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  1. Article ; Online: Cerebellar Deep Brain Stimulation in Cerebral Palsy: Promising Early Results and a Look Forward to a Larger Clinical Trial.

    Cajigas, Iahn / Morrison, Melanie A / San Luciano, Marta / Starr, Philip

    World neurosurgery

    2023  Volume 174, Page(s) 223–224

    MeSH term(s) Humans ; Cerebral Palsy/therapy ; Deep Brain Stimulation/methods ; Cerebellum
    Language English
    Publishing date 2023-03-20
    Publishing country United States
    Document type Letter
    ZDB-ID 2534351-8
    ISSN 1878-8769 ; 1878-8750
    ISSN (online) 1878-8769
    ISSN 1878-8750
    DOI 10.1016/j.wneu.2023.03.069
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  2. Article: Totally Implantable Bidirectional Neural Prostheses: A Flexible Platform for Innovation in Neuromodulation.

    Starr, Philip A

    Frontiers in neuroscience

    2018  Volume 12, Page(s) 619

    Abstract: Implantable neural prostheses are in widespread use for treating a variety of brain disorders. Until recently, most implantable brain devices have been unidirectional, either delivering neurostimulation without brain sensing, or sensing brain activity to ...

    Abstract Implantable neural prostheses are in widespread use for treating a variety of brain disorders. Until recently, most implantable brain devices have been unidirectional, either delivering neurostimulation without brain sensing, or sensing brain activity to drive external effectors without a stimulation component. Further, many neural interfaces that incorporate a sensing function have relied on hardwired connections, such that subjects are tethered to external computers and cannot move freely. A new generation of neural prostheses has become available, that are both bidirectional (stimulate as well as record brain activity) and totally implantable (no externalized connections). These devices provide an opportunity for discovering the circuit basis for neuropsychiatric disorders, and to prototype personalized neuromodulation therapies that selectively interrupt neural activity underlying specific signs and symptoms.
    Language English
    Publishing date 2018-09-07
    Publishing country Switzerland
    Document type Journal Article ; Review
    ZDB-ID 2411902-7
    ISSN 1662-453X ; 1662-4548
    ISSN (online) 1662-453X
    ISSN 1662-4548
    DOI 10.3389/fnins.2018.00619
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  3. Article ; Online: Studies of deep brain stimulation in Parkinson's disease.

    Vitek, Jerrold L / Starr, Philip A

    The Lancet. Neurology

    2020  Volume 19, Issue 10, Page(s) 807–808

    MeSH term(s) Deep Brain Stimulation ; Humans ; Parkinson Disease ; Subthalamic Nucleus
    Language English
    Publishing date 2020-09-16
    Publishing country England
    Document type Letter ; Comment
    ZDB-ID 2081241-3
    ISSN 1474-4465 ; 1474-4422
    ISSN (online) 1474-4465
    ISSN 1474-4422
    DOI 10.1016/S1474-4422(20)30323-9
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  4. Article ; Online: 1:2 entrainment is not a device-induced artefact, except when it is.

    Sermon, James J / Benjaber, Moaad / Duchet, Benoit / Anso, Juan / Olaru, Maria / Starr, Philip A / Denison, Timothy

    Brain stimulation

    2024  Volume 17, Issue 2, Page(s) 149–151

    Language English
    Publishing date 2024-02-06
    Publishing country United States
    Document type Letter
    ZDB-ID 2394410-9
    ISSN 1876-4754 ; 1935-861X
    ISSN (online) 1876-4754
    ISSN 1935-861X
    DOI 10.1016/j.brs.2024.01.010
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  5. Article ; Online: Cerebellar deep brain stimulation for the treatment of movement disorders in cerebral palsy.

    Cajigas, Iahn / Morrison, Melanie A / Luciano, Marta San / Starr, Philip A

    Journal of neurosurgery

    2023  Volume 139, Issue 3, Page(s) 605–614

    Abstract: Objective: Cerebral palsy (CP) represents the most common childhood physical disability that encompasses disorders of movement and posture attributed to nonprogressive disturbances that occurred in the developmental fetal or infant brain. Dyskinetic CP ( ...

    Abstract Objective: Cerebral palsy (CP) represents the most common childhood physical disability that encompasses disorders of movement and posture attributed to nonprogressive disturbances that occurred in the developmental fetal or infant brain. Dyskinetic CP (DCP), the second most common type of CP after spastic forms, refers to a subset of patients in whom dystonia and choreoathetosis are the predominant motor manifestations. Most children with CP have abnormal brain MRI studies indicative of cortical and deep gray matter damage consistent with hypoxic ischemic encephalopathy, which may preclude or suggest decreased efficacy of standard deep brain stimulation (DBS) targets. The cerebellum has been posited as an attractive target for treatment of DCP because it is frequently spared from hypoxic ischemic damage and has shown promise in alleviating patient symptoms both in early work in the 1970s and in more recent case series with DBS.
    Methods: The authors performed bilateral cerebellar DBS implantation, targeting the dentate nucleus (DN) and cerebellar outflow pathway, in 3 patients with DCP. Leads were connected to a pulse generator that senses local field potentials during chronic continuous DBS. The authors report their surgical methods, examples of chronic cerebellar local field potential recordings, and preliminary clinical outcomes. Motor outcomes were assessed using the Burke-Fahn-Marsden Dystonia Rating Scale.
    Results: Three patients 14-22 years old with DCP and MRI evidence of structural damage to the basal ganglia were offered cerebellar stimulation targeting the DN. All patients tolerated the procedure well and demonstrated improvement in subjective motor function as well as objective improvement in the Burke-Fahn-Marsden Dystonia Rating Scale movement subscale, although the range of responses was variable (19%-40%). Patients experienced subjective improvement in motor function including ease of hand movements and coordination, gait, head control, speech, decreased overflow, and diminished muscle tightness.
    Conclusions: DBS of the dentate nuclei in patients with DCP appears to be safe and shows preliminary evidence of clinical benefit. New chronic sensing technology may allow for determination of in vivo mechanisms of network disruption in DCP and allow for further understanding of the effects of neuromodulation on brain physiology. Larger studies with long-term follow up will be required to further elucidate the clinical benefits of this therapy. This report addresses a gap in the literature regarding the technical approach to image-based stereotactic targeting and chronic neural recording in the DN.
    MeSH term(s) Child ; Humans ; Adolescent ; Young Adult ; Adult ; Cerebral Palsy/complications ; Cerebral Palsy/therapy ; Dystonia/etiology ; Deep Brain Stimulation/methods ; Globus Pallidus/surgery ; Movement Disorders/etiology ; Movement Disorders/therapy ; Dystonic Disorders ; Cerebellum/diagnostic imaging ; Treatment Outcome
    Language English
    Publishing date 2023-02-10
    Publishing country United States
    Document type Journal Article
    ZDB-ID 3089-2
    ISSN 1933-0693 ; 0022-3085
    ISSN (online) 1933-0693
    ISSN 0022-3085
    DOI 10.3171/2023.1.JNS222289
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  6. Article: Protocol for combined N-of-1 trials to assess cerebellar neurostimulation for movement disorders in children and young adults with dyskinetic cerebral palsy.

    Luciano, Marta San / Oehrn, Carina R / Wang, Sarah S / Tolmie, John S / Wiltshire, Allisun / Graff, Rebecca E / Zhu, Jennifer / Starr, Philip A

    Research square

    2024  

    Abstract: Background: ...

    Abstract Background:
    Language English
    Publishing date 2024-04-01
    Publishing country United States
    Document type Preprint
    DOI 10.21203/rs.3.rs-4077387/v1
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  7. Article: Smart neuromodulation in movement disorders.

    Mitchell, Kyle T / Starr, Philip A

    Handbook of clinical neurology

    2020  Volume 168, Page(s) 153–161

    Abstract: Deep brain stimulation (DBS) is a technique for invasive subcortical neuromodulation using a totally implantable permanent device. DBS is an effective therapy for movement disorders and is under investigation for the treatment of many other conditions ... ...

    Abstract Deep brain stimulation (DBS) is a technique for invasive subcortical neuromodulation using a totally implantable permanent device. DBS is an effective therapy for movement disorders and is under investigation for the treatment of many other conditions including Tourette syndrome, epilepsy, and depression. Traditional DBS is limited by labor-intensive manual programming, high current requirements, and lack of responsiveness to fluctuations in the patient's signs and symptoms. The field is moving toward adaptive closed loop systems with stimulation modulated by peripheral or intracranial sensors, a technique often described as "smart neuromodulation." Advances in the understanding of brain rhythms associated with specific neurologic symptoms and the introduction of novel bidirectional neural interfaces are facilitating investigative studies of closed loop stimulation in movement disorders. These studies suggest the potential for greater efficacy with fewer adverse effects. It may be possible to generalize the hardware platforms and control strategies developed to other brain disorders.
    MeSH term(s) Brain/physiology ; Brain/physiopathology ; Brain Diseases/physiopathology ; Brain Diseases/therapy ; Deep Brain Stimulation/methods ; Humans ; Movement Disorders/therapy ; Tourette Syndrome/therapy
    Language English
    Publishing date 2020-03-12
    Publishing country Netherlands
    Document type Journal Article ; Review
    ISSN 0072-9752
    ISSN 0072-9752
    DOI 10.1016/B978-0-444-63934-9.00012-3
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  8. Article ; Online: Multi-night cortico-basal recordings reveal mechanisms of NREM slow-wave suppression and spontaneous awakenings in Parkinson's disease.

    Anjum, Md Fahim / Smyth, Clay / Zuzuárregui, Rafael / Dijk, Derk Jan / Starr, Philip A / Denison, Timothy / Little, Simon

    Nature communications

    2024  Volume 15, Issue 1, Page(s) 1793

    Abstract: Sleep disturbance is a prevalent and disabling comorbidity in Parkinson's disease (PD). We performed multi-night (n = 57) at-home intracranial recordings from electrocorticography and subcortical electrodes using sensing-enabled Deep Brain Stimulation ( ... ...

    Abstract Sleep disturbance is a prevalent and disabling comorbidity in Parkinson's disease (PD). We performed multi-night (n = 57) at-home intracranial recordings from electrocorticography and subcortical electrodes using sensing-enabled Deep Brain Stimulation (DBS), paired with portable polysomnography in four PD participants and one with cervical dystonia (clinical trial: NCT03582891). Cortico-basal activity in delta increased and in beta decreased during NREM (N2 + N3) versus wakefulness in PD. DBS caused further elevation in cortical delta and decrease in alpha and low-beta compared to DBS OFF state. Our primary outcome demonstrated an inverse interaction between subcortical beta and cortical slow-wave during NREM. Our secondary outcome revealed subcortical beta increases prior to spontaneous awakenings in PD. We classified NREM vs. wakefulness with high accuracy in both traditional (30 s: 92.6 ± 1.7%) and rapid (5 s: 88.3 ± 2.1%) data epochs of intracranial signals. Our findings elucidate sleep neurophysiology and impacts of DBS on sleep in PD informing adaptive DBS for sleep dysfunction.
    MeSH term(s) Humans ; Parkinson Disease/therapy ; Subthalamic Nucleus ; Sleep/physiology ; Polysomnography ; Electrocorticography
    Language English
    Publishing date 2024-02-27
    Publishing country England
    Document type Journal Article
    ZDB-ID 2553671-0
    ISSN 2041-1723 ; 2041-1723
    ISSN (online) 2041-1723
    ISSN 2041-1723
    DOI 10.1038/s41467-024-46002-7
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  9. Article ; Online: Physiological effects of dual target DBS in an individual with Parkinson's disease and a sensing-enabled pulse generator.

    Cummins, Daniel D / Sandoval-Pistorius, Stephanie S / Cernera, Stephanie / Fernandez-Gajardo, Rodrigo / Hammer, Lauren H / Starr, Philip A

    Parkinsonism & related disorders

    2024  Volume 122, Page(s) 106089

    Abstract: Introduction: Deep brain stimulation (DBS) of the subthalamic nucleus (STN) or globus pallidus (GP) is an established therapy for Parkinson's disease (PD). Novel DBS devices can record local field potential (LFP) physiomarkers from the STN or GP. While ... ...

    Abstract Introduction: Deep brain stimulation (DBS) of the subthalamic nucleus (STN) or globus pallidus (GP) is an established therapy for Parkinson's disease (PD). Novel DBS devices can record local field potential (LFP) physiomarkers from the STN or GP. While beta (13-30 Hz) and gamma (40-90 Hz) STN and GP LFP oscillations correlate with PD motor severity and with therapeutic effects of treatments, STN-GP interactions in electrophysiology in patients with PD are not well characterized.
    Methods: Simultaneous bilateral STN and GP LFPs were recorded in a patient with PD who received bilateral STN-DBS and GP-DBS. Power spectra in each target and STN-GP coherence were assessed in various ON- and OFF-levodopa and DBS states, both at rest and with voluntary movement.
    Results: OFF-levodopa and OFF-DBS, beta peaks were present at bilateral STN and GP, coincident with prominent STN-GP beta coherence. Levodopa and dual-target-DBS (simultaneous STN-DBS and GP-DBS) completely suppressed STN-GP coherence. Finely-tuned gamma (FTG) activity at half the stimulation frequency (62.5 Hz) was seen in the STN during GP-DBS at rest. To assess the effects of movement on FTG activity, we recorded LFPs during instructed movement. We observed FTG activity in bilateral GP and bilateral STN during contralateral body movements while on GP-DBS and ON-levodopa. No FTG was seen with STN-DBS or dual-target-DBS.
    Conclusion: Dual-target-DBS and levodopa suppressed STN-GP coherence. FTG throughout the basal ganglia was induced by GP-DBS in the presence of levodopa and movement. This bilateral STN-FTG and GP-FTG corresponded with the least severe bradykinesia state, suggesting a pro-kinetic role for FTG.
    Language English
    Publishing date 2024-03-06
    Publishing country England
    Document type Journal Article
    ZDB-ID 1311489-x
    ISSN 1873-5126 ; 1353-8020
    ISSN (online) 1873-5126
    ISSN 1353-8020
    DOI 10.1016/j.parkreldis.2024.106089
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    Zs.A 4553: Show issues Location:
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  10. Article ; Online: Artifact Characterization and a Multipurpose Template-Based Offline Removal Solution for a Sensing-Enabled Deep Brain Stimulation Device.

    Hammer, Lauren H / Kochanski, Ryan B / Starr, Philip A / Little, Simon

    Stereotactic and functional neurosurgery

    2022  Volume 100, Issue 3, Page(s) 168–183

    Abstract: Background: The Medtronic "Percept" is the first FDA-approved deep brain stimulation (DBS) device with sensing capabilities during active stimulation. Its real-world signal-recording properties have yet to be fully described.: Objective: This study ... ...

    Abstract Background: The Medtronic "Percept" is the first FDA-approved deep brain stimulation (DBS) device with sensing capabilities during active stimulation. Its real-world signal-recording properties have yet to be fully described.
    Objective: This study details three sources of artifact (and potential mitigations) in local field potential (LFP) signals collected by the Percept and assesses the potential impact of artifact on the future development of adaptive DBS (aDBS) using this device.
    Methods: LFP signals were collected from 7 subjects in both experimental and clinical settings. The presence of artifacts and their effect on the spectral content of neural signals were evaluated in both the stimulation ON and OFF states using three distinct offline artifact removal techniques.
    Results: Template subtraction successfully removed multiple sources of artifact, including (1) electrocardiogram (ECG), (2) nonphysiologic polyphasic artifacts, and (3) ramping-related artifacts seen when changing stimulation amplitudes. ECG removal from stimulation ON (at 0 mA) signals resulted in spectral shapes similar to OFF stimulation spectra (averaged difference in normalized power in theta, alpha, and beta bands ≤3.5%). ECG removal using singular value decomposition was similarly successful, though required subjective researcher input. QRS interpolation produced similar recovery of beta-band signal but resulted in residual low-frequency artifact.
    Conclusions: Artifacts present when stimulation is enabled notably affected the spectral properties of sensed signals using the Percept. Multiple discrete artifacts could be successfully removed offline using an automated template subtraction method. The presence of unrejected artifact likely influences online power estimates, with the potential to affect aDBS algorithm performance.
    MeSH term(s) Algorithms ; Artifacts ; Brain/physiology ; Deep Brain Stimulation/methods ; Humans
    Language English
    Publishing date 2022-02-07
    Publishing country Switzerland
    Document type Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 645069-6
    ISSN 1423-0372 ; 1011-6125
    ISSN (online) 1423-0372
    ISSN 1011-6125
    DOI 10.1159/000521431
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