Decoding voluntary movements and postural tremor based on thalamic LFPs for closed-loop stimulation for essential tremor

High frequency deep brain stimulation (DBS) targeting motor thalamus is an effective therapy for essential tremor (ET). However, conventional continuous stimulation may deliver unnecessary current to the brain since tremor mainly affects voluntary movements and sustained postures in ET. We recorded LFPs from the motor thalamus, surface electromyographic (EMG) signals and/or behavioural measurements in seven ET patients during temporary lead externalization after the first surgery for DBS when they performed different voluntary upper limb movements and in nine more patients during the surgery, when they were asked to lift their arms to trigger postural tremor. We show that both voluntary movements and postural tremor can be decoded based on features extracted from thalamic LFPs using a machine learning based binary classifier. This information can be used to close the loop for DBS so that stimulation could be delivered on demand, without the need for peripheral sensors or additional invasive electrodes.