Improving Deep Brain Stimulation for Parkinson’s: An Interview with ADPA Researcher, Dr. Enrico Opri

A Closer Look: An Interview with Dr. Enrico Opri

Dr. Enrico Opri

Our A Closer Look blog is designed to educate, inform, and inspire you through a variety of topics and insights about Parkinson’s disease (PD). One way we do that is through our Interview with APDA Researchers series within this blog so you can get a closer look at some of the dedicated APDA-funded researchers who are working tirelessly to understand this disease.

We would like to introduce Dr. Enrico Opri (pictured right). He received a 2021-2022 APDA Post-doctoral fellowship when he was at Emory University in Atlanta, Georgia. The Fellowship allowed him to study ways to improve the outcomes of deep brain stimulation (DBS) for people with Parkinson’s disease (PD). Because of his research successes, he now has his own laboratory as an Assistant Professor of Biomedical Engineering at the University of Michigan in Ann Arbor, Michigan. We asked him questions about his work.

Q&A with Dr. Enrico Opri about his research in DBS and Parkinson’s disease

Q: What is the overarching goal of your research? What do you hope to find out?

A: The focus of our research is to develop and enhance current DBS procedures for people affected by PD. DBS is a standard therapy for people with advancing PD symptoms. Its success critically depends on the accurate location of the stimulating lead. Traditionally, the optimal location is determined by micro-electrode recordings (MER) procedures, where the clinician is looking for specific neurological profiles by evaluating certain “sounds” and “look” of the electrical tracing from the neurons that are traversed during the DBS implantation. This is known as functional mapping, and it requires a patient with PD to be awake during the lead placement.

Following implantation, the DBS device requires postoperative programming to fully realize the therapeutic benefit, by determining which parameters (e.g., contact combination) provide the best symptomatic benefit and the fewest side effects. This process results in a very time-consuming trial and error process which depends on the skills of the involved clinician. Our aim is to develop patient-specific and objective functional-mapping measures that can guide clinicians during both DBS surgical implantation (validating the lead location) and postoperative programming, to streamline the process and improve patient-specific outcomes.

Toward that goal, we are studying the brain’s response to the electrical stimulation of DBS itself, also known as DBS local evoked potentials (DLEPs), and how we can recover it while the patient is asleep. By doing so, we hope to establish new ways to localize where the DBS leads should be placed, using real-time neuro-based mapping techniques that do not require the patient to be awake. This would potentially help reduce surgical time, improve surgical targeting, and reduce or eliminate the need for patients to be awake during surgery, thereby decreasing patient discomfort.

Q: Could you describe how you perform your research studies?

A: Our studies rely on the time and commitment of people affected by PD, who are undergoing DBS surgery as part of their clinical care. The same electrodes that are used to deliver the DBS clinical therapy can be used for recording DLEPs within the brain regions considered as potential targets of DBS. During the surgery, clinicians typically apply stimulation in the target region to validate the location of the DBS lead. At the same time, we record brain activity during DBS stimulation while the patient is both awake and asleep.

With this information, we can build a profile that matches each set of stimulation parameters with the type and location of brain changes in response to the stimulation. Post-operatively, we additionally collect clinical notes of the patient-specific DBS settings with the greatest therapeutic benefit. We use this information to build neurophysiology-based models that can estimate and predict clinical outcomes.

Q: Can you tell us a little bit about what you have found out so far?

A: We were able to recover DLEPs during surgical implantation both awake and under anesthesia in people affected by PD. We developed an algorithm for reliable recovery of the underlying DBS-evoked activity, and suppression of stimulation artifacts. While anesthesia affected the overall amplitude of the evoked brain activity, we were still able to correctly locate the sensorimotor region in both the subthalamic nucleus (STN) and globus pallidus internus (GPi), the two main targets of DBS for PD. Other biomarkers of interest, such as oscillatory brain activity, could not reliably discriminate between different locations when under anesthesia, suggesting that DLEPs could be more reliable. These results indicate the feasibility of the proposed DBS-based method for the purpose of providing an alternative data source for functional mapping within people affected by PD.

Q: What fuels your passion for research?

The brain’s inner workings, together with how we can use engineering techniques to explore its functioning, is what has sparked my interest and brought me to this field.

What made me stay and constantly fuels my passion, is the interaction with patients and hearing their stories. This motivates me to strive to bring better therapies for those who matter the most – the people affected by this challenging condition. A strong interdisciplinary collaboration between engineers and clinicians brings additional energy to my research, with the ultimate hope of introducing better techniques and methods for the treatment of PD.

Tips and Takeaways

  • Dr. Enrico Opri, an APDA-funded researcher, is studying ways to improve patient outcomes in those receiving deep brain stimulation (DBS).
  • Dr. Opri has identified a brain response to the electrical stimulation of DBS itself, which can be used to locate specific brain regions even while the patient is under anesthesia. This breakthrough could help make the placing of the electrodes during DBS surgery more accurate without requiring that the patient be awake during the surgery.
  • APDA can fund researchers like Dr. Opri because of the generous donations we receive from dedicated people like you. If you would like to support critical work like this, please consider making a donation of any size today. Thank you.
  • If you’re interested in more interviews like this one, you may enjoy our conversations with Dr. Abby Olsen, Dr. April Darling, and Dr. Edward Griffin.  

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