Comparison of DBS and levodopa on resting tremor using a fuzzy neural network system

Abstract

As a treatment for Parkinsonian resting tremors, deep brain stimulation (DBS) has been reported to be more effective than levodopa, and of the forms of DBS, subthalamic nucleus (STN) DBS has been reported to be more effective than internal globus pallidus (GPi) DBS. To assess the veracity of these claims, this study compared the effectiveness of DBS and levodopa and of STN DBS and GPi DBS in relieving resting tremors using a novel methodology consisting of wavelet transform (WT) technology and a neural network with weighted fuzzy membership functions (NEWFM). This simplified methodology offers the advantages of efficiency, low cost, and ease of use. The results indicate that subjects with high-amplitude resting tremors obtained almost the same relief from on-DES and off-levodopa treatment than on-DBS and on-levodopa treatment; that subjects with low-amplitude resting tremors experienced greater relief from on-DBS and off-levodopa treatment than on-DBS and on-levodopa treatment, indicating that relief could be relieved by DBS administration alone; and that DBS had stronger effects on subjects with high-amplitude resting tremors than subjects with low-amplitude resting tremors. This study's successful employment of WT technology and NEWFM to compare treatment effects demonstrated the utility of a simplified approach that even non-experts can utilize. (C) 2013 Elsevier Ltd. All rights reserved.