Abstract Details

Title Circadian Rhythm and Adaptive Deep Brain Stimulation in Essential Tremor

Topic Movement Disorders

Presentation(s) S32 - Movement Disorders: Neuroimaging and Neuromodulation (4:30 PM-4:42 PM)

Poster/Presentation
Number 006

Background Deep brain stimulation (DBS) in the VIM is an effective therapy for individuals with ET. However, over time, the benefits of DBS often wane due to disease progression and/or habituation to stimulation. Sleep disturbances are also common in ET patients and may be exacerbated by continuous DBS. Automatically turning off DBS during sleep may reduce sleep difficulties while potentially prolonging the therapeutic effects of stimulation.

Objective To study the influence of circadian rhythms on local field potentials (LFPs) recorded from the ventral intermediate nucleus (VIM) of the thalamus of essential tremor (ET) patients and develop an adaptive deep brain stimulation (aDBS) strategy.

Design/Methods This restospetcive study includes data from 33 ET patients with VIM DBS lead(s) attached to a Percept (Medtronic Inc.®) pulse generator capable of chronic brain sensing. VIM activity was recorded over 5 consecutive days. LFP power was averaged across two time windows: daytime (3 PM-8 PM) and nighttime (12 AM-5 AM), and the values were compared using a t-test to detect circadian fluctuations.

Results In most cases, circadian fluctuations in LFP power were observed. Alpha (8-12Hz) and low beta (13-20Hz) frequencies were either increased or decreased (50%) at night, while high beta (20-30Hz) frequencies were consistently decreased at night.

Conclusions VIM LFP activities exhibit circadian fluctuations that may be utilized to develop an aDBS system capable of turning off stimulation during sleep. Our next step is a prospective, single-center, crossover pilot trial to evaluate the feasibility, safety, and non-inferiority of this aDBS strategy in ET patients with stable VIM DBS settings.

Authors/Disclosures
Coralie De Hemptinne, PhD PRESENTER	The institution of Mrs. De Hemptinne has received research support from Alpha Omega. Mrs. De Hemptinne has received personal compensation in the range of $0-$499 for serving as a grant review with Michael J Fox foundation.
Patricia Coutinho, MD	Dr. Coutinho has nothing to disclose.
Tamara Bhardwaj	Miss Bhardwaj has nothing to disclose.
Jackson Cagle	Jackson Cagle has nothing to disclose.
Lauren Fanty, MD (Fixel Institute)	No disclosure on file
Jun Yu, MD (UF Norman Fixel Institute for Neurological Diseases)	Dr. Yu has nothing to disclose.
Joshua Wong, MD (University of Florida College of Medicine - Neurology)	The institution of Dr. Wong has received research support from NIH.
Adolfo Ramirez Zamora, MD (Fixel Neurological Institute)	Dr. Ramirez Zamora has received personal compensation in the range of $500-$4,999 for serving as a Consultant for CNS Ratings. Dr. Ramirez Zamora has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Medtronic. Dr. Ramirez Zamora has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Rho Inc. Dr. Ramirez Zamora has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Signant Health. Dr. Ramirez Zamora has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Cerevel therapeutics. Dr. Ramirez Zamora has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for NIH. The institution of Dr. Ramirez Zamora has received research support from Parkinsons Foundation.

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