About this Research Topic
Tremor is one of the most common involuntary movement disorders seen in clinical practice. It is generally caused by a dysfunction in the motor regions of the subcortical basal ganglia and may occur as a single symptom or be associated with several neurological disorders, including multiple sclerosis, stroke, traumatic brain injury, or neurodegenerative diseases affecting key structures for motor control (e.g., Parkinson's disease). Tremor is usually managed pharmacologically. The symptomatic benefit of drugs, though, may decline over time because of disease progression or development of drug tolerance, limiting the patient's activities of daily living. Alternative therapies for tremor are then highly needed. Among them, wearable sensors are gaining popularity as fundamental tools in helping clinicians perform early diagnosis and objective tremor quantification, while modern deep brain stimulation (DBS) implants have been shown to be effective in tremor suppression by constantly delivering electrical pulses to neural tissue.
Neurological disorders such as tremor, however, are often highly variable day to day and even moment to moment. For instance, patients with essential tremor suffer mostly from tremor while performing intentional movements, with their performance worsening under fatigue or stressful situations. In this scenario, a constant-open-loop DBS may not be effective in compensating for the sudden motor changes occurring in a patient’s daily routine.
For this reason, there is a growing interest in the realization of integrated “closed-loop” systems, in which wearable devices are used to feedback physical estimators of tremor to the implantable stimulation devices, fine-tuning in this way stimulation parameters according to the motor state of the patient. These systems are opening the era of “personalized” brain stimulation, and tremor is one of the more promising fields in which they could be applied.
In this issue, we invite clinicians, experimentalists, and theoreticians to investigate how the combination of closed-loop wearable and implantable devices could improve the treatment and the quality of life of patients affected by tremor-related disorders.
We encourage both reviews and original research papers that examine all the possible applications of closed-loop devices for both the detection and treatment of tremor.
We welcome evidence and contributions, analyzing the following, but not limited to, aspects:
-Advancements in hardware or software enhancing recordings and decoding of neuronal activity in patients with tremor-related disorders
-Advancements in hardware or software enhancing detection and recordings of tremor
-Clinical applications of bidirectional neuronal interfaces
-Prototypes of closed-loop neurostimulation to treat tremor-related disorders
-Research for possible pathologically enhanced oscillations' frequencies in the ventral intermediate nucleus (VIM) in patients with essential tremor or in GPI in patients with dystonia.
Keywords: closed-loop, electrical stimulation, tremor, implantable devices, wearable devices.
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