Online Bayesian Optimization of Nerve Stimulation

ObjectiveIn bioelectronic medicine, neuromodulation therapies induce neural signals to the brain or organs modifying their function. Stimulation devices, capable of triggering exogenous neural signals using electrical wave forms, require a complex and multi-dimensional parameter space in order to control such wave forms. Determining the best combination of parameters (wave form optimization, or dosing) for treating a particular patients illness is therefore challenging. Comprehensive parameter searching for an optimal stimulation effect is often infeasible in a clinical setting, due to the size of the parameter space. Restricting this space, however, may lead to sub-optimal therapeutic results, reduced responder rates, and adverse effects. ApproachAs an alternative to a full parameter search, we present a flexible machine learning, data acquisition and processing framework for optimizing neural stimulation parameters requiring as few steps as possible using Bayesian optimization. Such optimization builds a model of the neural and physiological responses to stimulations enabling it to optimize stimulation parameters and to provide estimates of the accuracy of the response model. The vagus nerve innervates, among other thoracic and visceral organs, the heart, thus controlling heart rate and is therefore ideal for demonstrating the effectiveness of our approach. Main results. The efficacy of our optimization approach was first evaluated on simulated neural responses, then applied to vagus nerve stimulation intraoperatively in porcine subjects. Optimization converged quickly on parameters achieving target heart rates and optimizing neural B-fibre activations despite high intersubject variability. SignificanceAn optimized stimulation waveform was achieved in real time with far fewer stimulations than required by alternative optimization strategies, thus minimizing exposure to side effects. Uncertainty estimates helped avoiding stimulations outside a safe range. Our approach shows that a complex set of neural stimulation parameters can be optimized in real-time for a patient to achieve a personalized precision dosing.