1. Deep brain stimulation evoked resonant neural activity
- Author
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Sinclair, Nicholas Campbell and Sinclair, Nicholas Campbell
- Abstract
Deep brain stimulation (DBS) involves surgically implanting electrodes within targeted subcortical structures and applying chronic electrical stimulation to produce therapeutic effects. DBS has utility for a range of movement and psychiatric disorders, with DBS of the subthalamic nucleus (STN) for the treatment of Parkinson’s disease a common application. Although DBS can be remarkably effective, several challenges can limit its application and efficacy, including 1) the target neural structures are very small and challenging to accurately implant with electrodes; 2) DBS implantation surgery commonly requires the patient to be awake; 3) selection of beneficial stimulation parameters for chronic therapy is a laborious manual process prone to suboptimal outcomes; 4) chronic therapy is applied constantly regardless of the patient’s present therapeutic needs; and 5) the mechanisms of action of DBS are yet to be fully elucidated. Electrophysiological feedback signals may provide the means for addressing these challenges. A signal localised to the target neural structure could be used like a homing beacon to guide electrode implantation and configuration for chronic therapy. Furthermore, if the signal was measurable under general anaesthesia, it could be used to guide implantation in unconscious patients. A signal that varies with patient symptomatic state and the application of DBS could also guide selection of stimulation parameters, inform on mechanisms of action, and act as a feedback signal for monitoring patient state in real-time and automatically adapting stimulation settings to optimise therapy. This thesis identifies a novel evoked potential – termed evoked resonant neural activity (ERNA) – elicited by DBS pulses applied in the vicinity of the STN and investigates its potential for improving DBS therapy. ERNA is confirmed to be of neural origin and is shown to have largest amplitude in the dorsal subregion of the STN, where DBS for Parkinson’s disease is typical
- Published
- 2023