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Improving Deep Brain Stimulation for Parkinson Patients

June 20, 2018

While deep brain stimulation (DBS) has been in use to treat symptoms of Parkinson disease (PD) for 25 years, certain limitations have halted researchers’ further progress in improving the technique.

Recently, however, a new study has been published showing a novel approach to refining the method. The research was supported by the National Institutes of Health Brain Research through Advancing Innovative technologies (BRAIN) Initiative and the National Institute of Neurological Disorders and Stroke (NINDS).

Conventional DBS involves a surgically implanted electrode in the brain to deliver constant stimulation to the basal ganglia to help ease PD symptoms. This can sometimes lead to unwanted side effects and the need for a clinician to reprogram the electrode.

The new method presented in the study uses technology that is adaptive, allowing stimulation to be delivered to the patient’s brain in response to real-time signals. Senior author of the study, Philip Star, MD, PhD, University of California, San Francisco, CA, said, “This is the first time a fully implanted device has been used for closed-loop, adaptive deep brain stimulation in human Parkinson’s disease patients.”

Two patients with PD received a fully implanted, adaptive DBS device in a short-term feasibility trial. The device, which was implanted over the primary motor cortex, is able to both monitor and modulate brain activity. Signals from this electrode are then fed into a computer program embedded in the device, which determines whether to stimulate the brain.

For this study the researchers taught the program to recognize a pattern of brain activity associated with dyskinesia as a guide to tailor stimulation. Stimulation was reduced when it identified dyskinesia-related brain activity and increased when brain sensing indicated no dyskinesia to minimize DBS-related side effects (Journal of Neural Engineering. 2018;15[4]:046006).

Results of the study showed that this adaptive approach was equally effective at controlling symptoms as traditional DBS. Because adaptive DBS did not continuously stimulate the brain, the system saved about 40% of the device’s battery used during traditional stimulation. The short time periods over which movement was assessed did not permit comparison of the 2 DBS paradigms relative to incidence of dyskinesia, but it is hoped that the variable stimulation will also translate into a reduction in adverse effects when tested over longer time periods.

“Other adaptive deep brain stimulation designs record brain activity from an area adjacent to where the stimulation occurs, in the basal ganglia, which is susceptible to interference from stimulation current,” said Dr Starr. “Instead, our device receives feedback from the motor cortex, far from the stimulation source, providing a more reliable signal.”

An adaptive DBS system like the one tested in the study could offer an effective alternative to traditional continuous DBS and may also limit adverse effects, but considerable testing is still needed.

—Amanda Del Signore

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