# Scalar Closed-Loop STN/GPi DBS Based on Evoked and Spontaneous Potentials

> **NIH NIH UH3** · DUKE UNIVERSITY · 2020 · $542,035

## Abstract

Abstract
DBS therapy for Parkinson's disease is now the primary surgical approach for Parkinson's disease, recently
FDA approved at 4 years after onset of disease. However, this therapy is still limited to treatment of a subset
of motor symptoms (ie, tremor, rigidity, bradykinesia and dyskinesias) and requires considerable postoperative
clinical adjustment to program and maintain function. A number of improvements to DBS for PD are being
tested, including changes in patterns of stimulation and specific targets. However, a major new approach
involves internal parameter adjustment using a surrogate physiological marker of clinical symptoms, useful for
confirming initial electrode placement, programming, and also long-term optimization of parameters. Several
research systems have been suggested and are in testing for development of closed loop systems, including
systems based on recording beta-band oscillations. Closed loop control involving recording a surrogate signal
relevant to PD could improve DBS therapy on several time scales, including short-term dynamics (ie, over
minutes), initial programming (over weeks to months), and long-term, depending on the time course of
response to STN DBS. In addition to spontaneous beta band recording we have also implemented direct
evoked potential recording using the stimulating DBS electrode, requiring suppression of the DBS-induced
artifact. These intraoperative DBS recordings during STN DBS implants have revealed a complex evoked
potential likely reflecting GPe/GPi activation, which may provide an excellent surrogate marker. This complex
evoked potential changes over a short-term time period as the treatment effect of STN DBS comes on,
indicating that the evoked potential likely reflects DBS effects on a larger motor circuit as the circuit
dynamically is altered to an improved state. We hypothesize that this surrogate marker (in addition to beta
band oscillations) may provide a key feedback signal for scalar, graded (proportional) closed loop DBS control,
highly relevant to DBS effects on PD circuitry. To test this hypothesis we will perform long-term recording of
this signal from humans (in either STN or GPe/GPi) together with DBS stimulation (in STN and/or GPi), using a
novel DBS recording/stimulation device (Medtronics RC+S).
These clinical experiments will focus on a small, pilot clinical study (n = 6 patients) to implant bilateral STN +
GPe/GPi DBS electrodes in Parkinson's patients eligible for DBS using conventional stereotactic localization,
connecting to Medtronics RC+S IPGs. Patients will benefit from either ordinary STN or GPi DBS stimulation
and then we will also test the possibility of synergism between the two electrodes for clinical efficacy.
Additionally, we will analyze the motor efficacy of both an external (using recording and modifying the
parameters manually) and internal (using an algorithm for providing parameters automatically) scalar, closed
loop response to these recorded surrogate...

## Key facts

- **NIH application ID:** 9987737
- **Project number:** 5UH3NS103468-03
- **Recipient organization:** DUKE UNIVERSITY
- **Principal Investigator:** DENNIS Alan TURNER
- **Activity code:** UH3 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $542,035
- **Award type:** 5
- **Project period:** 2017-09-15 → 2022-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9987737

## Citation

> US National Institutes of Health, RePORTER application 9987737, Scalar Closed-Loop STN/GPi DBS Based on Evoked and Spontaneous Potentials (5UH3NS103468-03). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/9987737. Licensed CC0.

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