{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T23:03:42Z","timestamp":1789427022727,"version":"build-2803163510"},"reference-count":40,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2023,12,21]],"date-time":"2023-12-21T00:00:00Z","timestamp":1703116800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/100000065","name":"National Institute of Neurological Disorders and Stroke","doi-asserted-by":"publisher","award":["UH3NS103468"],"award-info":[{"award-number":["UH3NS103468"]}],"id":[{"id":"10.13039\/100000065","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000065","name":"National Institute of Neurological Disorders and Stroke","doi-asserted-by":"publisher","award":["UH3NS129898"],"award-info":[{"award-number":["UH3NS129898"]}],"id":[{"id":"10.13039\/100000065","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,3,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Continuous deep brain stimulation (cDBS) of the subthalamic nucleus (STN) or globus pallidus is an effective treatment for the motor symptoms of Parkinson\u2019s disease. The relative benefit of one region over the other is of great interest but cannot usually be compared in the same patient. Simultaneous DBS of both regions may synergistically increase the therapeutic benefit. Continuous DBS is limited by a lack of responsiveness to dynamic, fluctuating symptoms intrinsic to the disease. Adaptive DBS (aDBS) adjusts stimulation in response to biomarkers to improve efficacy, side effects, and efficiency. We combined bilateral DBS of both STN and globus pallidus (dual target DBS) in a prospective within-participant, clinical trial in six patients with Parkinson\u2019s disease (n = 6, 55\u201365 years, n = 2 females).<\/jats:p>\n                  <jats:p>Dual target cDBS was tested for Parkinson\u2019s disease symptom control annually over 2 years, measured by motor rating scales, on time without dyskinesia, and medication reduction. Random amplitude experiments probed system dynamics to estimate parameters for aDBS. We then implemented proportional-plus-integral aDBS using a novel distributed (off-implant) architecture. In the home setting, we collected tremor and dyskinesia scores as well as individualized \u03b2 and DBS amplitudes.<\/jats:p>\n                  <jats:p>Dual target cDBS reduced motor symptoms as measured by Unified Parkinson\u2019s Disease Rating Scale (UPDRS) to a greater degree than either region alone (P &amp;lt; 0.05, linear mixed model) in the cohort. The amplitude of \u03b2-oscillations in the STN correlated to the speed of hand grasp movements for five of six participants (P &amp;lt; 0.05, Pearson correlation). Random amplitude experiments provided insight into temporal windowing to avoid stimulation artefacts and demonstrated a correlation between STN \u03b2 amplitude and DBS amplitude. Proportional plus integral control of aDBS reduced average power, while preserving UPDRS III scores in the clinic (P = 0.28, Wilcoxon signed rank), and tremor and dyskinesia scores during blinded testing at home (n = 3, P &amp;gt; 0.05, Wilcoxon ranked sum). In the home setting, DBS power reductions were slight but significant.<\/jats:p>\n                  <jats:p>Dual target cDBS may offer an improvement in treatment of motor symptoms of Parkinson\u2019s disease over DBS of either the STN or globus pallidus alone. When combined with proportional plus integral aDBS, stimulation power may be reduced, while preserving the increased benefit of dual target DBS.<\/jats:p>","DOI":"10.1093\/brain\/awad429","type":"journal-article","created":{"date-parts":[[2023,12,21]],"date-time":"2023-12-21T19:20:38Z","timestamp":1703186438000},"page":"911-922","source":"Crossref","is-referenced-by-count":53,"title":["At home adaptive dual target deep brain stimulation in Parkinson\u2019s disease with proportional control"],"prefix":"10.1093","volume":"147","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1547-3305","authenticated-orcid":false,"given":"Stephen L","family":"Schmidt","sequence":"first","affiliation":[{"name":"Department of Biomedical Engineering, Duke University , Durham, NC 27708 , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Afsana H","family":"Chowdhury","sequence":"additional","affiliation":[{"name":"Department of Electrical and Computer Engineering, Duke University , Durham, NC 27708 , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyle T","family":"Mitchell","sequence":"additional","affiliation":[{"name":"Department of Neurology, Duke University Medical Center , Durham, NC 27710 , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer J","family":"Peters","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering, Duke University , Durham, NC 27708 , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qitong","family":"Gao","sequence":"additional","affiliation":[{"name":"Department of Electrical and Computer Engineering, Duke University , Durham, NC 27708 , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hui-Jie","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Bioinformatics, Duke University , Durham, NC 27710 , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine","family":"Genty","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Duke University Medical Center , Durham, NC 27710 , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shein-Chung","family":"Chow","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Bioinformatics, Duke University , Durham, NC 27710 , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Warren M","family":"Grill","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering, Duke University , Durham, NC 27708 , USA"},{"name":"Department of Electrical and Computer Engineering, Duke University , Durham, NC 27708 , USA"},{"name":"Department of Neurosurgery, Duke University Medical Center , Durham, NC 27710 , USA"},{"name":"Department of Neurobiology, Duke University Medical Center , Durham, NC 27710 , 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