Self-Adjusting Brain Pacemaker May Help Reduce Parkinson’s Symptoms

A small NIH-funded feasibility study found that an implanted device regulated by the body’s brain activity could improve treatment for the symptoms of Parkinson’s disease (PD) in certain people with the disorder. This type of treatment, called adaptive deep brain stimulation (aDBS), is an improvement on a technique that has been used for PD and other brain disorders for many years. The study found aDBS was markedly more effective at controlling PD symptoms than conventional DBS treatments.

Implanted device responds to changes in brain biomarkers of Parkinson's symptoms by adjusting stimulation.

Photo:  Starr Lab, UCSF

DBS involves implanting electrodes into the brain at specific locations, which deliver electrical signals to help mitigate the symptoms of brain disorders such as PD. Conventional DBS provides a constant level of stimulation and can also lead to unwanted side effects, because the brain does not always need the same strength of treatment. Conversely, aDBS uses data taken directly from a person’s brain and uses machine learning to adjust the level of stimulation in real time.

aDBS treatment was given to four people already receiving conventional DBS. The patients reported involuntary movements or difficulty in initiating movement as their most bothersome symptom that persisted despite DBS treatment.

aDBS improved each participant’s most bothersome symptom roughly 50%. Notably, even though they were not told which type of treatment they were receiving at any one time, three of the four participants were often able to correctly guess when they were on aDBS due to noticeable symptom improvement.

Conventional treatment for PD often involves the drug levodopa. The amount of the drug in the brain peaks shortly after administration and gradually decreases as it is metabolized. aDBS could help smooth out the fluctuations, making it an attractive option for patients requiring high doses of levodopa.

Significant challenges remain for this therapy to be more widely available. Initial device setup requires considerable input from trained clinicians. Researchers envision a future where most of the work would be managed by the device itself, greatly reducing the need for repeat clinic visits. Further testing is needed before aDBS therapy can be offered in a clinical setting.