Optimal Closed-loop Deep Brain Stimulation with Multi-Contact Electrodes

Abstract

Deep brain stimulation (DBS) is a well-established treatment option for a variety of neurological disorders, including Parkinsons disease (PD) and essential tremor (ET). It is widely believed that the efficacy, efficiency and side-effects of the treatment can be improved by stimulating closed-loop, according to the symptoms of a patient. Multi-contact electrodes powered by independent current sources are a recent development in DBS technology which allow for greater precision when targeting one or more pathological regions but, in order to realise the potential of such systems, algorithms must be developed to deal with their increased complexity. This motivates the need to understand how applying DBS to multiple regions (or neural populations) can affect the efficacy and efficiency of the treatment. On the basis of a theoretical model, our paper aims to address the question of how to best apply DBS to multiple neural populations to maximally desynchronise brain activity. Using a coupled oscillator model, we derive analytical expressions which predict how the symptom severity should change as a result of applying stimulation. On the basis of these expressions we derive an algorithm describing when the stimulation should be delivered to individual contacts. Remarkably, these expressions also allow us to determine the conditions for when stimulation using information from individual contacts is likely to be advantageous. Using numerical simulation, we demonstrate that our methods have the potential to be both more effective and efficient than existing methods found in the literature.