Personalized medicine in deep brain stimulation through utilization of neural oscillations
A Wagle Shukla, MS Okun - Neurology, 2012 - AAN Enterprises
A Wagle Shukla, MS Okun
Neurology, 2012•AAN EnterprisesThe neural underpinnings for normal and abnormal basal ganglia functions and functional
connectivities remain unknown, although several important pieces to the puzzle have
emerged over 3 decades. First was the identification of segregated basal ganglia circuits. 1
This discovery was closely paralleled by the realization that these circuits communicated
through the use of a special physiologic language, 2 which proved to be more complex than
initially thought, as it was not the simple firing rate of neurons, but rather specific patterns of …
connectivities remain unknown, although several important pieces to the puzzle have
emerged over 3 decades. First was the identification of segregated basal ganglia circuits. 1
This discovery was closely paralleled by the realization that these circuits communicated
through the use of a special physiologic language, 2 which proved to be more complex than
initially thought, as it was not the simple firing rate of neurons, but rather specific patterns of …
The neural underpinnings for normal and abnormal basal ganglia functions and functional connectivities remain unknown, although several important pieces to the puzzle have emerged over 3 decades. First was the identification of segregated basal ganglia circuits. 1 This discovery was closely paralleled by the realization that these circuits communicated through the use of a special physiologic language, 2 which proved to be more complex than initially thought, as it was not the simple firing rate of neurons, but rather specific patterns of oscillatory neuronal discharges that were important. 3 The most recent realization is the oscillation model, according to which the oscillatory neuronal discharges in specific frequency bands dictate specific motor behaviors. 4 In Parkinson disease, increased endogenous frequencies in the(4–10 Hz) and(11–30 Hz) bands recorded from the subthalamic nucleus (STN) region are associated with worsening of motor symptoms. These bands have been referred to as antikinetic or bad frequency bands. In contrast, frequencies (31–100 Hz) are associated with motor improvements, and are referred to as prokinetic, or good frequency bands. 5 Complicating the picture, the peak frequencies in each of the 3 bands recorded from the STN region may vary widely among persons. 6 Tsang and colleagues, 7 in this issue of Neurology®, ask whether these specific oscillatory frequencies could be utilized to tailor a personalized approach to STN deep brain stimulation (DBS).
The current clinical practice of DBS is empirical, and utilizes a high-frequency 100 Hz signal for therapeutic stimulation of the STN region. 8 According to the oscillation model, therapeutic STN DBS in the (31–100 Hz) frequency band should artificially drive a prokinetic circuit. Stimulation in (4–10 Hz) and (11–30 Hz) bands should worsen the motor response. These stimulation effects could possibly be more robust if STN DBS was delivered at specific frequencies that were individualized for specific patients and specific symptoms. In this proof of
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