Advancements and advantages of adaptive DBS

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Hagai Bergman
The Hebrew University – Hadassah Medical School and the Edmond and Lily Safra Center (ELSC) for Brain Research, Jerusalem, ISRAEL

The basal ganglia (BG) use actor/critic architecture that enables multi-objective optimization of behavioural policy. The dopamine neurons (and other BG modulators, critics) encode the mismatch between prediction and reality; whereas the BG main axis (actor) provides the connection between state and action. In Parkinson’s disease and other basal ganglia related disorders (e.g., addiction), disordered activity of the BG critics leads to abnormal synchronized oscillations along the BG main axis and motor and non-motor clinical symptoms.
We have recently shown that in the non-human primate MPTP model of Parkinson’s disease, the basal ganglia can be observed and controlled, and that adaptive deep brain stimulation (DBS) is superior to open-loop DBS. Other groups have reported promising results of adaptive DBS in human patients with advanced Parkinson’s disease.
We therefore believe that in the near future DBS systems will use multi-level and telemetry (home) sensing devices, multi-contact and multi-source actuators, connected by multi-objective, optimal, adaptive machine-learning control algorithms to enable better treatment of full spectrum of basal ganglia related disorders.