Thank you very much for your attention. I am very interested to know the working model of brain pacemaker used for Parkinson's disease, it stimulates the nucleus continuously or in a special stimulate rhythm？
Thank you!
We use continuous stimulation parameters for deep brain stimulation in Parkinson's disease. Typically it is a high frequency (130 Hz) square wave stimulation with pulse width of 90 micro-seconds. there are two modes - constant voltage (most common) and constant current (upcoming).
What is a "regulate model"?
If you want to know about a model of the basal ganglia and in particular a control theoretical approach to closed loop stimulation, check the work of Lowery et al., like:
Paor, A. M. d. and M. M. Lowery (2009). "Analysis of the Mechanism of Action of Deep Brain Stimulation Using the Concepts of Dither Injection and the Equivalent Nonlinearity." IEEE TBME 56(11): 2717-2720.
Grant, P. F. and M. M. Lowery (2013). "Simulation of Cortico-Basal Ganglia Oscillations and Their Suppression by Closed Loop Deep Brain Stimulation." IEEE Trans Neural Syst Rehabil Eng 21(4): 584-594.
Dr. Jules Nazzaro was with the Department of Neurology at BUSM when I was in training. He invited me to come to Kansas to do research with him but I did not want to relocate at that time. He is really an expert in this field and if I had a question he is the person I would consult.
https://www.youtube.com/watch?v=QTCH1pDFN44
Thank you for all of your kindly answers. The "regulate mode" I mean is whether the stimulate of DBS is continuously all the day or the device just sent out stimulation just a certain time period during one day?
Merry christmas, all of you!
It needs to be on as long as the patient is awake to attenuate a tremor. If it is shut off the tremor returns.
Thank you for reply so soon. That's mean the device should be working all the day long, thank you very much!
Dear Marcia,
I disagree: Check out "Little, S., A. Pogosyan, S. Neal, B. Zavala, L. Zrinzo, M. Hariz, Thomas Foltynie, P. Limousin, K. Ashkan, J. FitzGerald, A. L. Green, T. Z. Aziz and P. Brown (2013). "Adaptive Deep Brain Stimulation in Advanced Parkinson Disease." Ann. Neurol. 74: 449-457."
They implemented a closed-loop, meaning on demand DBS stimulation. It triggers on the beta-band activity of the patient and thus suppresses the tremor etc... WITHOUT continuous stimulation. I doubt that beta-activity is the last word on the trigger, but at least, it is a start!
For a more technical approach and model (even though, it is limited) check out: Priori, A., G. Foffani, L. Rossi and S. Marceglia (2013). "Adaptive deep brain stimulation (aDBS) controlled by local field potential oscillations." Exp Neurol 245: 77-86.
Merry Christmas!
uli
Irrespective of whether the device has a manually adjusted pulse or one that responds automatically based LFPs the device still needs to be on in order to induce a performance improvement. In practice most patients prefer to leave the device on all the time, even when they are sleeping so that they can move better when they wake up in the middle of the night. A device that uses biofeedback to optimize signal intensity eliminates the need for the patient or neurologist to adjust the device to optimize performance but the device still needs to be turned on.
This treatment is deep brain stimulation(DBS). The pacemaker is also called implanted pulse generator. For PD, the pacemaker deliver continuous electrical pulse to stimulation the brain nucleus, such as GPi or STN. The mode electrical stimulation is mainly interval square wave. For treating PD, the frequency of pulse could be 90-180Hz. The duration of pulse could be 60-120 microsecond. The intensity could be 1.5-4.0 volt. Frequency, duration(pulse width) and intensity are the important parameter for DBS. The most common parameter is 130Hz, 60/90 microsecond with moderate intensity.
The stimulation must deliver all the time to alleviate the symptoms of PD. When the stimulation is turned off, the symptoms will reemerge.
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