Elsevier

Brain Stimulation

Volume 14, Issue 6, November–December 2021, Pages 1434-1443
Brain Stimulation

Wearable sensor-driven responsive deep brain stimulation for essential tremor

https://doi.org/10.1016/j.brs.2021.09.002Get rights and content
Under a Creative Commons license
open access

Highlights

  • Two sensor-driven responsive deep brain stimulation (DBS) paradigms were studied.

  • Both paradigms provided equivalent tremor reduction compared to continuous DBS.

  • Both paradigms reduced the electrical energy delivered compared to continuous DBS.

Abstract

Background

Deep brain stimulation (DBS) is an effective surgical therapy for individuals with essential tremor (ET). However, DBS operates continuously, resulting in adverse effects such as postural instability or dysarthria. Continuous DBS (cDBS) also presents important practical issues including limited battery life of the implantable neurostimulator (INS). Collectively, these shortcomings impact optimal therapeutic benefit in ET.

Objective

The goal of the study was to establish a physiology-driven responsive DBS (rDBS) system to provide targeted and personalized therapy based on electromyography (EMG) signals.

Methods

Ten participants with ET underwent rDBS using Nexus-D, a Medtronic telemetry wand that acts as a direct conduit to the INS by modulating stimulation voltage. Two different rDBS paradigms were tested: one driven by one EMG (single-sensor) and another driven by two or more EMGs (multi-sensor). The feature(s) used in the rDBS algorithms was the pow2er in the participant's tremor frequency band derived from the sensors controlling stimulation. Both algorithms were trained on kinetic and postural data collected during DBS off and cDBS states.

Results

Using established clinical scales and objective measurements of tremor severity, we confirm that both rDBS paradigms deliver equivalent clinical benefit as cDBS. Moreover, both EMG-driven rDBS paradigms delivered less total electrical energy translating to an increase in the battery life of the INS.

Conclusions

The results of this study verify that EMG-driven rDBS provides clinically equivalent tremor suppression compared to cDBS, while delivering less total electrical energy. Controlling stimulation using a dynamic rDBS paradigm can mitigate limitations of traditional cDBS systems.

Keywords

Deep brain stimulation
Responsive stimulation
Essential tremor
Wearable sensors
Electromyography

Cited by (0)