PMID- 35234664
OWN - NLM
STAT- MEDLINE
DCOM- 20220401
LR  - 20230429
IS  - 1741-2552 (Electronic)
IS  - 1741-2560 (Print)
IS  - 1741-2552 (Linking)
VI  - 19
IP  - 2
DP  - 2022 Mar 31
TI  - Concurrent stimulation and sensing in bi-directional brain interfaces: a 
      multi-site translational experience.
LID - 10.1088/1741-2552/ac59a3 [doi]
AB  - Objective. To provide a design analysis and guidance framework for the 
      implementation of concurrent stimulation and sensing during adaptive deep brain 
      stimulation (aDBS) with particular emphasis on artifact mitigations.Approach. We 
      defined a general architecture of feedback-enabled devices, identified key 
      components in the signal chain which might result in unwanted artifacts and 
      proposed methods that might ultimately enable improved aDBS therapies. We 
      gathered data from research subjects chronically-implanted with an 
      investigational aDBS system, Summit RC + S, to characterize and explore artifact 
      mitigations arising from concurrent stimulation and sensing. We then used a 
      prototype investigational implantable device, DyNeuMo, and a bench-setup that 
      accounts for tissue-electrode properties, to confirm our observations and verify 
      mitigations. The strategies to reduce transient stimulation artifacts and improve 
      performance during aDBS were confirmed in a chronic implant using updated 
      configuration settings.Main results.We derived and validated a 'checklist' of 
      configuration settings to improve system performance and areas for future device 
      improvement. Key considerations for the configuration include (a) active instead 
      of passive recharge, (b) sense-channel blanking in the amplifier, (c) high-pass 
      filter settings, (d) tissue-electrode impedance mismatch management, (e) 
      time-frequency trade-offs in the classifier, (f) algorithm blanking and 
      transition rate limits. Without proper channel configuration, the aDBS algorithm 
      was susceptible to limit-cycles of oscillating stimulation independent of 
      physiological state. By applying the checklist, we could optimize each block's 
      performance characteristics within the overall system. With system-level 
      optimization, a 'fast' aDBS prototype algorithm was demonstrated to be feasible 
      without reentrant loops, and with noise performance suitable for subcortical 
      brain circuits.Significance. We present a framework to study sources and propose 
      mitigations of artifacts in devices that provide chronic aDBS. This work 
      highlights the trade-offs in performance as novel sensing devices translate to 
      the clinic. Finding the appropriate balance of constraints is imperative for 
      successful translation of aDBS therapies.Clinical trial:Institutional Review 
      Board and Investigational Device Exemption numbers: NCT02649166/IRB201501021 
      (University of Florida), NCT04043403/IRB52548 (Stanford University), 
      NCT03582891/IRB1824454 (University of California San Francisco). IDE #180 097.
CI  - Creative Commons Attribution license.
FAU - Anso, Juan
AU  - Anso J
AUID- ORCID: 0000-0001-9127-0396
AD  - Department of Neurological Surgery, University of California, San Francisco, CA, 
      United States of America.
FAU - Benjaber, Moaad
AU  - Benjaber M
AUID- ORCID: 0000-0002-0506-2337
AD  - MRC Brain Network Dynamics Unit, Nuffield Department of Clinical Neurosciences, 
      University of Oxford, Oxford, United Kingdom.
FAU - Parks, Brandon
AU  - Parks B
AUID- ORCID: 0000-0002-1317-5358
AD  - Department of Electrical and Computer Engineering, University of Florida, 
      Gainesville, FL, United States of America.
FAU - Parker, Samuel
AU  - Parker S
AD  - School of Engineering and Carney Institute, Brown University, Providence, RI, 
      United States of America.
FAU - Oehrn, Carina Renate
AU  - Oehrn CR
AD  - Department of Neurological Surgery, University of California, San Francisco, CA, 
      United States of America.
FAU - Petrucci, Matthew
AU  - Petrucci M
AD  - Department of Neurology and Neurological Sciences, Stanford University School of 
      Medicine, Stanford, CA, United States of America.
FAU - Gilron, Ro'ee
AU  - Gilron R
AUID- ORCID: 0000-0001-8761-5654
AD  - Department of Neurological Surgery, University of California, San Francisco, CA, 
      United States of America.
FAU - Little, Simon
AU  - Little S
AD  - Department of Neurology, University of California San Francisco, San Francisco, 
      CA, United States of America.
FAU - Wilt, Robert
AU  - Wilt R
AD  - Department of Neurological Surgery, University of California, San Francisco, CA, 
      United States of America.
FAU - Bronte-Stewart, Helen
AU  - Bronte-Stewart H
AD  - Department of Neurology and Neurological Sciences, Stanford University School of 
      Medicine, Stanford, CA, United States of America.
FAU - Gunduz, Aysegul
AU  - Gunduz A
AD  - Department of Biomedical Engineering, University of Florida, Gainesville, FL, 
      United States of America.
FAU - Borton, David
AU  - Borton D
AUID- ORCID: 0000-0003-0710-3005
AD  - School of Engineering and Carney Institute, Brown University, Providence, RI, 
      United States of America.
FAU - Starr, Philip A
AU  - Starr PA
AD  - Department of Neurological Surgery, University of California, San Francisco, CA, 
      United States of America.
FAU - Denison, Timothy
AU  - Denison T
AD  - Institute of Biomedical Engineering, Department of Engineering Science, 
      University of Oxford, Oxford, United Kingdom.
LA  - eng
GR  - R01 NS096008/NS/NINDS NIH HHS/United States
GR  - T32 HD043730/HD/NICHD NIH HHS/United States
GR  - U24 NS113637/NS/NINDS NIH HHS/United States
GR  - K23 NS120037/NS/NINDS NIH HHS/United States
GR  - S10 OD025181/OD/NIH HHS/United States
GR  - UH3 NS100544/NS/NINDS NIH HHS/United States
GR  - UH3 NS107709/NS/NINDS NIH HHS/United States
GR  - UH3 NS095553/NS/NINDS NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
PT  - Research Support, Non-U.S. Gov't
DEP - 20220331
PL  - England
TA  - J Neural Eng
JT  - Journal of neural engineering
JID - 101217933
SB  - IM
MH  - Algorithms
MH  - Brain
MH  - *Deep Brain Stimulation/methods
MH  - Feedback
MH  - Humans
PMC - PMC9095704
MID - NIHMS1794307
OTO - NOTNLM
OT  - adaptive deep brain stimulation
OT  - algorithms
OT  - artifacts
OT  - chronic implant
OT  - closed loop
OT  - embedded
OT  - neural sensing
COIS- Conflict of interest JA and RG have worked for Rune Labs Inc. since September 
      2021. SL is a scientific advisor to Rune Labs Inc. and has received reimbursement 
      for educational activities for Medtronic. Bronte-Stewart serves on a clinical 
      advisory board for Medtronic PLC. TD has received funding for educational 
      activities by Medtronic PLC, has stock ownership in Bioinduction Ltd and Amber 
      Therapeutics, has consulted with Synchron, Cortec Neuro, and Amber Therapeutics.
EDAT- 2022/03/03 06:00
MHDA- 2022/04/02 06:00
PMCR- 2023/03/31
CRDT- 2022/03/02 12:18
PHST- 2021/11/30 00:00 [received]
PHST- 2022/03/01 00:00 [accepted]
PHST- 2022/03/03 06:00 [pubmed]
PHST- 2022/04/02 06:00 [medline]
PHST- 2022/03/02 12:18 [entrez]
PHST- 2023/03/31 00:00 [pmc-release]
AID - 10.1088/1741-2552/ac59a3 [doi]
PST - epublish
SO  - J Neural Eng. 2022 Mar 31;19(2):10.1088/1741-2552/ac59a3. doi: 
      10.1088/1741-2552/ac59a3.