Perspectives of Implementation of Closed-Loop Deep Brain Stimulation: From Neurological to Psychiatric Disorders
Sergiu Groppa, Gabriel González‐Escamilla, Gerd Tinkhauser, Halim Ibrahim Baqapuri, Bastian Sajonz, Christoph Wiest, Joana B. Pereira, Damian M. Herz, Matthias Dold, Manuel Bange, Dumitru Ciolac, Viviane Almeida, John Neuber, Daniela Mîrzac, Juan Francisco Martin‐Rodríguez, Christian Dresel, Muthuraman Muthuraman, Astrid D. Adarmes Gomez, Marta Navas, Gizem Temiz, Aysegul Gunduz, Lilia Rotaru, Yaroslav Winter, Rick Schuurman, Maria Fiorella Contarino, Martin Gläser, Michael Tangermann, Albert F.G. Leentjens, Pablo Mir, Cristina V. Torres, Carine Karachi, David E.J. Linden, Huiling Tan, Volker A. Coenen, on behalf of the EuroDBS
Abstract
BACKGROUND: Deep brain stimulation (DBS) is a highly efficient, evidence-based therapy to alleviate symptoms and improve quality of life in movement disorders such as Parkinson's disease, essential tremor, and dystonia, which is also being applied in several psychiatric disorders, such as obsessive-compulsive disorder and depression, when they are otherwise resistant to therapy. SUMMARY: At present, DBS is clinically applied in the so-called open-loop approach, with fixed stimulation parameters, irrespective of the patients' clinical state(s). This approach ignores the brain states or feedback from the central nervous system or peripheral recordings, thus potentially limiting its efficacy and inducing side effects by stimulation of the targeted networks below or above the therapeutic level. KEY MESSAGES: The currently emerging closed-loop (CL) approaches are designed to adapt stimulation parameters to the electrophysiological surrogates of disease symptoms and states. CL-DBS paves the way for adaptive personalized DBS protocols. This review elaborates on the perspectives of the CL technology and discusses its opportunities as well as its potential pitfalls for both clinical and research use in neuropsychiatric disorders.