Limits...
The modulatory effect of adaptive deep brain stimulation on beta bursts in Parkinson ’ s disease

View Article: PubMed Central - PubMed

ABSTRACT

Pilot studies suggest that adaptive deep brain stimulation (DBS) may be more effective than conventional DBS for the treatment of Parkinson's disease. Tinkhauser et al. show that adaptive DBS regulates pathological beta synchronisation in the subthalamic nucleus by selectively limiting long duration beta bursts, which are related to clinical impairment.

No MeSH data available.


Related in: MedlinePlus

Summary schematic. Beta amplitude profile shown during noStim, adaptive and conventional DBS. Without DBS both short and long beta bursts occur. During adaptive DBS the longer bursts are trimmed. This in turn affords more space for shorter bursts to occur. During conventional DBS the distribution of short and long bursts does not change, but overall beta is still suppressed, implying that the amplitude of all beta bursts is reduced. Note that background levels of beta are shown as similar between conditions as our signal processing is focussed on burst behaviour. We cannot rule out additional changes in background levels of beta in the subthalamic nucleus, particularly during conventional DBS, but such changes are difficult to ascertain whilst amplifier noise floors may vary between conditions. aDBS = adaptive DBS; cDBS = conventional DBS.
© Copyright Policy - cc-by
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC5382944&req=5

awx010-F7: Summary schematic. Beta amplitude profile shown during noStim, adaptive and conventional DBS. Without DBS both short and long beta bursts occur. During adaptive DBS the longer bursts are trimmed. This in turn affords more space for shorter bursts to occur. During conventional DBS the distribution of short and long bursts does not change, but overall beta is still suppressed, implying that the amplitude of all beta bursts is reduced. Note that background levels of beta are shown as similar between conditions as our signal processing is focussed on burst behaviour. We cannot rule out additional changes in background levels of beta in the subthalamic nucleus, particularly during conventional DBS, but such changes are difficult to ascertain whilst amplifier noise floors may vary between conditions. aDBS = adaptive DBS; cDBS = conventional DBS.

Mentions: Here we confirm that the subthalamic nucleus LFP in patients with Parkinson’s disease is characterized by bursts of beta activity of varying duration, and show that the amplitude of the beta bursts is reduced by both conventional and adaptive DBS. However, this is accomplished in different ways. In adaptive DBS it paradoxically occurs despite an increase in the frequency of bursts. However, in this condition there is a shift from long beta bursts to shorter bursts as long bursts are prematurely terminated by triggered stimulation. This both converts long bursts into shorter ones and frees up more time for spontaneously short bursts to occur. Critically, beta burst amplitude ramps up with burst duration, so that this shift in burst duration distribution with adaptive DBS explains the overall reduction in integrated burst amplitude in this stimulation condition. In contrast, in conventional DBS there is no change in the frequency of beta bursts and no change in the distribution of burst durations compared to the unstimulated state. By exclusion therefore, the reduction in integrated burst duration relative to the unstimulated condition must entail an attenuation of burst amplitude. This turns out to be equally distributed across short and long bursts. The contrasting effects of adaptive and conventional DBS are summarized in the schematic given in Fig. 7.Figure 7


The modulatory effect of adaptive deep brain stimulation on beta bursts in Parkinson ’ s disease
Summary schematic. Beta amplitude profile shown during noStim, adaptive and conventional DBS. Without DBS both short and long beta bursts occur. During adaptive DBS the longer bursts are trimmed. This in turn affords more space for shorter bursts to occur. During conventional DBS the distribution of short and long bursts does not change, but overall beta is still suppressed, implying that the amplitude of all beta bursts is reduced. Note that background levels of beta are shown as similar between conditions as our signal processing is focussed on burst behaviour. We cannot rule out additional changes in background levels of beta in the subthalamic nucleus, particularly during conventional DBS, but such changes are difficult to ascertain whilst amplifier noise floors may vary between conditions. aDBS = adaptive DBS; cDBS = conventional DBS.
© Copyright Policy - cc-by
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5382944&req=5

awx010-F7: Summary schematic. Beta amplitude profile shown during noStim, adaptive and conventional DBS. Without DBS both short and long beta bursts occur. During adaptive DBS the longer bursts are trimmed. This in turn affords more space for shorter bursts to occur. During conventional DBS the distribution of short and long bursts does not change, but overall beta is still suppressed, implying that the amplitude of all beta bursts is reduced. Note that background levels of beta are shown as similar between conditions as our signal processing is focussed on burst behaviour. We cannot rule out additional changes in background levels of beta in the subthalamic nucleus, particularly during conventional DBS, but such changes are difficult to ascertain whilst amplifier noise floors may vary between conditions. aDBS = adaptive DBS; cDBS = conventional DBS.
Mentions: Here we confirm that the subthalamic nucleus LFP in patients with Parkinson’s disease is characterized by bursts of beta activity of varying duration, and show that the amplitude of the beta bursts is reduced by both conventional and adaptive DBS. However, this is accomplished in different ways. In adaptive DBS it paradoxically occurs despite an increase in the frequency of bursts. However, in this condition there is a shift from long beta bursts to shorter bursts as long bursts are prematurely terminated by triggered stimulation. This both converts long bursts into shorter ones and frees up more time for spontaneously short bursts to occur. Critically, beta burst amplitude ramps up with burst duration, so that this shift in burst duration distribution with adaptive DBS explains the overall reduction in integrated burst amplitude in this stimulation condition. In contrast, in conventional DBS there is no change in the frequency of beta bursts and no change in the distribution of burst durations compared to the unstimulated state. By exclusion therefore, the reduction in integrated burst duration relative to the unstimulated condition must entail an attenuation of burst amplitude. This turns out to be equally distributed across short and long bursts. The contrasting effects of adaptive and conventional DBS are summarized in the schematic given in Fig. 7.Figure 7

View Article: PubMed Central - PubMed

ABSTRACT

Pilot studies suggest that adaptive deep brain stimulation (DBS) may be more effective than conventional DBS for the treatment of Parkinson's disease. Tinkhauser et al. show that adaptive DBS regulates pathological beta synchronisation in the subthalamic nucleus by selectively limiting long duration beta bursts, which are related to clinical impairment.

No MeSH data available.


Related in: MedlinePlus