Towards adaptive deep brain stimulation: clinical and technical notes on a novel commercial device for chronic brain sensing

Abstract

ABSTRACTBackgroundTechnical advances in deep brain stimulation (DBS) are crucial to improve therapeutic efficacy and battery life. A prerogative of new devices is the recording and processing of a given input signal to instruct the delivery of stimulation.ObjectiveWe studied the advances and pitfalls of one of the first commercially available devices capable of recording brain local field potentials (LFP) from the implanted DBS leads, chronically and during stimulation.MethodsWe collected clinical and neurophysiological data of the first 20 patients (14 with Parkinson’s disease [PD], five with various types of dystonia, one with chronic pain) that received the Percept™ PC in our centers. We also performed tests in a saline bath to validate the recordings quality.ResultsThe Percept PC reliably recorded the LFP of the implanted site, wirelessly and in real time. We recorded the most promising clinically useful biomarkers for PD and dystonia (beta and theta oscillations) with and without stimulation. Critical aspects of the system are presently related to contact selection, artefact detection, data loss, and synchronization with other devices. Furthermore, we provide an open-source code to facilitate export and analysis of data.ConclusionNew technologies will soon allow closed-loop neuromodulation therapies, capable of adapting the stimulation based on real-time symptom-specific and task-dependent input signals. However, technical aspects need to be considered to ensure clean synchronized recordings. The critical use by a growing number of DBS experts will alert new users about the currently observed shortcomings and inform on how to overcome them.