Beta initiated advanced closed loop D B S devices in achieving movement in Parkinson`s

Abstract

In Parkinson disease there is a normal physio- logical reduction of STN-β-band power, shorter smoothing period could have the advantage of being more sensitive to changes in β power, which could enhance motor performance. Objective: In this study, we addressed this question by evaluating effectiveness of STN-β-triggered ACL-DBS by a standard 400ms and a shorter 200ms smoothing-window during reaching movements. Findings of Parkinson`s with advanced idiopathic Parkinson’s disease showed that reducing the smoothing-window for quantifying β did lead to shortened β-burst-durations by increasing number of β-bursts <200ms and more frequent switching “ON/OFF” of the stimulator but had no behavioral effects. Both ACL-DBS, COL-DBS improved motor performance to an equivalent extent compared to no DBS. Also, there were indemarkerdent effects of a decrease in β power and an increase in gam- ma power in predicting faster movement speed, while a decrease in β event-related-desynchronization (ERD) predicted quicker movement initiation. COL-DBS blocked both β and gamma (γ) more than ACL-DBS, whereas β ERD was reduced to a similar level during COL-DBS and ACL-DBS compared with no DBS, which together explained the achieved similar performance improvement in reaching movements during COL-DBS and ACL-DBS. Results suggesting STN-β-triggered ACL-DBS is effective in improving motor performance during reaching movements in people with Parkinson’s disease, and that shortening of the smoothing window does not result in any additional behavioral benefit. When developing ACL-DBS systems for Parkinson’s disease, it might not be necessary to track very fast β dynamics; combining β, gamma, and information from motor decoding might be more beneficial with additional bio- markers needed for optimal treatment of tremor. This research is not just fundamentally designed to expand knowledge of basic mechanisms and principles of health and care problems. This is generally longer-term research with broad applicability and involves strategic, applied, developmental and implementation.