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New Study Further Personalizes Deep Brain Stimulation

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Deep brain stimulation (DBS) is a surgical treatment that provides relief to people with Parkinson's disease (PD) who experience movement symptoms and medication side effects. Since its U.S. Food and Drug Administration (FDA) approval to treat PD symptoms in 2002, DBS can help reduce medication needs and stabilize symptoms. PD symptom severity often varies throughout the day — because DBS provides constant electrical stimulation, there can be times when it is too much or too little, which limits its effectiveness. 

A recent study has developed a new approach, known as adaptive DBS, which has the potential to further personalize DBS treatment for Parkinson's. It was recently tested in a small clinical trial reported in Nature Medicine. 

Utilizing custom computer algorithms and artificial intelligence (AI), adaptive DBS can detect symptom changes in real time by monitoring brain activity that is specific to each participant. When it detects changes, the system delivers precisely calibrated electrical pulses to counteract these shifts. 

The system delivers more electrical stimulation during periods of stiffness (bradykinesia) and less during phases of involuntary movement (dyskinesia). It also adjusts stimulation based on the effectiveness of levodopa medication, providing more stimulation when the medication wears off and less when it's active.  

About the Study & Results

deep brain stimulation

The clinical trial enrolled four participants who were diagnosed with Parkinson’s at least six years earlier. Each participant underwent conventional DBS surgery. Researchers collected brain activity data for each participant, then used that data to create personalized algorithms to detect and respond to symptom fluctuations. Months after the initial DBS surgery, each participant was switched to adaptive DBS. 

To compare the two types of DBS, participants switched between conventional stimulation and the personalized version every two to seven days over a period of two months (one month spent with each stimulation type). Neither the participants nor most of the researchers knew which type of stimulation was being delivered at any time. Participants reported their symptoms daily, and wearable monitors detected changes in their movement symptoms. 

All four participants experienced nearly a 50% reduction in time spent with their most troublesome symptom when adaptive DBS was active compared to conventional stimulation. They reported that their worst symptoms went from persisting for about 25% of their day down to about 12%. Additionally, adaptive DBS did not worsen other PD-related symptoms. Overall, participants reported an improved quality of life with adaptive DBS.  

By dynamically adjusting stimulation parameters based on real-time brain signals, adaptive DBS appears to offer a more personalized and effective treatment for Parkinson's than conventional DBS. 

Highlights 

  • A clinical trial enrolled four participants to test a surgical treatment called adaptive DBS that detects and responds to brain activity to provide individualized and customized stimulation to help with Parkinson’s symptoms. 

  • All four participants experienced a nearly 50% reduction in time spent with their most troublesome symptom when adaptive DBS was active. 

  • Adaptive DBS did not worsen other PD-related symptoms. 

  • Participants reported improved quality of life with adaptive DBS compared to conventional DBS. 

What does this mean? 

Adaptive DBS may be an evolved version of DBS treatment for improving movement symptoms of Parkinson’s. The study finds that using new technology can further personalize DBS currents and make DBS even more effective in treating troublesome PD symptoms. However, developing the customized algorithms for each participant was time consuming in this small study, and it will take time before it becomes widely available. 

What do these findings mean to the people with PD right now? 

It’s important to keep in mind that this was a small study of only four participants. The study, and its technology will need to be replicated on a much larger scale. Still, the study findings are exciting and bring hope for the PD community, as proven by its media coverage. The concept of adaptive DBS may eventually become the standard for DBS treatment, and with further development and refinement, people with conventional DBS may be able to use adaptive DBS in the future.  

Adaptive DBS is still in testing and it does not have widespread availability. People should talk to their doctors about their treatment options and if they have DBS, ask doctors or their care team to inform them if a similar adaptive DBS study begins to recruit.  

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