Long-term Behavioral Tracking and Adaptive Electrical Brain Stimulation
Abstract number :
1.096
Submission category :
2. Translational Research / 2B. Devices, Technologies, Stem Cells
Year :
2022
Submission ID :
2204066
Source :
www.aesnet.org
Presentation date :
12/3/2022 12:00:00 PM
Published date :
Nov 22, 2022, 05:23 AM
Authors :
Vaclav Kremen, MSc.Eng, PhD – Mayo Clinic; Vladimir Sladky, MSc. – Mayo Clinic; Filip Mivalt, MSc. – Data Scientist, Neurology, Mayo Clinic; Benjamin Brinkmann, Ph.D. – Senior Associate Consultant, Neurology, Mayo Clinic; Inyong Kim, BSc. – Principal Engineer, Neurology, Mayo Clinic; Beverly Sturges, MD, Ph.D. – University of California Davis; Chelsea Crowe, BSc. – University of California Davis; Nicholas Gregg, MD, Ph.D. – Resident, Neurology, Mayo Clinic; Brian Lundstrom, MD, Ph.D. – Consultant, Neurology, Mayo Clinic; Irena Balzekas, BSc. – Ph.D. student, Neurology, Mayo Clinic; Victoria Marks, BSc. – Ph.D. student, Neurology, Mayo Clinic; Kevin McQuown, Ph.D. – Windy City Lab; Jamie Van Gompel, MD, Ph.D. – Neurosurgeon, Neurosurgery, Mayo Clinic; Kai Miller, MD, Ph.D. – Neurosurgeon, Neurosurgery, Mayo Clinic; TImothy Denison, Ph.D. – University of Oxford; Hal Blumenfeld, MD, Ph.D. – Yale; Gregory Worrell, MD, Ph.D. – Senior Consultant, Neurology, Mayo Clinic
Rationale: Current neuromodulatory approaches with electrical brain stimulation devices (EBS) for drug resistant epilepsy are largely palliative, hard to optimize, and do not target psychiatric, sleep or cognitive comorbidities. A new generation of devices enabling adaptive EBS that is informed by tracking interictal epileptiform spikes (IES), seizures, behavioral state and bi-directional patient interactions may improve therapy optimization, outcomes and will enable discovery neuroscience.
Methods: We developed a system integrating implanted neural sensing & stimulating (INSS) devices with commercial electronic devices (smartphone & smartwatch) to collect real-time physiology, dense behavioral tracking and electrophysiology triggered behavioral testing. Here we used an Apple iPhone and iWatch, Microsoft tablet computer, and investigational Medtronic Summit RC+STM with electrodes targeting bilateral hippocampus & anterior nucleus of the thalamus. The INSS, tablet, phone and watch system enables continuous intracranial EEG streaming combined with Apple Health Kit (EKG, actigraphy, etc.) data maintained in Google Cloud. The system enables multi-model physiology, brain electrophysiology, and behavior tracking for optimizing adaptive closed-loop EBS. The system can launch surveys triggered on real-time EEG data with millisecond precision synchronization across all devices. The eco-system provides rich data streams (seizures, IES, medication & seizure logs, memory, sleep, and mood surveys) for analysis. Initial pre-clinical testing of some components was performed in 2 pet canines with epilepsy living with their owners.
Results: Five people with mesial temporal lobe epilepsy were implanted with the RC+STM and streaming, continuous 24/7 EEG data were collected and synchronized with mood, memory, and sleep surveys along with smartwatch physiology data streams. Automated behavioral state, IES and seizure classification algorithms provide continuous brain physiology tracking. We acquired and analyzed over 5 years of data including IES rates, seizures, medication diaries, sleep, mood, and behavioral assessments in 5 people with temporal lobe epilepsy living in their home environment.
Conclusions: We created a EBS eco-system that enables precise time synchronization of the implanted and external components (INSS, smartphone and smartwatch) for tracking behavior, electrophysiology and adaptive EBS. Early results show that individualized EBS therapy is required for optimizing epilepsy, seizures, and sleep, mood, and memory comorbidities.
Funding: This research was supported by the National Institutes of Health: UH2/UH3 NS95495 and R01-5 NS09288203, UG3 NS112826, DARPA HR0011- 20-2-0028 Manipulating and Optimizing Brain Rhythms for Enhancement of Sleep (Morpheus).
Translational Research