Chronic adaptive deep brain stimulation versus conventional stimulation in Parkinson's disease: a blinded randomized feasibility trial.

Deep brain stimulation (DBS) is a widely used therapy for Parkinson's disease (PD) but lacks dynamic responsiveness to changing clinical and neural states. Feedback control might improve therapeutic effectiveness, but the optimal control strategy and additional benefits of 'adaptive' neurostimulation are unclear. Here we present the results of a blinded randomized cross-over pilot trial aimed at determining the neural correlates of specific motor signs in individuals with PD and the feasibility of using these signals to drive adaptive DBS. Four male patients with PD were recruited from a population undergoing DBS implantation for motor fluctuations, with each patient receiving adaptive DBS and continuous DBS. We identified stimulation-entrained gamma oscillations in the subthalamic nucleus or motor cortex as optimal markers of high versus low dopaminergic states and their associated residual motor signs in all four patients. We then demonstrated improved motor symptoms and quality of life with adaptive compared to clinically optimized standard stimulation. The results of this pilot trial highlight the promise of personalized adaptive neurostimulation in PD based on data-driven selection of neural signals. Furthermore, these findings provide the foundation for further larger clinical trials to evaluate the efficacy of personalized adaptive neurostimulation in PD and other neurological disorders. ClinicalTrials.gov registration: NCT03582891 .

Personalized chronic adaptive deep brain stimulation outperforms conventional stimulation in Parkinson's disease.

Deep brain stimulation is a widely used therapy for Parkinson's disease (PD) but currently lacks dynamic responsiveness to changing clinical and neural states. Feedback control has the potential to improve therapeutic effectiveness, but optimal control strategy and additional benefits of "adaptive" neurostimulation are unclear. We implemented adaptive subthalamic nucleus stimulation, controlled by subthalamic or cortical signals, in three PD patients (five hemispheres) during normal daily life. We identified neurophysiological biomarkers of residual motor fluctuations using data-driven analyses of field potentials over a wide frequency range and varying stimulation amplitudes. Narrowband gamma oscillations (65-70 Hz) at either site emerged as the best control signal for sensing during stimulation. A blinded, randomized trial demonstrated improved motor symptoms and quality of life compared to clinically optimized standard stimulation. Our approach highlights the promise of personalized adaptive neurostimulation based on data-driven selection of control signals and may be applied to other neurological disorders.

A multimodal deep learning system to distinguish late stages of AMD and to compare expert vs. AI ocular biomarkers.

Within the next 1.5 decades, 1 in 7 U.S. adults is anticipated to suffer from age-related macular degeneration (AMD), a degenerative retinal disease which leads to blindness if untreated. Optical coherence tomography angiography (OCTA) has become a prime technique for AMD diagnosis, specifically for late-stage neovascular (NV) AMD. Such technologies generate massive amounts of data, challenging to parse by experts alone, transforming artificial intelligence into a valuable partner. We describe a deep learning (DL) approach which achieves multi-class detection of non-AMD vs. non-neovascular (NNV) AMD vs. NV AMD from a combination of OCTA, OCT structure, 2D b-scan flow images, and high definition (HD) 5-line b-scan cubes; DL also detects ocular biomarkers indicative of AMD risk. Multimodal data were used as input to 2D-3D Convolutional Neural Networks (CNNs). Both for CNNs and experts, choroidal neovascularization and geographic atrophy were found to be important biomarkers for AMD. CNNs predict biomarkers with accuracy up to 90.2% (positive-predictive-value up to 75.8%). Just as experts rely on multimodal data to diagnose AMD, CNNs also performed best when trained on multiple inputs combined. Detection of AMD and its biomarkers from OCTA data via CNNs has tremendous potential to expedite screening of early and late-stage AMD patients.

Ballistocardiogram Artifact Reduction in Simultaneous EEG-fMRI Using Deep Learning.

OBJECTIVE: The concurrent recording of electroencephalography (EEG) and functional magnetic resonance imaging (fMRI) is a technique that has received much attention due to its potential for combined high temporal and spatial resolution. However, the ballistocardiogram (BCG), a large-amplitude artifact caused by cardiac induced movement contaminates the EEG during EEG-fMRI recordings. Removal of BCG in software has generally made use of linear decompositions of the corrupted EEG. This is not ideal as the BCG signal propagates in a manner which is non-linearly dependent on the electrocardiogram (ECG). In this paper, we present a novel method for BCG artifact suppression using recurrent neural networks (RNNs). METHODS: EEG signals were recovered by training RNNs on the nonlinear mappings between ECG and the BCG corrupted EEG. We evaluated our model's performance against the commonly used Optimal Basis Set (OBS) method at the level of individual subjects, and investigated generalization across subjects. RESULTS: We show that our algorithm can generate larger average power reduction of the BCG at critical frequencies, while simultaneously improving task relevant EEG based classification. CONCLUSION: The presented deep learning architecture can be used to reduce BCG related artifacts in EEG-fMRI recordings. SIGNIFICANCE: We present a deep learning approach that can be used to suppress the BCG artifact in EEG-fMRI without the use of additional hardware. This method may have scope to be combined with current hardware methods, operate in real-time and be used for direct modeling of the BCG.