Responsive neurostimulation device
{{short description|Category of medical devices that respond to signals in a patient's body to treat disease}}
Responsive neurostimulation device is a medical device that senses changes in a person's body and uses neurostimulation to respond in the treatment of disease. The FDA has approved devices for use in the United States in the treatment of epileptic seizures{{Cite journal |last=Geller |first=Eric B. |date=2018-11-01 |title=Responsive neurostimulation: Review of clinical trials and insights into focal epilepsy |url=https://www.epilepsybehavior.com/article/S1525-5050(18)30499-2/abstract |journal=Epilepsy & Behavior |language=English |volume=88 |pages=11–20 |doi=10.1016/j.yebeh.2018.06.042 |issn=1525-5050 |pmid=30243756|s2cid=52341485 |url-access=subscription }} and chronic pain{{Cite journal |last1=Kim |first1=Eun kyoung |last2=Lee |first2=Chang-soon |last3=Yoo |first3=Yongjae |last4=Park |first4=Jin-Woo |last5=Kim |first5=Jung Soo |last6=Kim |first6=Youngwon |last7=Moon |first7=Jee Youn |last8=Kim |first8=Yong-Chul |date=2020-03-13 |title=The Long-term Effectiveness of the Automatic Position-Adaptive System in Spinal Cord Stimulation: A Retrospective Comparative Study with a Two-Year Follow-up |url=https://doi.org/10.1093/pm/pnaa121 |journal=Pain Medicine |volume=21 |issue=10 |pages=2288–2297 |doi=10.1093/pm/pnaa121 |pmid=32443142 |issn=1526-2375|url-access=subscription }} conditions. Devices are being studied for use in the treatment of essential tremor,{{Cite journal |last1=Castaño-Candamil |first1=Sebastián |last2=Ferleger |first2=Benjamin I. |last3=Haddock |first3=Andrew |last4=Cooper |first4=Sarah S. |last5=Herron |first5=Jeffrey |last6=Ko |first6=Andrew |last7=Chizeck |first7=Howard J. |last8=Tangermann |first8=Michael |date=2020 |title=A Pilot Study on Data-Driven Adaptive Deep Brain Stimulation in Chronically Implanted Essential Tremor Patients |journal=Frontiers in Human Neuroscience |volume=14 |pages=541625 |doi=10.3389/fnhum.2020.541625 |issn=1662-5161 |pmc=7674800 |pmid=33250727|doi-access=free }} Parkinson's disease,{{Cite journal |last1=Arlotti |first1=Mattia |last2=Colombo |first2=Matteo |last3=Bonfanti |first3=Andrea |last4=Mandat |first4=Tomasz |last5=Lanotte |first5=Michele Maria |last6=Pirola |first6=Elena |last7=Borellini |first7=Linda |last8=Rampini |first8=Paolo |last9=Eleopra |first9=Roberto |last10=Rinaldo |first10=Sara |last11=Romito |first11=Luigi |last12=Janssen |first12=Marcus L. F. |last13=Priori |first13=Alberto |last14=Marceglia |first14=Sara |date=2021-12-07 |title=A New Implantable Closed-Loop Clinical Neural Interface: First Application in Parkinson's Disease |journal=Frontiers in Neuroscience |volume=15 |pages=763235 |doi=10.3389/fnins.2021.763235 |issn=1662-4548 |pmc=8689059 |pmid=34949982|doi-access=free }} Tourette's syndrome,{{Cite journal |last1=Molina |first1=Rene |last2=Okun |first2=Michael S. |last3=Shute |first3=Jonathan B. |last4=Opri |first4=Enrico |last5=Rossi |first5=P. Justin |last6=Martinez-Ramirez |first6=Daniel |last7=Foote |first7=Kelly D. |last8=Gunduz |first8=Aysegul |date=2017-09-17 |title=Report of a patient undergoing chronic responsive deep brain stimulation for Tourette syndrome: proof of concept |journal=Journal of Neurosurgery |volume=129 |issue=2 |pages=308–314 |doi=10.3171/2017.6.JNS17626 |issn=0022-3085 |pmc=7007215 |pmid=28960154}} depression,{{Cite journal |last1=Scangos |first1=Katherine W. |last2=Makhoul |first2=Ghassan S. |last3=Sugrue |first3=Leo P. |last4=Chang |first4=Edward F. |last5=Krystal |first5=Andrew D. |date=2021-01-18 |title=State-dependent responses to intracranial brain stimulation in a patient with depression |journal=Nature Medicine |language=en |volume=27 |issue=2 |pages=229–231 |doi=10.1038/s41591-020-01175-8 |issn=1546-170X |pmc=8284979 |pmid=33462446}} obesity,{{Cite journal |last1=Formolo |first1=Douglas A. |last2=Gaspar |first2=Joana M. |last3=Melo |first3=Hiago M. |last4=Eichwald |first4=Tuany |last5=Zepeda |first5=Ramiro Javier |last6=Latini |first6=Alexandra |last7=Okun |first7=Michael S. |last8=Walz |first8=Roger |date=2019 |title=Deep Brain Stimulation for Obesity: A Review and Future Directions |journal=Frontiers in Neuroscience |volume=13 |page=323 |doi=10.3389/fnins.2019.00323 |issn=1662-453X |pmc=6482165 |pmid=31057350|doi-access=free }} and post-traumatic stress disorder.{{Cite journal |last1=Bina |first1=Robert W. |last2=Langevin |first2=Jean-Phillipe |date=2018 |title=Closed Loop Deep Brain Stimulation for PTSD, Addiction, and Disorders of Affective Facial Interpretation: Review and Discussion of Potential Biomarkers and Stimulation Paradigms |journal=Frontiers in Neuroscience |volume=12 |page=300 |doi=10.3389/fnins.2018.00300 |issn=1662-453X |pmc=5945819 |pmid=29780303|doi-access=free }}
Medical uses
= Epilepsy =
The use of neurostimulation to treat epileptic seizures is only recommended in those who have failed multiple medications for the treatment of their seizures. The NeuroPace RNS system was approved for use by the FDA in 2013 and is the only medical device for epilepsy that uses responsive neurostimulation. The device is surgically implanted into the patient's head with electrical leads placed near the site in the brain that is believed to be the origin of the patient's seizures. These leads record electrical activity in the brain and deliver electrical stimulation when a seizure is detected.{{Cite journal |last1=Nair |first1=Dileep R. |last2=Laxer |first2=Kenneth D. |last3=Weber |first3=Peter B. |last4=Murro |first4=Anthony M. |last5=Park |first5=Yong D. |last6=Barkley |first6=Gregory L. |last7=Smith |first7=Brien J. |last8=Gwinn |first8=Ryder P. |last9=Doherty |first9=Michael J. |last10=Noe |first10=Katherine H. |last11=Zimmerman |first11=Richard S. |last12=Bergey |first12=Gregory K. |last13=Anderson |first13=William S. |last14=Heck |first14=Christianne |last15=Liu |first15=Charles Y. |date=2020-09-01 |title=Nine-year prospective efficacy and safety of brain-responsive neurostimulation for focal epilepsy |journal=Neurology |language=en |volume=95 |issue=9 |pages=e1244–e1256 |doi=10.1212/WNL.0000000000010154 |issn=0028-3878 |pmc=7538230 |pmid=32690786}} The device keeps a record of abnormal electrical activity that is reviewed by a neurologist to improve the detection and treatment of seizures. The patient is able to record when they are having symptoms with the device to see if their symptoms are correlating with seizures. The use of responsive stimulation has found to be effective for seizure reduction. Some patients are able to achieve complete seizure freedom with responsive and non-responsive neurostimulation.{{Cite journal |last1=Touma |first1=Lahoud |last2=Dansereau |first2=Bénédicte |last3=Chan |first3=Alvin Y. |last4=Jetté |first4=Nathalie |last5=Kwon |first5=Churl-Su |last6=Braun |first6=Kees P. J. |last7=Friedman |first7=Daniel |last8=Jehi |first8=Lara |last9=Rolston |first9=John D. |last10=Vadera |first10=Sumeet |last11=Wong-Kisiel |first11=Lily C. |last12=Englot |first12=Dario J. |last13=Keezer |first13=Mark R. |date=2022-03-22 |title=Neurostimulation in people with drug-resistant epilepsy: Systematic review and meta-analysis from the ILAE Surgical Therapies Commission |url=https://onlinelibrary.wiley.com/doi/10.1111/epi.17243 |journal=Epilepsia |language=en |volume=63 |issue=6 |pages=1314–1329 |doi=10.1111/epi.17243 |pmid=35352349 |s2cid=247792263 |issn=0013-9580|url-access=subscription }}
= Chronic pain =
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Neurostimulation for chronic pain is primarily through the use of spinal cord stimulators.{{Cite journal |last1=Knotkova |first1=Helena |last2=Hamani |first2=Clement |last3=Sivanesan |first3=Eellan |last4=Le Beuffe |first4=María Francisca Elgueta |last5=Moon |first5=Jee Youn |last6=Cohen |first6=Steven P |last7=Huntoon |first7=Marc A |date=2021-05-29 |title=Neuromodulation for chronic pain |journal=The Lancet |language=en |volume=397 |issue=10289 |pages=2111–2124 |doi=10.1016/S0140-6736(21)00794-7|pmid=34062145 |s2cid=235245558 |doi-access=free }} These devices deliver electrical stimulation to different areas of the spine based on where they are implanted. Since 2012, Medtronic has produced spinal cord stimulators with accelerometers that can predict the patient's position. The device can be programmed to give additional electrical stimulation if the patient is thought to be in a more painful position.{{Cite journal |last1=Schultz |first1=David M. |last2=Webster |first2=Lynn |last3=Kosek |first3=Peter |last4=Dar |first4=Urfan |last5=Tan |first5=Ye |last6=Sun |first6=Mark |date=January 2012 |title=Sensor-driven position-adaptive spinal cord stimulation for chronic pain |journal=Pain Physician |volume=15 |issue=1 |pages=1–12 |doi=10.36076/ppj.2012/15/1 |issn=2150-1149 |pmid=22270733|doi-access=free }}
Research
Reponsive neurostimulation is an active area of research with multiple clinical trials underway. Continuous, or non-responsive, neurostimulation has been FDA approved since 2002 with the introduction of deep brain stimulators for Parkinson's disease.{{Cite journal |last=Gardner |first=John |date=2013-05-13 |title=A history of deep brain stimulation: Technological innovation and the role of clinical assessment tools |journal=Social Studies of Science |language=en |volume=43 |issue=5 |pages=707–728 |doi=10.1177/0306312713483678 |issn=0306-3127 |pmc=3785222}} As medical technology has improved, so has our understanding of neural networks and their role in human disease. Adding sensing capabilities to these devices has provided new targets to stimulate and feedback into how to more effectively stimulate the brain.{{Cite journal |last1=Denison |first1=Tim |last2=Morrell |first2=Martha J. |date=2022-01-11 |title=Neuromodulation in 2035: The Neurology Future Forecasting Series |url=https://n.neurology.org/content/98/2/65 |journal=Neurology |language=en |volume=98 |issue=2 |pages=65–72 |doi=10.1212/WNL.0000000000013061 |issn=0028-3878 |pmc=8762584 |pmid=35263267}} At this time, there are clinical trials for reponsive neurostimulation devices in the treatment of essential tremor, Parkinson's disease, Tourette's syndrome, depression, obesity, and post-traumatic stress disorder.