Deep Brain Stimulation最新文献

{"title":"Ethical considerations in closed loop deep brain stimulation","authors":"Sunderland Baker ,&nbsp;Eliz Fenstermacher ,&nbsp;Rachel A. Davis ,&nbsp;Drew S. Kern ,&nbsp;John A. Thompson ,&nbsp;Gidon Felsen ,&nbsp;Alexander J. Baumgartner","doi":"10.1016/j.jdbs.2023.11.001","DOIUrl":"https://doi.org/10.1016/j.jdbs.2023.11.001","url":null,"abstract":"<div><h3>Background</h3><p>Closed-loop deep brain stimulation (DBS) uses feedback to infer a clinical state and adjust stimulation accordingly. This novel mechanism has several potential advantages over conventional DBS including reducing stimulation-induced side effects, improving battery longevity, and alleviating symptoms not optimally treated with standard protocols. However, several ethical challenges may arise with the implementation of this technology, particularly with respect to clinical decision making.</p></div><div><h3>Objective</h3><p>To discuss potential ethical and clinical dilemmas encountered in using closed-loop DBS for neurological and psychiatric disorders.</p></div><div><h3>Methods</h3><p>The relevant literature is reviewed and supplemented with discussion of ethically challenging clinical scenarios. We outline an ethical framework for addressing these issues and provide practical recommendations for clinicians and researchers.</p></div><div><h3>Results</h3><p>Ethical considerations in closed-loop DBS revolve around five key principles: 1) risk/benefit analysis; 2) inclusion and exclusion criteria; 3) respect for patient autonomy; 4) quality of life and patient benefit; and 5) concerns associated with recording neural activity.</p></div><div><h3>Conclusion(s)</h3><p>Developing and implementing a pragmatic framework for ethical considerations in closed-loop DBS will be critical as this technology is utilized in patients with both neurologic and psychiatric indications.</p></div>","PeriodicalId":100359,"journal":{"name":"Deep Brain Stimulation","volume":"3 ","pages":"Pages 8-15"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S294966912300012X/pdfft?md5=168abcc6e8af88c5de3585f384bca01b&pid=1-s2.0-S294966912300012X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134832941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Deep brain stimulation of the subthalamic nucleus in Parkinson’s disease after 15 years: Clinical outcome and caregiver burden","authors":"Lucas G. Westerink ,&nbsp;Felix Gubler ,&nbsp;Annelien Duits ,&nbsp;Linda Ackermans ,&nbsp;Anouk Smeets ,&nbsp;Mark L. Kuijf ,&nbsp;Yasin Temel","doi":"10.1016/j.jdbs.2023.06.001","DOIUrl":"https://doi.org/10.1016/j.jdbs.2023.06.001","url":null,"abstract":"<div><h3>Background and objectives</h3><p>To provide a detailed overview of motor and non-motor outcome of Parkinson disease (PD) patients with deep brain stimulation (DBS) of the Subthalamic nucleus (STN) 13–17 years after surgery. Little information on long-term follow-up (&gt;10 years) after surgery is available yet, with a high percentage of loss to follow-up (FU).</p></div><div><h3>Methods</h3><p>In this observational cohort study data on motor, autonomic symptoms, cognitive outcome, mood, quality of life, activities of daily living, Unified Parkinson’s disease rating scale (UPDRS, version 1) scores and dopaminergic medication were collected average 15.1 years (± 1.5 standard deviation) after surgery. To limit the loss to FU, patients unable to visit the hospital have been evaluated at their place of residency (e.g. home or nursing home). Furthermore, caregiver burden was assessed.</p></div><div><h3>Results</h3><p>Fifteen (35%) of the 43 included patients survived follow-up, of which 9 patients were assessed at their institution. UPDRS I (1.46 vs. 6.7, p &lt; 0.005), UPDRS II (10.5 vs. 30.5, p &lt; 0.01) and UPDRS III (47.7 vs. 18.3, p = 0.005) significantly worsened compared to baseline with medication. Axial symptoms and bradykinesia were most severely affected of the UPDRS III score. New autonomic symptoms were dominant. One third (n = 5) of caregivers reported significant burden. EQ-5D was 0.43 and 4 patients (27%) showed signs of moderate to severe depression. Six patients (40%) met criteria of dementia.</p></div><div><h3>Conclusion</h3><p>Cognitive, axial, bradykinesia and autonomic symptoms are highly dominant after 15 years of follow-up, whereas tremor and rigidity show no significant worsening over time. This significantly affects health status, quality of life and caregiver burden.</p></div>","PeriodicalId":100359,"journal":{"name":"Deep Brain Stimulation","volume":"2 ","pages":"Pages 20-25"},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49750248","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Employing LFP recording to optimize stimulation location and amplitude in chronic DBS for Parkinson’s disease: A proof-of-concept pilot study","authors":"Bart E.K.S. Swinnen ,&nbsp;Mariëlle J. Stam ,&nbsp;Arthur W.G. Buijink ,&nbsp;Martijn G.J. de Neeling ,&nbsp;Peter R. Schuurman ,&nbsp;Rob M.A. de Bie ,&nbsp;Martijn Beudel","doi":"10.1016/j.jdbs.2023.05.003","DOIUrl":"https://doi.org/10.1016/j.jdbs.2023.05.003","url":null,"abstract":"<div><h3>Objectives</h3><p>Parkinson patients with chronic DBS routinely receive sensing-enabled implantable pulse generators upon battery replacement. Here we aimed to assess whether and/or how local field potential based reprogramming may be of use in this population.</p></div><div><h3>Methods</h3><p>In four Parkinson patients on chronic treatment with bilateral STN-DBS and implanted with the Percept™ PC implantable pulse generator, we employed an approach to select stimulation contacts and amplitudes based on beta-activity. When applicable, the effect of parameter adjustments on DBS effectiveness and DBS-induced side effects was assessed.</p></div><div><h3>Results</h3><p>In one out of eight electrodes, the LFP-guided contact was different from the clinically determined one. Beta-based therapeutic windows could be defined in five out of eight electrodes. LFP-guided parameter adjustments were performed in two patients, resulting in improved motor fluctuations and decreased stimulation-induced side effects respectively.</p></div><div><h3>Discussion</h3><p>LFP-guided DBS reprogramming has the potential to improve effectiveness and decrease side effects in selected cases. Prospective controlled research is required to assess the clinical usefulness of LFP-guided DBS reprogramming.</p></div>","PeriodicalId":100359,"journal":{"name":"Deep Brain Stimulation","volume":"2 ","pages":"Pages 1-5"},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49750521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial Deep Brain Stimulation Issue 2 by Dr Yasin Temel & Dr Abdelhamid Benazzouz","authors":"Yasin Temel ,&nbsp;Abdelhamid Benazzouz","doi":"10.1016/j.jdbs.2023.08.001","DOIUrl":"https://doi.org/10.1016/j.jdbs.2023.08.001","url":null,"abstract":"","PeriodicalId":100359,"journal":{"name":"Deep Brain Stimulation","volume":"2 ","pages":"Pages e1-e2"},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49750502","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An alternative electrode implantation and tethering approach for neuromodulation of non-cranial areas in freely moving rats","authors":"Aryo Zare ,&nbsp;Gommert A. van Koeveringe ,&nbsp;Celine Meriaux ,&nbsp;Yasin Temel ,&nbsp;Ali Jahanshahi","doi":"10.1016/j.jdbs.2023.05.001","DOIUrl":"https://doi.org/10.1016/j.jdbs.2023.05.001","url":null,"abstract":"<div><p>Electrical stimulation and recording from non-cranial areas in freely moving rodents often require tethered devices for monitoring from a distant location. Inspired by our experience in electrode implantation for deep brain stimulation (DBS), we developed an implantation approach, which allows for performing electrical modulation of the urinary bladder. In order to prevent the wires from being damaged by rats in freely moving conditions and compromising animal welfare, we guided the wires subcutaneously toward the nape to reach a plug, which was mounted on the skull. No complications such as infection, gastrointestinal tract injury, or inflammation occurred during or after surgery. The device allowed easy plugging and unplugging throughout the bladder stimulation and behavioral testing sessions undertaken in freely moving animals. This method enables modulation of peripheral organs in combination with DBS in freely moving rodents and can encompass many procedures such as electrical stimulation and recording, drug delivery, or electromyography.</p></div>","PeriodicalId":100359,"journal":{"name":"Deep Brain Stimulation","volume":"2 ","pages":"Pages 15-19"},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49750243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of preoperative computed tomography image slice thickness on the planning of deep brain stimulation surgery: A phantom study","authors":"Felix S. Gubler ,&nbsp;Onur Alptekin ,&nbsp;Linda Ackermans ,&nbsp;Pieter L. Kubben ,&nbsp;Mark L. Kuijf ,&nbsp;Ersoy Kocabicak ,&nbsp;Yasin Temel","doi":"10.1016/j.jdbs.2023.05.004","DOIUrl":"https://doi.org/10.1016/j.jdbs.2023.05.004","url":null,"abstract":"<div><h3>Background</h3><p>Preoperative Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) coregistration is often applied to perform deep brain stimulation (DBS) surgeries. Thin sliced (high dose) CT is used and recommended because of the high reported accuracy but there are no comparative studies. Thin sliced CT could lead to a higher radiation exposure for the patient in contrast to thicker sliced CT (low dose) due to a longer scanning time. In this study we investigated if the preoperative CT slice thickness had an effect on the registration accuracy in a preoperative simulated DBS setting.</p></div><div><h3>Material and methods</h3><p>An implanted phantom, a Citrullus lanatus (watermelon), was used to acquire an MRI data set (2 millimeter (mm) T2) with a fixed reference point. Two observers targeted the reference point independently and they recorded and compared the coordinates, ring, and arc angles from all coregistered series with different CT slice thicknesses of 0.5 mm, 1 mm, 1.5 mm, 2 mm, 3 mm, 4 mm, and 5 mm. Separately, both MRI and CT were used as reference series for coregistration and analysis. Lastly, inter-observer reliability was calculated with Kendall’s coefficient of concordance (W). With W&gt; 0.9 defined as very good.</p></div><div><h3>Results</h3><p>Our results show no relevant effect on the preoperative registration accuracies for the different CT’s with all absolute differences in mm for the stereotactic coordinates&lt; 0.5 and angles in degrees&lt; 0.4. Additionally, the inter-observer reliability was high (W 0.991).</p></div><div><h3>Conclusion</h3><p>We found no relevant effect of increased slice thickness of preoperative CT on the preoperative registration accuracy in a simulated DBS setting.</p></div>","PeriodicalId":100359,"journal":{"name":"Deep Brain Stimulation","volume":"2 ","pages":"Pages 6-14"},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49750595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An unusual early and persistent symptomatic presentation of peri-lead edema following deep brain stimulation: Case report and literature review","authors":"Miguel Bertelli Ramos ,&nbsp;João Pedro Einsfeld Britz ,&nbsp;Marcelo Mattana ,&nbsp;Paulo Henrique Pires de Aguiar ,&nbsp;Paulo Roberto Franceschini","doi":"10.1016/j.jdbs.2022.09.001","DOIUrl":"https://doi.org/10.1016/j.jdbs.2022.09.001","url":null,"abstract":"<div><h3>Background</h3><p>Peri-lead edema (PLE) following deep brain stimulation surgery is apparently a common, self-limiting condition. PLE generally occurs within days to weeks, rarely occurring before postoperative day one. Majority of patients are asymptomatic, although a wide range of sings/symptoms may be present.</p></div><div><h3>Case description</h3><p>A 62-year-old female patient with Parkinson’s Disease underwent DBS of the subthalamic nucleus in November 2018. Asymptomatic, the patient presented bilateral PLE in the immediate post-operative CT. After two weeks, she developed a frontal lobe dysfunction and persistence of PLE in MRI. She underwent a three-week course of dexamethasone, with mild improvement. However, she subsequently fell at home in January 2019, sustaining an injury to the scalp over the connection site surgical incision. Due to persisting PLE, this was managed with a new course of Dexamethasone, and she was followed-up with CT scans. Two months later (March 2019) the patient presented with urinary tract infection and a lateral scalp erosion over the lead’s connection site. Debridement and primary closure of the skin were performed, followed by a four-week vancomycin course. A MRI at the stage showed marked improvement of the edema. The most recent MRI (May 2019) and CT scan (July 2019) showed resolution of the edema.</p></div><div><h3>Conclusions</h3><p>We reported an atypical case of ultra early and persistent PLE presentation following DBS surgery, which improved with courses of steroids. It is unknown whether steroids have a role in the management of PLE.</p></div>","PeriodicalId":100359,"journal":{"name":"Deep Brain Stimulation","volume":"1 ","pages":"Pages 1-4"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49749478","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Application of current steering with MICC directional lead in STN-DBS for Parkinson’s disease","authors":"Atsushi Umemura ,&nbsp;Genko Oyama ,&nbsp;Hirokazu Iwamuro ,&nbsp;Yasushi Shimo ,&nbsp;Taku Hatano ,&nbsp;Hikaru Kamo ,&nbsp;Noriko Nishikawa ,&nbsp;Daiki Kamiyama ,&nbsp;Akihide Kondo ,&nbsp;Nobutaka Hattori","doi":"10.1016/j.jdbs.2023.03.002","DOIUrl":"https://doi.org/10.1016/j.jdbs.2023.03.002","url":null,"abstract":"<div><h3>Background</h3><p>Deep brain stimulation (DBS) of the subthalamic nucleus (STN) has been widely performed for medically refractory Parkinson's disease (PD). Recent new technology of the multiple independent current control (MICC) with the directional lead provides both vertical and horizontal current steering on purposes. Consequently, MICC directional lead allows fine stimulation adjustment tailoring the condition of the individual patient. It is also expected to avoid stimulation induced adverse effects.</p></div><div><h3>Methods</h3><p>We retrospectively investigated the situation of current steering and the reason for doing so 3-month and 1-year after surgery in 80 patients who underwent bilateral STN-DBS for PD using MICC directional lead.</p></div><div><h3>Results</h3><p>In 160 leads of 80 patients, current steering was used in 39 leads (24%) 3-month after surgery, but in 80 leads (50%) 1-year after surgery. As for the reason, vertical steering was used in 7 leads (4%) and horizontal steering was used in 28 leads (18%) to explore better stimulation effect for cardinal symptoms of PD. In addition, vertical steering was used for improving dyskinesia in 40 leads (25%) and alleviating tremor in 5 leads (3%). Horizontal steering was also used for avoiding adverse effects in 15 leads (9%), most of which were used to alleviate the symptoms of excessive stimulation of pyramidal tract.</p></div><div><h3>Conclusions</h3><p>Current steering with the MICC directional lead was actually utilized in STN-DBS to explore more precise control of motor symptoms and also useful to avoid stimulation-induced adverse effect. Current steering is especially used in the later period after introduction of DBS.</p></div>","PeriodicalId":100359,"journal":{"name":"Deep Brain Stimulation","volume":"1 ","pages":"Pages 20-25"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49749809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gender disparities in deep brain stimulation surgery for Parkinson disease and essential tremor","authors":"Lisa M. Deuel ,&nbsp;Ryan Peterson ,&nbsp;Stefan Sillau ,&nbsp;Allison W. Willis ,&nbsp;Cherry Yu ,&nbsp;Drew S. Kern ,&nbsp;Michelle Fullard","doi":"10.1016/j.jdbs.2023.04.001","DOIUrl":"https://doi.org/10.1016/j.jdbs.2023.04.001","url":null,"abstract":"<div><h3>Background</h3><p>Women with Parkinson’s Disease (PD) receive Deep Brain Stimulation (DBS) less often than men.</p></div><div><h3>Objective</h3><p>To determine gender differences in the use of DBS for PD and essential tremor (ET) in the United States and at a single academic center.</p></div><div><h3>Methods</h3><p>The Nationwide Readmissions Database (NRD) was used to identify patients with PD and ET who underwent DBS from 2016 to 2017. The primary outcome was a comparison of the proportions of women and men who underwent DBS using chi-square tests. Locally, we identified patients with PD and ET referred for DBS from 2011 to 2020. The primary outcomes included a comparison of the proportions of women and men who were referred, completed the evaluation, were approved for surgery, and underwent DBS using Fisher’s exact tests.</p></div><div><h3>Results</h3><p>From 2016–2017, 6952 patients with PD (30.5% women) and 3000 patients with ET (42.6% women) underwent DBS in the United States. At a single academic center, 428 patients with PD (30.6% women) and 126 patients with ET (34% women) were referred for DBS, which was significantly different than the proportion of women with PD and ET in the neurology clinic population (p = 0.001 and p &lt; 0.001, respectively). In both groups, women and men were equally likely to complete the evaluation and be approved for surgery; however, women with ET were more likely to decline surgery (35% vs 13%, p = 0.05).</p></div><div><h3>Conclusion</h3><p>Women with PD and ET were less likely to be referred for DBS evaluation, and women with ET were more likely to decline surgery once approved.</p></div>","PeriodicalId":100359,"journal":{"name":"Deep Brain Stimulation","volume":"1 ","pages":"Pages 26-33"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49749812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Symptom optimization through sensing local field potentials: Balancing beta and gamma in Parkinson's disease","authors":"Okeanis E. Vaou ,&nbsp;Matthew D. Spidi ,&nbsp;Robert Raike ,&nbsp;Amanda Moises ,&nbsp;Scott Stanslaski ,&nbsp;Michelle Case ,&nbsp;Anna Hohler","doi":"10.1016/j.jdbs.2023.01.001","DOIUrl":"https://doi.org/10.1016/j.jdbs.2023.01.001","url":null,"abstract":"<div><p>Deep brain stimulation (DBS) is an important clinical therapeutic tool to control motor symptoms of Parkinson’s disease (PD) for many patients whose symptoms are not well controlled by medication alone (Malek, 2019 [1]). DBS therapy involves the delivery of an electrical current through an electrode that is surgically placed in the brain, traditionally in the subthalamic nucleus (STN) or globus pallidus internus (GPi). Recent technology has allowed these devices to not only deliver an electrical current, but also measure local field potentials (LFPs). LFPs are electrical potentials, produced by the activation of neurons, that act as markers for the frequency and severity of specific motor symptoms in PD (Neumann et al., 2017 [2], Swann et al., 2016 [3]). These markers can give insight into the efficacy of a given treatment regiment, by providing data to use as clinical benchmarks for the treatment team. The utility of LFPs in the treatment of PD is illustrated in this case series of three patients with complex motor fluctuations such as dyskinesias, Levodopa wearing-off and muscle rigidity. Here we demonstrate how we used LFP sensing through Timeline, Streaming and Event Capture to gain insight to the patients’ symptoms and offer data driven therapy optimization. The first case is a 72-year-old y/o female patient with PD, who presented with severe dyskinesias and motor fluctuations. By monitoring real-time LFPs, the treatment team was able to identify significant dyskinesias and optimize medication and stimulation frequency, which led to more personalized and efficacious treatment. The second case is a 66 y/o male patient with PD, hoping to achieve more on time without troublesome dyskinesias. Using chronic LFP data the treatment team was able to adjust therapy amplitude and pulse width to better manage the patient’s symptoms. In addition, the LFP data was used to educate the patient on when the patient programmer could be used situationally for changing programming groups. The third case is a 65 y/o male patient with a ten-year history of PD, experiencing abrupt and unpredictable medication wearing off times and severe dyskinesias, which compromised gait and activities of daily living. Real time and chronic LFP sensing supported the optimization of his stimulation amplitude and pulse width and medication regimen, ultimately decreasing his fluctuations and greatly improving his gait and quality of life.</p></div>","PeriodicalId":100359,"journal":{"name":"Deep Brain Stimulation","volume":"1 ","pages":"Pages 5-14"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49749483","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}