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Abstract
Dr. Carina Oehrn will discuss how neural oscillations can be leveraged to develop next-generation neuromodulation therapies for Parkinson’s disease (PD). She will present findings from a study where she and coauthors recorded chronic subthalamic and cortical local field potentials in four patients with PD using sensing-enabled deep brain stimulation (DBS) devices. In the first step, they tracked symptom fluctuations in daily life and identified the associated neural signatures. Second, they developed closed-loop stimulation algorithms that adjusted therapy in real time in response to these signals. Compared with continuous DBS, adaptive stimulation halved motor symptom duration and improved quality of life. This work represents the first chronic, blinded, randomized real-world implementation of closed-loop DBS. Dr. Oehrn will then present a study demonstrating how neural signals can guide adjustments to continuous DBS settings. In this work, her team applied theta-frequency stimulation to the subthalamic nucleus in patients with PD, a rhythm associated with cognitive function in this region, and showed that it enhances working memory in a frequency- and task-specific manner. Finally, she will give an outlook on ongoing projects, including the first human recordings from the cerebellum during emotional and cognitive processing and chronic recordings from the subthalamic nucleus during cognitive processing in PD.
Bio
Dr. Carina Oehrn is a physician‑neuroscientist at UC Davis, where she leads a lab at the Center for Neuroscience and the Department of Neurological Surgery. Her team specializes in human intracranial recordings and deep brain stimulation, with a focus on the neural networks underlying non‑motor symptoms in movement disorders. Her goal is to harness neural signals to develop new neuromodulation therapies for cognitive and affective symptoms using frequency‑based stimulation strategies and adaptive DBS.
She received her undergraduate degree in Neuroscience from the University of Cologne, Germany, and her master’s degree in Brain and Mind Sciences from University College London and the École normale supérieure in Paris. Carina completed her medical studies and PhD at the University of Cologne and Bonn, Germany, where her research focused on prefrontal-hippocampal interactions during executive functions. Throughout this time, she undertook research stays at the Montreal Neurological Institute and the University of Sydney, as well as clinical volunteering in Shanghai, China, and The Gambia.
She then received funding for her own research group in Marburg, Germany, to investigate the neural signature of DBS effects on cognitive processing in Parkinson’s disease. In 2021, she received the Parkinson Fellowship of the Thiemann Foundation to join Philip Starr at UCSF as a visiting scholar, where she focused on developing algorithms for adaptive deep brain stimulation.
✒️ -> Scratch Notes
Harnessing Neural Oscillations to Guide Novel Deep Brain Stimulation Therapies
Characteristics of Oscillations
- Decompose signals into freqs and amplitude (spectral power)
Recently, tech allows for long term recordings (instead of in clinical settings)
Implanted subthalamic nucleus (STN), connected to pulse generator in ch(est
- usually at 130hz. helps bradykinesia and tremor
- stn part of BG
Symptoms in DBS are not equal in severity, oscillates throughout day (some points too mobile, others not mobile enough)
Conventional DBS (cDBS) doesnt respond well to fluctuations in symptoms
Introducing aDBS
Past studies issues:
- limited lab setting
- short recordings
- limited to off-med state
- no control condition (cDBS)
- beta osciallation focused
- biomarker identification off stimulation
- obviously stim has impact, just unnacounted for previously
Now…
New tech, allowing streaming of invasive data (bluetooth transmitter to receiver and tablet)
Trial
11-31 months of cDBS optimization
After, start the aDBS trial
- Oehm, Cernera and Hammer et al. Nature Medicine
They found that PSD changed in med on/off:
- beta slightly suppresed in on
- all patients showed a large spike at ~65hz in medication on state
beta algos FDA approved, gamm algos not yet
Working Memory
Neural signature of WM in the STN
Activity in range above theta in successful trials (encoding/maintenance)
salehi et al Brain 2024
oehrnlab.ucdavis.edu
?
- why is QOL rating not increase, when symptoms halved?
- how do we expect users to habituate to aDBS?
actual qs:
- Stimulate multiple freqs?
- Possible! different parts of STN affect different things, project in the works (dorsal, etc.)
- High low gamma:
- 130 hz and (70?). Low/High gamma, both stat sig from baseline.
- Where else put electrode but cant?
- PF electrodes as well, communication between PF and BG.
- Multiple BG electrodes too.
- Cerebellum also suitable.
- Use biomarkers for diagnostic?
- Its kinda deep in there…
- Epilepsy scalp studies?
- She guesses that the frequency occurs in healthy individuals too
- How freqs found?
- missed…
- Non invasive approaches to parkinsons
- Auditory stimuli at a freq. Preliminary evidence for tremor relief
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