Toward On-Demand Deep Brain Stimulation Using Online Parkinson's Disease Prediction Driven by Dynamic Detection.

In Parkinson's disease (PD), on-demand deep brain stimulation is required so that stimulation is regulated to reduce side effects resulting from continuous stimulation and PD exacerbation due to untimely stimulation. Also, the progressive nature of PD necessitates the use of dynamic detection schemes that can track the nonlinearities in PD. This paper proposes the use of dynamic feature extraction and dynamic pattern classification to achieve dynamic PD detection taking into account the demand for high accuracy, low computation, and real-time detection. The dynamic feature extraction and dynamic pattern classification are selected by evaluating a subset of feature extraction, dimensionality reduction, and classification algorithms that have been used in brain-machine interfaces. A novel dimensionality reduction technique, the maximum ratio method (MRM) is proposed, which provides the most efficient performance. In terms of accuracy and complexity for hardware implementation, a combination having discrete wavelet transform for feature extraction, MRM for dimensionality reduction, and dynamic k-nearest neighbor for classification was chosen as the most efficient. It achieves a classification accuracy of 99.29%, an F1-score of 97.90%, and a choice probability of 99.86%.

A decade of experience with deep brain stimulation for patients with refractory medial temporal lobe epilepsy.

In this study, we present long-term results from patients with medial temporal lobe (MTL) epilepsy treated with deep brain stimulation (DBS). Since 2001, 11 patients (8M) with refractory MTL epilepsy underwent MTL DBS. When unilateral DBS failed to decrease seizures by > 90%, a switch to bilateral MTL DBS was proposed. After a mean follow-up of 8.5 years (range: 67-120 months), 6/11 patients had a ≥ 90% seizure frequency reduction with 3/6 seizure-free for > 3 years; three patients had a 40%-70% reduction and two had a < 30% reduction. In 3/5 patients switching to bilateral DBS further improved outcome. Uni- or bilateral MTL DBS did not affect neuropsychological functioning. This open study with an extended long-term follow-up demonstrates maintained efficacy of DBS for MTL epilepsy. In more than half of the patients, a seizure frequency reduction of at least 90% was reached. Bilateral MTL DBS may herald superior efficacy in unilateral MTL epilepsy.