Closed-loop Responsive Stimulation
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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 The United States Food and Drug Administration (FDA or US FDA) is a federal agency of the Department of Health and Human Services. The FDA is responsible for protecting and promoting public health through the control and supervision of food s ...
has approved devices for use in the United States in the treatment of epileptic seizures and chronic pain conditions. Devices are being studied for use in the treatment of essential tremor, Parkinson's disease, Tourette's syndrome, depression, obesity, and post-traumatic stress disorder.


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. 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 patient's are able to achieve complete seizure freedom with responsive and non-responsive neurostimulation.


Chronic Pain

Neurostimulation for chronic pain is primarily through the use of spinal cord stimulators. These devices deliver electrical stimulation to different areas of the
spine Spine or spinal may refer to: Science Biology * Vertebral column, also known as the backbone * Dendritic spine, a small membranous protrusion from a neuron's dendrite * Thorns, spines, and prickles, needle-like structures in plants * Spine (zoolog ...
based on where they are implanted. Since 2012,
Medtronic Medtronic plc is an American medical device company. The company's operational and executive headquarters are in Minneapolis, Minnesota, and its legal headquarters are in Ireland due to its acquisition of Irish-based Covidien in 2015. While it ...
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.


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. As medical technology has improved, so has our understanding of
neural network A neural network is a network or circuit of biological neurons, or, in a modern sense, an artificial neural network, composed of artificial neurons or nodes. Thus, a neural network is either a biological neural network, made up of biological ...
s 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. 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.


See also

*
Brain implant Brain implants, often referred to as neural implants, are technological devices that connect directly to a biological subject's brain – usually placed on the surface of the brain, or attached to the brain's cortex. A common purpose of modern brai ...
*
Cranial electrotherapy stimulation Cranial electrotherapy stimulation (CES) is a form of neurostimulation that delivers a small, pulsed, alternating current via electrodes on the head. CES is used with the intention of treating a variety of conditions such as anxiety, depression a ...
* Electroconvulsive therapy *
Electroencephalography Electroencephalography (EEG) is a method to record an electrogram of the spontaneous electrical activity of the brain. The biosignals detected by EEG have been shown to represent the postsynaptic potentials of pyramidal neurons in the neocortex ...
* Neuromodulation (medicine) * Neuroprosthetics * Organization for Human Brain Mapping * Transcranial direct-current stimulation *
Vagal nerve stimulation Vagus nerve stimulation (VNS) is a medical treatment that involves delivering electrical impulses to the vagus nerve. It is used as an add-on treatment for certain types of intractable epilepsy and treatment-resistant depression. Medical use VNS ...


References

{{Reflist Epilepsy Pain Implants (medicine) Neuroprosthetics Neurotechnology