Deep Brain Stimulation - DBS › MDS-Files1 › Private-Files › DB… · Deep Brain Stimulation -...
Transcript of Deep Brain Stimulation - DBS › MDS-Files1 › Private-Files › DB… · Deep Brain Stimulation -...
![Page 1: Deep Brain Stimulation - DBS › MDS-Files1 › Private-Files › DB… · Deep Brain Stimulation - DBS Technological innovations Alberto Priori Center for Neurotechnology and Experimental](https://reader034.fdocuments.us/reader034/viewer/2022042315/5f042b377e708231d40ca6ed/html5/thumbnails/1.jpg)
S.Marceglia
DeepBrainStimulation- DBSTechnologicalinnovations
AlbertoPriori
CenterforNeurotechnology andExperimental BrainTherapeutics
University ofMilan,Italy
![Page 2: Deep Brain Stimulation - DBS › MDS-Files1 › Private-Files › DB… · Deep Brain Stimulation - DBS Technological innovations Alberto Priori Center for Neurotechnology and Experimental](https://reader034.fdocuments.us/reader034/viewer/2022042315/5f042b377e708231d40ca6ed/html5/thumbnails/2.jpg)
S.Marceglia
(Priori 2015)
INNOVATIVEFIELDS
AlbertoPrioriCenterforNeurotechnology andExperimental BrainTherapeutics
University ofMilan,Italy
![Page 3: Deep Brain Stimulation - DBS › MDS-Files1 › Private-Files › DB… · Deep Brain Stimulation - DBS Technological innovations Alberto Priori Center for Neurotechnology and Experimental](https://reader034.fdocuments.us/reader034/viewer/2022042315/5f042b377e708231d40ca6ed/html5/thumbnails/3.jpg)
S.Marceglia
STEERINGSTIMULATION• Currentsteeringà basedonnewelectrodesallowingdirectingtheEFradiallyandlongitudinallywithmultiple contacts
• Stimulatingdeviceallwing independentcontroldifferentcontacts
Steigerwald etal,Mov Disord 2016
VERCISE (Boston Scientific)
AlbertoPriori
CenterforNeurotechnology andExperimental BrainTherapeutics
University ofMilan,Italy
![Page 4: Deep Brain Stimulation - DBS › MDS-Files1 › Private-Files › DB… · Deep Brain Stimulation - DBS Technological innovations Alberto Priori Center for Neurotechnology and Experimental](https://reader034.fdocuments.us/reader034/viewer/2022042315/5f042b377e708231d40ca6ed/html5/thumbnails/4.jpg)
S.Marceglia
STEERINGSTIMULATION
Steigerwald etal,Mov Disord 2016
Lasteeringstimulationconsentediavere una
maggiore finestra terapeutica
Verde=effetto terapeuticoRosso=effetto collaterale
AlbertoPriori
CenterforNeurotechnology andExperimental BrainTherapeutics
University ofMilan,Italy
![Page 5: Deep Brain Stimulation - DBS › MDS-Files1 › Private-Files › DB… · Deep Brain Stimulation - DBS Technological innovations Alberto Priori Center for Neurotechnology and Experimental](https://reader034.fdocuments.us/reader034/viewer/2022042315/5f042b377e708231d40ca6ed/html5/thumbnails/5.jpg)
S.Marceglia
INTERLEAVINGSTIMULATION
• Interleavingstimulationà apairofelectrodeseachdekivering adifferentamount ofchargeepulsesbutatthesamefrequency
• Forpatientsnotrespondingtoconventional DBS
• TestedinPD,ETanddystonia• Limitationà
• Timeconsumingprogramming• Relativelyshortbatteryduration
Miocinovic etal,Parkisonism RelatedDisrd 2014AlbertoPriori
CenterforNeurotechnology andExperimental BrainTherapeutics
University ofMilan,Italy
![Page 6: Deep Brain Stimulation - DBS › MDS-Files1 › Private-Files › DB… · Deep Brain Stimulation - DBS Technological innovations Alberto Priori Center for Neurotechnology and Experimental](https://reader034.fdocuments.us/reader034/viewer/2022042315/5f042b377e708231d40ca6ed/html5/thumbnails/6.jpg)
S.Marceglia
INTERLEAVINGSTIMULATION
Programmingaccordingtoanatomical(electrodeposition)andclinical
Zhangetal,2016
AlbertoPriori
CenterforNeurotechnology andExperimental BrainTherapeutics
University ofMilan,Italy
![Page 7: Deep Brain Stimulation - DBS › MDS-Files1 › Private-Files › DB… · Deep Brain Stimulation - DBS Technological innovations Alberto Priori Center for Neurotechnology and Experimental](https://reader034.fdocuments.us/reader034/viewer/2022042315/5f042b377e708231d40ca6ed/html5/thumbnails/7.jpg)
S.Marceglia
DUALSTIMULATION• Delivered through asingle16-contactselectrode independentlystimulating twostructures
• Electrodeswithmorethan4contactswhichcanbeindependently controlled
Hollingworth etal,BrainSci,2017
AlbertoPriori
CenterforNeurotechnology andExperimental BrainTherapeutics
University ofMilan,Italy
![Page 8: Deep Brain Stimulation - DBS › MDS-Files1 › Private-Files › DB… · Deep Brain Stimulation - DBS Technological innovations Alberto Priori Center for Neurotechnology and Experimental](https://reader034.fdocuments.us/reader034/viewer/2022042315/5f042b377e708231d40ca6ed/html5/thumbnails/8.jpg)
S.Marceglia
ADAPTIVEDBSoCLOSEDLOOPDBSDBS
CONTROL VARIABLEANALYSIS
FEEDBACK ALGORITHM
NEW PARAMETERS
Thechoiceofthecontrolvariableiscrucial
AlbertoPriori
CenterforNeurotechnology andExperimental BrainTherapeutics
University ofMilan,Italy
![Page 9: Deep Brain Stimulation - DBS › MDS-Files1 › Private-Files › DB… · Deep Brain Stimulation - DBS Technological innovations Alberto Priori Center for Neurotechnology and Experimental](https://reader034.fdocuments.us/reader034/viewer/2022042315/5f042b377e708231d40ca6ed/html5/thumbnails/9.jpg)
S.Marceglia
(Arlotti 2016)
POSSIBLECONTROLVARIABLES• Areadjunctiveimplantsnecessary?
• Arechangesinsurgicalprocedure required?
• Isthenewdevice/implant welltoleratedbythepatient?
• Docontrolvariablescorrelatewiththeclinical state?
• Canthesystembepersonalised tothespecific cliniocalphenotype?
• Doesthesystemdecrease batteryduration?
• Isthereanyproof-of-concept?
AlbertoPriori
CenterforNeurotechnology andExperimental BrainTherapeutics
University ofMilan,Italy
![Page 10: Deep Brain Stimulation - DBS › MDS-Files1 › Private-Files › DB… · Deep Brain Stimulation - DBS Technological innovations Alberto Priori Center for Neurotechnology and Experimental](https://reader034.fdocuments.us/reader034/viewer/2022042315/5f042b377e708231d40ca6ed/html5/thumbnails/10.jpg)
S.Marceglia
CONTROLVARIABLESsEMG and accelerometers Cortical neurosignals Basal ganglia LFPs Neurotransmitters
Additional implant/equipment YES – external sensors required YES – implanted cortical electrodes required
NO – LFPs are recorded from the implanted DBS electrode YES – at least 4 additional CFM
Changes in the surgical procedures
NO – the additional implant is external and does not affect the
surgical procedure
YES – the surgery needs to include the implant of cortical
electrodes
NO – no additional implant during surgery
YES– the additional CFMs need to be implanted during surgery
Patient’s management/acceptability
NO – it may be difficult to manage the recording sensors and
the external equipment may be uncomfortable
YES – all the equipment is implanted
YES – the patient perceives the same system as for traditional
DBS
NO - CFMs have a time life of only a few months and have to be
replaced
Correlation with the clinical state
YES/NO – optimal correlation with tremor, but no correlations with rigidity and bradikinesia
YES – EcoG phase amplitude coupling and M1 action potentials correlate with main PD symptoms
and can be used to drive aDBS
YES – multiple LFP oscillations are modulated by levodopa
administration, DBS, movements, and non-motor tasks
even years after electrode implant
YES - the time duration of tremor-free period is comparable to the duration of increased levels of stimulation-induced dopamine
release after DBS pulse trains
Personalization and adaptability
NO – cannot be used if patients do not show tremor
YES/NO – it may encode patient specific information
YES – the presence of multiple rhythms correlating with
different patient’s characteristics may account for inter-subject
variability
NOT$YET$TESTED
Low battery consumptionYES/NO – the processing can be
done externally, but triggers should be sent via telemetry links
YES/NO$– the$IPG$needs$to$include$the$sensing$circuit$and$
the$feedback$algorithm
YES/NO – the IPG needs to include the sensing circuit and
the feedback algorithm
NO$– the$IPG$needs$to$include$the$sensing$circuit$and$the$
feedback$algorithm
Proof of conceptYES in humans (ET)
[Yamamoto et al., 2013]YES in animals [Rosin et al.,
2011]
YES in humans (PD) [Little et al., 2013; Rosa et al., 2015; Little
et al., 2015]NO
AlbertoPriori
CenterforNeurotechnology andExperimental BrainTherapeutics
University ofMilan,Italy
![Page 11: Deep Brain Stimulation - DBS › MDS-Files1 › Private-Files › DB… · Deep Brain Stimulation - DBS Technological innovations Alberto Priori Center for Neurotechnology and Experimental](https://reader034.fdocuments.us/reader034/viewer/2022042315/5f042b377e708231d40ca6ed/html5/thumbnails/11.jpg)
S.Marceglia
AccsEMG
IPG
Processingandcontrol
policy
(Shukla et al.2012, Shukla et al.2013, Basu et al.2013, Yamamoto et al. 2013)
Tremor onset prediction in 4 PD patients (Basu et. al 2013):100% sensitivity 80% accuracy
ACCELEROMETRY& EMG
AlbertoPriori
CenterforNeurotechnology andExperimental BrainTherapeutics
University ofMilan,Italy
![Page 12: Deep Brain Stimulation - DBS › MDS-Files1 › Private-Files › DB… · Deep Brain Stimulation - DBS Technological innovations Alberto Priori Center for Neurotechnology and Experimental](https://reader034.fdocuments.us/reader034/viewer/2022042315/5f042b377e708231d40ca6ed/html5/thumbnails/12.jpg)
S.Marceglia
(Cagnan etal.2017)
ACCELEROMETRY
PATIENTSWITHET
AlbertoPriori
CenterforNeurotechnology andExperimental BrainTherapeutics
University ofMilan,Italy
![Page 13: Deep Brain Stimulation - DBS › MDS-Files1 › Private-Files › DB… · Deep Brain Stimulation - DBS Technological innovations Alberto Priori Center for Neurotechnology and Experimental](https://reader034.fdocuments.us/reader034/viewer/2022042315/5f042b377e708231d40ca6ed/html5/thumbnails/13.jpg)
S.Marceglia
ACCELEROMETRYsEMG and accelerometers Cortical neurosignals Basal ganglia LFPs Neurotransmitters
Additional implant/equipment YES – external sensors required YES – implanted cortical electrodes required
NO – LFPs are recorded from the implanted DBS electrode YES – at least 4 additional CFM
Changes in the surgical procedures
NO – the additional implant is external and does not affect the
surgical procedure
YES – the surgery needs to include the implant of cortical
electrodes
NO – no additional implant during surgery
YES– the additional CFMs need to be implanted during surgery
Patient’s management/acceptability
NO – it may be difficult to manage the recording sensors and
the external equipment may be uncomfortable
YES – all the equipment is implanted
YES – the patient perceives the same system as for traditional
DBS
NO - CFMs have a time life of only a few months and have to be
replaced
Correlation with the clinical state
YES/NO – optimal correlation with tremor, but no correlations with rigidity and bradikinesia
YES – EcoG phase amplitude coupling and M1 action potentials correlate with main PD symptoms
and can be used to drive aDBS
YES – multiple LFP oscillations are modulated by levodopa
administration, DBS, movements, and non-motor tasks
even years after electrode implant
YES - the time duration of tremor-free period is comparable to the duration of increased levels of stimulation-induced dopamine
release after DBS pulse trains
Personalization and adaptability
NO – cannot be used if patients do not show tremor
YES/NO – it may encode patient specific information
YES – the presence of multiple rhythms correlating with
different patient’s characteristics may account for inter-subject
variability
NOT$YET$TESTED
Low battery consumptionYES/NO – the processing can be
done externally, but triggers should be sent via telemetry links
YES/NO$– the$IPG$needs$to$include$the$sensing$circuit$and$
the$feedback$algorithm
YES/NO – the IPG needs to include the sensing circuit and
the feedback algorithm
NO$– the$IPG$needs$to$include$the$sensing$circuit$and$the$
feedback$algorithm
Proof of conceptYES in humans (ET)
[Yamamoto et al., 2013]YES in animals [Rosin et al.,
2011]
YES in humans (PD) [Little et al., 2013; Rosa et al., 2015; Little
et al., 2015]NO
sEMG and accelerometers Cortical neurosignals Basal ganglia LFPs Neurotransmitters
Additional implant/equipment YES – external sensors required YES – implanted cortical electrodes required
NO – LFPs are recorded from the implanted DBS electrode YES – at least 4 additional CFM
Changes in the surgical procedures
NO – the additional implant is external and does not affect the
surgical procedure
YES – the surgery needs to include the implant of cortical
electrodes
NO – no additional implant during surgery
YES– the additional CFMs need to be implanted during surgery
Patient’s management/acceptability
NO – it may be difficult to manage the recording sensors and
the external equipment may be uncomfortable
YES – all the equipment is implanted
YES – the patient perceives the same system as for traditional
DBS
NO - CFMs have a time life of only a few months and have to be
replaced
Correlation with the clinical state
YES/NO – optimal correlation with tremor, but no correlations with rigidity and bradikinesia
YES – EcoG phase amplitude coupling and M1 action potentials correlate with main PD symptoms
and can be used to drive aDBS
YES – multiple LFP oscillations are modulated by levodopa
administration, DBS, movements, and non-motor tasks
even years after electrode implant
YES - the time duration of tremor-free period is comparable to the duration of increased levels of stimulation-induced dopamine
release after DBS pulse trains
Personalization and adaptability
NO – cannot be used if patients do not show tremor
YES/NO – it may encode patient specific information
YES – the presence of multiple rhythms correlating with
different patient’s characteristics may account for inter-subject
variability
NOT$YET$TESTED
Low battery consumptionYES/NO – the processing can be
done externally, but triggers should be sent via telemetry links
YES/NO$– the$IPG$needs$to$include$the$sensing$circuit$and$
the$feedback$algorithm
YES/NO – the IPG needs to include the sensing circuit and
the feedback algorithm
NO$– the$IPG$needs$to$include$the$sensing$circuit$and$the$
feedback$algorithm
Proof of conceptYES in humans (ET)
[Yamamoto et al., 2013]YES in animals [Rosin et al.,
2011]
YES in humans (PD) [Little et al., 2013; Rosa et al., 2015; Little
et al., 2015]NO
sEMG and accelerometers Cortical neurosignals Basal ganglia LFPs Neurotransmitters
Additional implant/equipment YES – external sensors required YES – implanted cortical electrodes required
NO – LFPs are recorded from the implanted DBS electrode YES – at least 4 additional CFM
Changes in the surgical procedures
NO – the additional implant is external and does not affect the
surgical procedure
YES – the surgery needs to include the implant of cortical
electrodes
NO – no additional implant during surgery
YES– the additional CFMs need to be implanted during surgery
Patient’s management/acceptability
NO – it may be difficult to manage the recording sensors and
the external equipment may be uncomfortable
YES – all the equipment is implanted
YES – the patient perceives the same system as for traditional
DBS
NO - CFMs have a time life of only a few months and have to be
replaced
Correlation with the clinical state
YES/NO – optimal correlation with tremor, but no correlations with rigidity and bradikinesia
YES – EcoG phase amplitude coupling and M1 action potentials correlate with main PD symptoms
and can be used to drive aDBS
YES – multiple LFP oscillations are modulated by levodopa
administration, DBS, movements, and non-motor tasks
even years after electrode implant
YES - the time duration of tremor-free period is comparable to the duration of increased levels of stimulation-induced dopamine
release after DBS pulse trains
Personalization and adaptability
NO – cannot be used if patients do not show tremor
YES/NO – it may encode patient specific information
YES – the presence of multiple rhythms correlating with
different patient’s characteristics may account for inter-subject
variability
NOT$YET$TESTED
Low battery consumptionYES/NO – the processing can be
done externally, but triggers should be sent via telemetry links
YES/NO$– the$IPG$needs$to$include$the$sensing$circuit$and$
the$feedback$algorithm
YES/NO – the IPG needs to include the sensing circuit and
the feedback algorithm
NO$– the$IPG$needs$to$include$the$sensing$circuit$and$the$
feedback$algorithm
Proof of conceptYES in humans (ET)
[Yamamoto et al., 2013]YES in animals [Rosin et al.,
2011]
YES in humans (PD) [Little et al., 2013; Rosa et al., 2015; Little
et al., 2015]NO
AlbertoPriori
CenterforNeurotechnology andExperimental BrainTherapeutics
University ofMilan,Italy
![Page 14: Deep Brain Stimulation - DBS › MDS-Files1 › Private-Files › DB… · Deep Brain Stimulation - DBS Technological innovations Alberto Priori Center for Neurotechnology and Experimental](https://reader034.fdocuments.us/reader034/viewer/2022042315/5f042b377e708231d40ca6ed/html5/thumbnails/14.jpg)
S.Marceglia
ECoGiEEG
sEEG
IPG
Processingandcontrol
policy
• Single and Multi-unit activity based on micro-electrode arrays (MEA)• Electrocorticography (ECoG)• Surface electroencephalography (sEEG)
(Rosin et al.2011)(Hemptinne et al.2015)
(Herron et al.2015)
CORTICALBIOPOTENTIAL
AlbertoPriori
CenterforNeurotechnology andExperimental BrainTherapeutics
University ofMilan,Italy
![Page 15: Deep Brain Stimulation - DBS › MDS-Files1 › Private-Files › DB… · Deep Brain Stimulation - DBS Technological innovations Alberto Priori Center for Neurotechnology and Experimental](https://reader034.fdocuments.us/reader034/viewer/2022042315/5f042b377e708231d40ca6ed/html5/thumbnails/15.jpg)
S.Marceglia
CORTICALBIOPOTENTIAL
sEMG and accelerometers Cortical neurosignals Basal ganglia LFPs Neurotransmitters
Additional implant/equipment YES – external sensors required YES – implanted cortical electrodes required
NO – LFPs are recorded from the implanted DBS electrode YES – at least 4 additional CFM
Changes in the surgical procedures
NO – the additional implant is external and does not affect the
surgical procedure
YES – the surgery needs to include the implant of cortical
electrodes
NO – no additional implant during surgery
YES– the additional CFMs need to be implanted during surgery
Patient’s management/acceptability
NO – it may be difficult to manage the recording sensors and
the external equipment may be uncomfortable
YES – all the equipment is implanted
YES – the patient perceives the same system as for traditional
DBS
NO - CFMs have a time life of only a few months and have to be
replaced
Correlation with the clinical state
YES/NO – optimal correlation with tremor, but no correlations with rigidity and bradikinesia
YES – EcoG phase amplitude coupling and M1 action potentials correlate with main PD symptoms
and can be used to drive aDBS
YES – multiple LFP oscillations are modulated by levodopa
administration, DBS, movements, and non-motor tasks
even years after electrode implant
YES - the time duration of tremor-free period is comparable to the duration of increased levels of stimulation-induced dopamine
release after DBS pulse trains
Personalization and adaptability
NO – cannot be used if patients do not show tremor
YES/NO – it may encode patient specific information
YES – the presence of multiple rhythms correlating with
different patient’s characteristics may account for inter-subject
variability
NOT$YET$TESTED
Low battery consumptionYES/NO – the processing can be
done externally, but triggers should be sent via telemetry links
YES/NO$– the$IPG$needs$to$include$the$sensing$circuit$and$
the$feedback$algorithm
YES/NO – the IPG needs to include the sensing circuit and
the feedback algorithm
NO$– the$IPG$needs$to$include$the$sensing$circuit$and$the$
feedback$algorithm
Proof of conceptYES in humans (ET)
[Yamamoto et al., 2013]YES in animals [Rosin et al.,
2011]
YES in humans (PD) [Little et al., 2013; Rosa et al., 2015; Little
et al., 2015]NO
sEMG and accelerometers Cortical neurosignals Basal ganglia LFPs Neurotransmitters
Additional implant/equipment YES – external sensors required YES – implanted cortical electrodes required
NO – LFPs are recorded from the implanted DBS electrode YES – at least 4 additional CFM
Changes in the surgical procedures
NO – the additional implant is external and does not affect the
surgical procedure
YES – the surgery needs to include the implant of cortical
electrodes
NO – no additional implant during surgery
YES– the additional CFMs need to be implanted during surgery
Patient’s management/acceptability
NO – it may be difficult to manage the recording sensors and
the external equipment may be uncomfortable
YES – all the equipment is implanted
YES – the patient perceives the same system as for traditional
DBS
NO - CFMs have a time life of only a few months and have to be
replaced
Correlation with the clinical state
YES/NO – optimal correlation with tremor, but no correlations with rigidity and bradikinesia
YES – EcoG phase amplitude coupling and M1 action potentials correlate with main PD symptoms
and can be used to drive aDBS
YES – multiple LFP oscillations are modulated by levodopa
administration, DBS, movements, and non-motor tasks
even years after electrode implant
YES - the time duration of tremor-free period is comparable to the duration of increased levels of stimulation-induced dopamine
release after DBS pulse trains
Personalization and adaptability
NO – cannot be used if patients do not show tremor
YES/NO – it may encode patient specific information
YES – the presence of multiple rhythms correlating with
different patient’s characteristics may account for inter-subject
variability
NOT$YET$TESTED
Low battery consumptionYES/NO – the processing can be
done externally, but triggers should be sent via telemetry links
YES/NO$– the$IPG$needs$to$include$the$sensing$circuit$and$
the$feedback$algorithm
YES/NO – the IPG needs to include the sensing circuit and
the feedback algorithm
NO$– the$IPG$needs$to$include$the$sensing$circuit$and$the$
feedback$algorithm
Proof of conceptYES in humans (ET)
[Yamamoto et al., 2013]YES in animals [Rosin et al.,
2011]
YES in humans (PD) [Little et al., 2013; Rosa et al., 2015; Little
et al., 2015]NO
sEMG and accelerometers Cortical neurosignals Basal ganglia LFPs Neurotransmitters
Additional implant/equipment YES – external sensors required YES – implanted cortical electrodes required
NO – LFPs are recorded from the implanted DBS electrode YES – at least 4 additional CFM
Changes in the surgical procedures
NO – the additional implant is external and does not affect the
surgical procedure
YES – the surgery needs to include the implant of cortical
electrodes
NO – no additional implant during surgery
YES– the additional CFMs need to be implanted during surgery
Patient’s management/acceptability
NO – it may be difficult to manage the recording sensors and
the external equipment may be uncomfortable
YES – all the equipment is implanted
YES – the patient perceives the same system as for traditional
DBS
NO - CFMs have a time life of only a few months and have to be
replaced
Correlation with the clinical state
YES/NO – optimal correlation with tremor, but no correlations
with rigidity and bradikinesia
YES – EcoG phase amplitude coupling and M1 action potentials correlate with main PD symptoms
and can be used to drive aDBS
YES – multiple LFP oscillations are modulated by levodopa
administration, DBS, movements, and non-motor tasks
even years after electrode implant
YES - the time duration of tremor-free period is comparable to the duration of increased levels of stimulation-induced dopamine
release after DBS pulse trains
Personalization and adaptability
NO – cannot be used if patients do not show tremor
YES/NO – it may encode patient specific information
YES – the presence of multiple rhythms correlating with
different patient’s characteristics may account for inter-subject
variability
NOT$YET$TESTED
Low battery consumptionYES/NO – the processing can be
done externally, but triggers should be sent via telemetry links
YES/NO$– the$IPG$needs$to$include$the$sensing$circuit$and$
the$feedback$algorithm
YES/NO – the IPG needs to include the sensing circuit and
the feedback algorithm
NO$– the$IPG$needs$to$include$the$sensing$circuit$and$the$
feedback$algorithm
Proof of conceptYES in humans (ET)
[Yamamoto et al., 2013]YES in animals [Rosin et al.,
2011]
YES in humans (PD) [Little et al., 2013; Rosa et al., 2015; Little
et al., 2015]NO
sEMG and accelerometers Cortical neurosignals Basal ganglia LFPs Neurotransmitters
Additional implant/equipment YES – external sensors required YES – implanted cortical electrodes required
NO – LFPs are recorded from the implanted DBS electrode YES – at least 4 additional CFM
Changes in the surgical procedures
NO – the additional implant is external and does not affect the
surgical procedure
YES – the surgery needs to include the implant of cortical
electrodes
NO – no additional implant during surgery
YES– the additional CFMs need to be implanted during surgery
Patient’s management/acceptability
NO – it may be difficult to manage the recording sensors and
the external equipment may be uncomfortable
YES – all the equipment is implanted
YES – the patient perceives the same system as for traditional
DBS
NO - CFMs have a time life of only a few months and have to be
replaced
Correlation with the clinical state
YES/NO – optimal correlation with tremor, but no correlations with rigidity and bradikinesia
YES – EcoG phase amplitude coupling and M1 action potentials correlate with main PD symptoms
and can be used to drive aDBS
YES – multiple LFP oscillations are modulated by levodopa
administration, DBS, movements, and non-motor tasks
even years after electrode implant
YES - the time duration of tremor-free period is comparable to the duration of increased levels of stimulation-induced dopamine
release after DBS pulse trains
Personalization and adaptability
NO – cannot be used if patients do not show tremor
YES/NO – it may encode patient specific information
YES – the presence of multiple rhythms correlating with
different patient’s characteristics may account for inter-subject
variability
NOT$YET$TESTED
Low battery consumptionYES/NO – the processing can be
done externally, but triggers should be sent via telemetry links
YES/NO$– the$IPG$needs$to$include$the$sensing$circuit$and$
the$feedback$algorithm
YES/NO – the IPG needs to include the sensing circuit and
the feedback algorithm
NO$– the$IPG$needs$to$include$the$sensing$circuit$and$the$
feedback$algorithm
Proof of conceptYES in humans (ET)
[Yamamoto et al., 2013]YES in animals [Rosin et al.,
2011]
YES in humans (PD) [Little et al., 2013; Rosa et al., 2015; Little
et al., 2015]NO
sEMG and accelerometers Cortical neurosignals Basal ganglia LFPs Neurotransmitters
Additional implant/equipment YES – external sensors required YES – implanted cortical electrodes required
NO – LFPs are recorded from the implanted DBS electrode YES – at least 4 additional CFM
Changes in the surgical procedures
NO – the additional implant is external and does not affect the
surgical procedure
YES – the surgery needs to include the implant of cortical
electrodes
NO – no additional implant during surgery
YES– the additional CFMs need to be implanted during surgery
Patient’s management/acceptability
NO – it may be difficult to manage the recording sensors and
the external equipment may be uncomfortable
YES – all the equipment is implanted
YES – the patient perceives the same system as for traditional
DBS
NO - CFMs have a time life of only a few months and have to be
replaced
Correlation with the clinical state
YES/NO – optimal correlation with tremor, but no correlations
with rigidity and bradikinesia
YES – EcoG phase amplitude coupling and M1 action potentials correlate with main PD symptoms
and can be used to drive aDBS
YES – multiple LFP oscillations are modulated by levodopa
administration, DBS, movements, and non-motor tasks
even years after electrode implant
YES - the time duration of tremor-free period is comparable to the duration of increased levels of stimulation-induced dopamine
release after DBS pulse trains
Personalization and adaptability
NO – cannot be used if patients do not show tremor
YES/NO – it may encode patient specific information
YES – the presence of multiple rhythms correlating with
different patient’s characteristics may account for inter-subject
variability
NOT$YET$TESTED
Low battery consumptionYES/NO – the processing can be
done externally, but triggers should be sent via telemetry links
YES/NO$– the$IPG$needs$to$include$the$sensing$circuit$and$
the$feedback$algorithm
YES/NO – the IPG needs to include the sensing circuit and
the feedback algorithm
NO$– the$IPG$needs$to$include$the$sensing$circuit$and$the$
feedback$algorithm
Proof of conceptYES in humans (ET)
[Yamamoto et al., 2013]YES in animals [Rosin et al.,
2011]
YES in humans (PD) [Little et al., 2013; Rosa et al., 2015; Little
et al., 2015]NO
sEMG and accelerometers Cortical neurosignals Basal ganglia LFPs Neurotransmitters
Additional implant/equipment YES – external sensors required YES – implanted cortical electrodes required
NO – LFPs are recorded from the implanted DBS electrode YES – at least 4 additional CFM
Changes in the surgical procedures
NO – the additional implant is external and does not affect the
surgical procedure
YES – the surgery needs to include the implant of cortical
electrodes
NO – no additional implant during surgery
YES– the additional CFMs need to be implanted during surgery
Patient’s management/acceptability
NO – it may be difficult to manage the recording sensors and
the external equipment may be uncomfortable
YES – all the equipment is implanted
YES – the patient perceives the same system as for traditional
DBS
NO - CFMs have a time life of only a few months and have to be
replaced
Correlation with the clinical state
YES/NO – optimal correlation with tremor, but no correlations with rigidity and bradikinesia
YES – EcoG phase amplitude coupling and M1 action potentials correlate with main PD symptoms
and can be used to drive aDBS
YES – multiple LFP oscillations are modulated by levodopa
administration, DBS, movements, and non-motor tasks
even years after electrode implant
YES - the time duration of tremor-free period is comparable to the duration of increased levels of stimulation-induced dopamine
release after DBS pulse trains
Personalization and adaptability
NO – cannot be used if patients do not show tremor
YES/NO – it may encode patient specific information
YES – the presence of multiple rhythms correlating with
different patient’s characteristics may account for inter-subject
variability
NOT$YET$TESTED
Low battery consumptionYES/NO – the processing can be
done externally, but triggers should be sent via telemetry links
YES/NO$– the$IPG$needs$to$include$the$sensing$circuit$and$
the$feedback$algorithm
YES/NO – the IPG needs to include the sensing circuit and
the feedback algorithm
NO$– the$IPG$needs$to$include$the$sensing$circuit$and$the$
feedback$algorithm
Proof of conceptYES in humans (ET)
[Yamamoto et al., 2013]YES in animals [Rosin et al.,
2011]
YES in humans (PD) [Little et al., 2013; Rosa et al., 2015; Little
et al., 2015]NO
AlbertoPriori
CenterforNeurotechnology andExperimental BrainTherapeutics
University ofMilan,Italy
![Page 16: Deep Brain Stimulation - DBS › MDS-Files1 › Private-Files › DB… · Deep Brain Stimulation - DBS Technological innovations Alberto Priori Center for Neurotechnology and Experimental](https://reader034.fdocuments.us/reader034/viewer/2022042315/5f042b377e708231d40ca6ed/html5/thumbnails/16.jpg)
S.Marceglia
LFPs
IPG
Processingandcontrol
policy
(Chang SY et al.2013; Graham et al, 2014)
NEUROCHEMICALSIGNALS
DBSCHANGESNEUROTRASMITTERCONCENTRATIONà CLOSEDLOOPWITHDOPAMINECONCENTRATION
AlbertoPriori
CenterforNeurotechnology andExperimental BrainTherapeutics
University ofMilan,Italy
![Page 17: Deep Brain Stimulation - DBS › MDS-Files1 › Private-Files › DB… · Deep Brain Stimulation - DBS Technological innovations Alberto Priori Center for Neurotechnology and Experimental](https://reader034.fdocuments.us/reader034/viewer/2022042315/5f042b377e708231d40ca6ed/html5/thumbnails/17.jpg)
S.Marceglia
NEUROCHEMICALSIGNALS
sEMG and accelerometers Cortical neurosignals Basal ganglia LFPs Neurotransmitters
Additional implant/equipment YES – external sensors required YES – implanted cortical electrodes required
NO – LFPs are recorded from the implanted DBS electrode YES – at least 4 additional CFM
Changes in the surgical procedures
NO – the additional implant is external and does not affect the
surgical procedure
YES – the surgery needs to include the implant of cortical
electrodes
NO – no additional implant during surgery
YES– the additional CFMs need to be implanted during surgery
Patient’s management/acceptability
NO – it may be difficult to manage the recording sensors and
the external equipment may be uncomfortable
YES – all the equipment is implanted
YES – the patient perceives the same system as for traditional
DBS
NO - CFMs have a time life of only a few months and have to be
replaced
Correlation with the clinical state
YES/NO – optimal correlation with tremor, but no correlations with rigidity and bradikinesia
YES – EcoG phase amplitude coupling and M1 action potentials correlate with main PD symptoms
and can be used to drive aDBS
YES – multiple LFP oscillations are modulated by levodopa
administration, DBS, movements, and non-motor tasks
even years after electrode implant
YES - the time duration of tremor-free period is comparable to the duration of increased levels of stimulation-induced dopamine
release after DBS pulse trains
Personalization and adaptability
NO – cannot be used if patients do not show tremor
YES/NO – it may encode patient specific information
YES – the presence of multiple rhythms correlating with
different patient’s characteristics may account for inter-subject
variability
NOT$YET$TESTED
Low battery consumptionYES/NO – the processing can be
done externally, but triggers should be sent via telemetry links
YES/NO$– the$IPG$needs$to$include$the$sensing$circuit$and$
the$feedback$algorithm
YES/NO – the IPG needs to include the sensing circuit and
the feedback algorithm
NO$– the$IPG$needs$to$include$the$sensing$circuit$and$the$
feedback$algorithm
Proof of conceptYES in humans (ET)
[Yamamoto et al., 2013]YES in animals [Rosin et al.,
2011]
YES in humans (PD) [Little et al., 2013; Rosa et al., 2015; Little
et al., 2015]NO
sEMG and accelerometers Cortical neurosignals Basal ganglia LFPs Neurotransmitters
Additional implant/equipment YES – external sensors required YES – implanted cortical electrodes required
NO – LFPs are recorded from the implanted DBS electrode YES – at least 4 additional CFM
Changes in the surgical procedures
NO – the additional implant is external and does not affect the
surgical procedure
YES – the surgery needs to include the implant of cortical
electrodes
NO – no additional implant during surgery
YES– the additional CFMs need to be implanted during surgery
Patient’s management/acceptability
NO – it may be difficult to manage the recording sensors and
the external equipment may be uncomfortable
YES – all the equipment is implanted
YES – the patient perceives the same system as for traditional
DBS
NO - CFMs have a time life of only a few months and have to be
replaced
Correlation with the clinical state
YES/NO – optimal correlation with tremor, but no correlations
with rigidity and bradikinesia
YES – EcoG phase amplitude coupling and M1 action potentials correlate with main PD symptoms
and can be used to drive aDBS
YES – multiple LFP oscillations are modulated by levodopa
administration, DBS, movements, and non-motor tasks
even years after electrode implant
YES - the time duration of tremor-free period is comparable to the duration of increased levels of stimulation-induced dopamine
release after DBS pulse trains
Personalization and adaptability
NO – cannot be used if patients do not show tremor
YES/NO – it may encode patient specific information
YES – the presence of multiple rhythms correlating with
different patient’s characteristics may account for inter-subject
variability
NOT$YET$TESTED
Low battery consumptionYES/NO – the processing can be
done externally, but triggers should be sent via telemetry links
YES/NO$– the$IPG$needs$to$include$the$sensing$circuit$and$
the$feedback$algorithm
YES/NO – the IPG needs to include the sensing circuit and
the feedback algorithm
NO$– the$IPG$needs$to$include$the$sensing$circuit$and$the$
feedback$algorithm
Proof of conceptYES in humans (ET)
[Yamamoto et al., 2013]YES in animals [Rosin et al.,
2011]
YES in humans (PD) [Little et al., 2013; Rosa et al., 2015; Little
et al., 2015]NO
sEMG and accelerometers Cortical neurosignals Basal ganglia LFPs Neurotransmitters
Additional implant/equipment YES – external sensors required YES – implanted cortical electrodes required
NO – LFPs are recorded from the implanted DBS electrode YES – at least 4 additional CFM
Changes in the surgical procedures
NO – the additional implant is external and does not affect the
surgical procedure
YES – the surgery needs to include the implant of cortical
electrodes
NO – no additional implant during surgery
YES– the additional CFMs need to be implanted during surgery
Patient’s management/acceptability
NO – it may be difficult to manage the recording sensors and
the external equipment may be uncomfortable
YES – all the equipment is implanted
YES – the patient perceives the same system as for traditional
DBS
NO - CFMs have a time life of only a few months and have to be
replaced
Correlation with the clinical state
YES/NO – optimal correlation with tremor, but no correlations with rigidity and bradikinesia
YES – EcoG phase amplitude coupling and M1 action potentials correlate with main PD symptoms
and can be used to drive aDBS
YES – multiple LFP oscillations are modulated by levodopa
administration, DBS, movements, and non-motor tasks
even years after electrode implant
YES - the time duration of tremor-free period is comparable to the duration of increased levels of stimulation-induced dopamine
release after DBS pulse trains
Personalization and adaptability
NO – cannot be used if patients do not show tremor
YES/NO – it may encode patient specific information
YES – the presence of multiple rhythms correlating with
different patient’s characteristics may account for inter-subject
variability
NOT$YET$TESTED
Low battery consumptionYES/NO – the processing can be
done externally, but triggers should be sent via telemetry links
YES/NO$– the$IPG$needs$to$include$the$sensing$circuit$and$
the$feedback$algorithm
YES/NO – the IPG needs to include the sensing circuit and
the feedback algorithm
NO$– the$IPG$needs$to$include$the$sensing$circuit$and$the$
feedback$algorithm
Proof of conceptYES in humans (ET)
[Yamamoto et al., 2013]YES in animals [Rosin et al.,
2011]
YES in humans (PD) [Little et al., 2013; Rosa et al., 2015; Little
et al., 2015]NO
sEMG and accelerometers Cortical neurosignals Basal ganglia LFPs Neurotransmitters
Additional implant/equipment YES – external sensors required YES – implanted cortical electrodes required
NO – LFPs are recorded from the implanted DBS electrode YES – at least 4 additional CFM
Changes in the surgical procedures
NO – the additional implant is external and does not affect the
surgical procedure
YES – the surgery needs to include the implant of cortical
electrodes
NO – no additional implant during surgery
YES– the additional CFMs need to be implanted during surgery
Patient’s management/acceptability
NO – it may be difficult to manage the recording sensors and
the external equipment may be uncomfortable
YES – all the equipment is implanted
YES – the patient perceives the same system as for traditional
DBS
NO - CFMs have a time life of only a few months and have to be
replaced
Correlation with the clinical state
YES/NO – optimal correlation with tremor, but no correlations
with rigidity and bradikinesia
YES – EcoG phase amplitude coupling and M1 action potentials correlate with main PD symptoms
and can be used to drive aDBS
YES – multiple LFP oscillations are modulated by levodopa
administration, DBS, movements, and non-motor tasks
even years after electrode implant
YES - the time duration of tremor-free period is comparable to the duration of increased levels of stimulation-induced dopamine
release after DBS pulse trains
Personalization and adaptability
NO – cannot be used if patients do not show tremor
YES/NO – it may encode patient specific information
YES – the presence of multiple rhythms correlating with
different patient’s characteristics may account for inter-subject
variability
NOT$YET$TESTED
Low battery consumptionYES/NO – the processing can be
done externally, but triggers should be sent via telemetry links
YES/NO$– the$IPG$needs$to$include$the$sensing$circuit$and$
the$feedback$algorithm
YES/NO – the IPG needs to include the sensing circuit and
the feedback algorithm
NO$– the$IPG$needs$to$include$the$sensing$circuit$and$the$
feedback$algorithm
Proof of conceptYES in humans (ET)
[Yamamoto et al., 2013]YES in animals [Rosin et al.,
2011]
YES in humans (PD) [Little et al., 2013; Rosa et al., 2015; Little
et al., 2015]NO
sEMG and accelerometers Cortical neurosignals Basal ganglia LFPs Neurotransmitters
Additional implant/equipment YES – external sensors required YES – implanted cortical electrodes required
NO – LFPs are recorded from the implanted DBS electrode YES – at least 4 additional CFM
Changes in the surgical procedures
NO – the additional implant is external and does not affect the
surgical procedure
YES – the surgery needs to include the implant of cortical
electrodes
NO – no additional implant during surgery
YES– the additional CFMs need to be implanted during surgery
Patient’s management/acceptability
NO – it may be difficult to manage the recording sensors and
the external equipment may be uncomfortable
YES – all the equipment is implanted
YES – the patient perceives the same system as for traditional
DBS
NO - CFMs have a time life of only a few months and have to be
replaced
Correlation with the clinical state
YES/NO – optimal correlation with tremor, but no correlations with rigidity and bradikinesia
YES – EcoG phase amplitude coupling and M1 action potentials correlate with main PD symptoms
and can be used to drive aDBS
YES – multiple LFP oscillations are modulated by levodopa
administration, DBS, movements, and non-motor tasks
even years after electrode implant
YES - the time duration of tremor-free period is comparable to the duration of increased levels of stimulation-induced dopamine
release after DBS pulse trains
Personalization and adaptability
NO – cannot be used if patients do not show tremor
YES/NO – it may encode patient specific information
YES – the presence of multiple rhythms correlating with
different patient’s characteristics may account for inter-subject
variability
NOT$YET$TESTED
Low battery consumptionYES/NO – the processing can be
done externally, but triggers should be sent via telemetry links
YES/NO$– the$IPG$needs$to$include$the$sensing$circuit$and$
the$feedback$algorithm
YES/NO – the IPG needs to include the sensing circuit and
the feedback algorithm
NO$– the$IPG$needs$to$include$the$sensing$circuit$and$the$
feedback$algorithm
Proof of conceptYES in humans (ET)
[Yamamoto et al., 2013]YES in animals [Rosin et al.,
2011]
YES in humans (PD) [Little et al., 2013; Rosa et al., 2015; Little
et al., 2015]NO
sEMG and accelerometers Cortical neurosignals Basal ganglia LFPs Neurotransmitters
Additional implant/equipment YES – external sensors required YES – implanted cortical electrodes required
NO – LFPs are recorded from the implanted DBS electrode YES – at least 4 additional CFM
Changes in the surgical procedures
NO – the additional implant is external and does not affect the
surgical procedure
YES – the surgery needs to include the implant of cortical
electrodes
NO – no additional implant during surgery
YES– the additional CFMs need to be implanted during surgery
Patient’s management/acceptability
NO – it may be difficult to manage the recording sensors and
the external equipment may be uncomfortable
YES – all the equipment is implanted
YES – the patient perceives the same system as for traditional
DBS
NO - CFMs have a time life of only a few months and have to be
replaced
Correlation with the clinical state
YES/NO – optimal correlation with tremor, but no correlations
with rigidity and bradikinesia
YES – EcoG phase amplitude coupling and M1 action potentials correlate with main PD symptoms
and can be used to drive aDBS
YES – multiple LFP oscillations are modulated by levodopa
administration, DBS, movements, and non-motor tasks
even years after electrode implant
YES - the time duration of tremor-free period is comparable to the duration of increased levels of stimulation-induced dopamine
release after DBS pulse trains
Personalization and adaptability
NO – cannot be used if patients do not show tremor
YES/NO – it may encode patient specific information
YES – the presence of multiple rhythms correlating with
different patient’s characteristics may account for inter-subject
variability
NOT$YET$TESTED
Low battery consumptionYES/NO – the processing can be
done externally, but triggers should be sent via telemetry links
YES/NO$– the$IPG$needs$to$include$the$sensing$circuit$and$
the$feedback$algorithm
YES/NO – the IPG needs to include the sensing circuit and
the feedback algorithm
NO$– the$IPG$needs$to$include$the$sensing$circuit$and$the$
feedback$algorithm
Proof of conceptYES in humans (ET)
[Yamamoto et al., 2013]YES in animals [Rosin et al.,
2011]
YES in humans (PD) [Little et al., 2013; Rosa et al., 2015; Little
et al., 2015]NO
AlbertoPriori
CenterforNeurotechnology andExperimental BrainTherapeutics
University ofMilan,Italy
![Page 18: Deep Brain Stimulation - DBS › MDS-Files1 › Private-Files › DB… · Deep Brain Stimulation - DBS Technological innovations Alberto Priori Center for Neurotechnology and Experimental](https://reader034.fdocuments.us/reader034/viewer/2022042315/5f042b377e708231d40ca6ed/html5/thumbnails/18.jpg)
S.Marceglia
LOCALFIELDPOTENTIALS(LFPs)
Neuronalpopulation
DBS electrode
Local fieldpotential
DEEPEEGACTIVITY
AlbertoPriori
CenterforNeurotechnology andExperimental BrainTherapeutics
University ofMilan,Italy
![Page 19: Deep Brain Stimulation - DBS › MDS-Files1 › Private-Files › DB… · Deep Brain Stimulation - DBS Technological innovations Alberto Priori Center for Neurotechnology and Experimental](https://reader034.fdocuments.us/reader034/viewer/2022042315/5f042b377e708231d40ca6ed/html5/thumbnails/19.jpg)
S.Marceglia
LFPs
IPG
Processingandcontrol
policy
LFPs CANBECAPTUREDBYTHESAMEELECTRODEDELIVERINGDBS à
1.Noadditional implant2.Nochanges insurgical procedure3. acceptable bythepatients asconventional DBS
LOCALFIELDPOTENTIALS
AlbertoPriori
CenterforNeurotechnology andExperimental BrainTherapeutics
University ofMilan,Italy
![Page 20: Deep Brain Stimulation - DBS › MDS-Files1 › Private-Files › DB… · Deep Brain Stimulation - DBS Technological innovations Alberto Priori Center for Neurotechnology and Experimental](https://reader034.fdocuments.us/reader034/viewer/2022042315/5f042b377e708231d40ca6ed/html5/thumbnails/20.jpg)
S.Marceglia
LFPs
IPG
Processingandcontrol
policy
(Priori et al 2004)
LFPscorrelatewiththeclinicalstateRisposta alla terapia dopaminergica
AlbertoPriori
CenterforNeurotechnology andExperimental BrainTherapeutics
University ofMilan,Italy
![Page 21: Deep Brain Stimulation - DBS › MDS-Files1 › Private-Files › DB… · Deep Brain Stimulation - DBS Technological innovations Alberto Priori Center for Neurotechnology and Experimental](https://reader034.fdocuments.us/reader034/viewer/2022042315/5f042b377e708231d40ca6ed/html5/thumbnails/21.jpg)
S.Marceglia
LFPs
IPG
Processingandcontrol
policy
(Foffani et al 2005)
(Kuhn et al 2009)
LFPscorrelatewiththeclinicalstateRisposta al movimento volontario Correlazione a rigidità e bradicinesia
AlbertoPriori
CenterforNeurotechnology andExperimental BrainTherapeutics
University ofMilan,Italy
![Page 22: Deep Brain Stimulation - DBS › MDS-Files1 › Private-Files › DB… · Deep Brain Stimulation - DBS Technological innovations Alberto Priori Center for Neurotechnology and Experimental](https://reader034.fdocuments.us/reader034/viewer/2022042315/5f042b377e708231d40ca6ed/html5/thumbnails/22.jpg)
S.Marceglia
LFPs
IPG
Processingandcontrol
policy
(Rodriguez-Oroz et al 2011)
LFPscorrelatewiththeclinicalstateDyskinesias
(Alonso-French et al 2006)
(Foffani et al, 2005)
AlbertoPriori
CenterforNeurotechnology andExperimental BrainTherapeutics
University ofMilan,Italy
![Page 23: Deep Brain Stimulation - DBS › MDS-Files1 › Private-Files › DB… · Deep Brain Stimulation - DBS Technological innovations Alberto Priori Center for Neurotechnology and Experimental](https://reader034.fdocuments.us/reader034/viewer/2022042315/5f042b377e708231d40ca6ed/html5/thumbnails/23.jpg)
S.Marceglia
LFPscorrelatewiththeclinicalstate
(Quinn et al, 2015)
Response to DBS
AlbertoPriori
CenterforNeurotechnology andExperimental BrainTherapeutics
University ofMilan,Italy
![Page 24: Deep Brain Stimulation - DBS › MDS-Files1 › Private-Files › DB… · Deep Brain Stimulation - DBS Technological innovations Alberto Priori Center for Neurotechnology and Experimental](https://reader034.fdocuments.us/reader034/viewer/2022042315/5f042b377e708231d40ca6ed/html5/thumbnails/24.jpg)
S.Marceglia
aDBS INHUMANS:APPROACH1A
B
Rosaetal.2015 e2017Arlottietal,2017
Voltagemodulationofstimulation infunctionoftheSTNbetapower
AlbertoPriori
CenterforNeurotechnology andExperimental BrainTherapeutics
University ofMilan,Italy
![Page 25: Deep Brain Stimulation - DBS › MDS-Files1 › Private-Files › DB… · Deep Brain Stimulation - DBS Technological innovations Alberto Priori Center for Neurotechnology and Experimental](https://reader034.fdocuments.us/reader034/viewer/2022042315/5f042b377e708231d40ca6ed/html5/thumbnails/25.jpg)
S.Marceglia
Littleetal.2013
Littleetal.2015
aDBS INHUMANS:APPROACH2
Off/onDBSinfunctionofagivenbetapowerlevel
AlbertoPriori
CenterforNeurotechnology andExperimental BrainTherapeutics
University ofMilan,Italy
![Page 26: Deep Brain Stimulation - DBS › MDS-Files1 › Private-Files › DB… · Deep Brain Stimulation - DBS Technological innovations Alberto Priori Center for Neurotechnology and Experimental](https://reader034.fdocuments.us/reader034/viewer/2022042315/5f042b377e708231d40ca6ed/html5/thumbnails/26.jpg)
S.Marceglia
COORDINATED-RESETDBS• train of high frequency
through electrodes different from those implanted
• Tested in primate and humans à beta reduction and clinical improvement
Adamcich etal,Mov Disord,2014
AlbertoPriori
CenterforNeurotechnology andExperimental BrainTherapeutics
University ofMilan,Italy