Adaptive Deep Brain Stimulation for Parkinson’s Disease and Dystonia

Deep brain stimulation (DBS) is a neurosurgical treatment, in which electrodes are implanted in deep regions of the brain. This procedure can be used to treat patients with movement disorders, such as Parkinson’s disease (PD) and dystonia. The implanted electrodes deliver electrical pulses, that help to control the main disease symptoms. Until recently, stimulation could only be continuously applied, without taking into account daily symptom fluctuations.Adaptive DBS (aDBS) is an upgrade of this treatment. With aDBS, the stimulation delivered is regulated (in real time), based on the severity of symptoms. To indicate when and how stimulation should be delivered, brain oscillations are used as feedback signal. These oscillations are able to reflect the clinical state of the patients. By dynamically adjusting the stimulation according to the needs of each patient, aDBS might be able to provide a better symptom control. In addition to this, aDBS could prevent the occurrence of side effects caused by excessive stimulation. This thesis investigates the intraoperative efficacy of aDBS in patients with PD and dystonia at the University Medical Center Groningen, The Netherlands. The first part of this thesis describes the characteristics of the signals that can be used to estimate the severity of symptoms in these patients. The second and third parts of the thesis evaluate the immediate effects of aDBS in patients with PD and dystonia, respectively. The main conclusions are that aDBS is effective for PD, and feasible for dystonia. This opens the possibility to further investigate aDBS outside the hospital