marin Tremor Rating Scale; VIM = ventral intermediate nucleus of the thalamus; closed-loop systems; deep brain stimulation; essential tremor; functional neurosurgery.