Combined DBS and Epidural Spinal Stimulation for Parkinsonian Gait
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Solution Overview
Problem
Existing treatments for locomotor deficits in Parkinson's disease, such as dopamine replacement strategies and deep brain stimulation, are ineffective at the late stages of the disease, particularly for gait and balance issues due to disrupted communication between the brain and spinal cord.
Innovation Solution
A combined neuromodulation system involving deep brain stimulation (DBS) and epidural electrical stimulation (EES) of the spinal cord, targeting the dorsal side, is used to modulate spinal neural circuits responsible for locomotion, with specific frequency and pulse parameters to enhance gait and balance recovery.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Reliability
If deep brain stimulation (DBS) and epidural electrical stimulation (EES) are combined to treat locomotor deficits, then gait and balance improvements are significantly enhanced, but device complexity and surgical procedure complexity increase
Solution Approach 1:
The patent combines two neuromodulation systems (DBS and EES) into a unified treatment approach. The DBS system targets brain regions involved in locomotor control while the EES system stimulates spinal cord dorsal columns, creating a coordinated brain-spine interface that addresses both central and peripheral components of locomotor deficits simultaneously
Solution Approach 2:
The treatment is divided into distinct functional segments: the DBS component addresses supraspinal control and motor planning, while the EES component addresses spinal cord transmission and peripheral motor output. This segmentation allows each system to be optimized independently while working together synergistically
2Reliability
If epidural electrical stimulation (EES) is applied to the dorsal side of the spinal cord, then spinal neural circuits are effectively modulated, but surgical implantation complexity increases
Solution Approach 1:
The epidural space serves as an intermediary zone between the external environment and the spinal cord parenchyma. By placing electrodes in this intermediate space rather than directly in the cord, the system achieves effective neural stimulation while avoiding the complexities and risks of intramedullary implantation
Solution Approach 2:
The epidural electrode array is designed to stimulate multiple spinal segments and neural circuits simultaneously through a single implantation procedure. The dorsal column stimulation can modulate various locomotor pathways and reflex arcs, providing multiple therapeutic effects from one surgical intervention
Applied Scientific Principles
This section explains which scientific principles are used to turn an abstract innovation direction into a practical engineering solution.
Function Achieved in This Case
The combination of DBS and EES provides a synergistic effect, significantly improving gait and balance deficits in Parkinson's disease patients, leveraging spinal-cord stimulation to recruit posterior roots and restore natural motor circuit dynamics.
Implementation Method 1
at least one Deep Brain Stimulation (DBS) System for providing Deep Brain Stimulation to brain tissue of a subject
Implementation Method 2
at least one stimulation unit being configured and adapted to deliver epidural electrical stimulation (EES) to the dorsal side of the spinal cord (S) of said subject (P)
Data Source
AI summary
A combined neuromodulation and/or neurostimulation system for mitigating locomotor deficits of/or neuronal disorders, especially Parkinson's disease, said system comprises: at least one Deep Brain Stimulation System for providing Deep Brain Stimulation to brain tissue of a subject, at least one control unit, configured and adapted to provide stimulation data, at least one stimulation unit, operatively connected to the at least one control unit, the at least one stimulation unit being configured and adapted to deliver epidural electrical stimulation to the dorsal side of the spinal cord of said subject, and at least one implantable pulse generator, wherein the at least one stimulation unit includes one or more electrodes configured to be implanted epidurally, the one or more electrodes being operatively connected to the at least one IPG.