A new approach to brain stimulation could give people with Parkinson’s disease better control over their symptoms and halve the duration of their most troublesome symptoms, experts say.
Deep brain stimulation (DBS) is now an important treatment for people with Parkinson’s and can help with symptoms such as stiffness, slowness and tremors.
The approach involves implanting tiny electrodes in the brain to deliver electrical stimulation to specific areas that control movement.
Currently, this stimulation is set at a constant level regardless of what the patient is doing, or the severity of their symptoms. The resulting technique may result in under-stimulation, resulting in improvement of symptoms, or over-stimulation, leading to irregular movements.
Experts say a big step has been taken to improve the technique by helping to automatically adjust the level of stimulation in response to the patient’s needs based on real-time signals. the brain.
The team behind the work says more trials are needed to confirm the results of the pilot study, changes to routine clinical practice and training for doctors. However, they say the technology — known as “adaptive” DPS — could become widespread in a few years, with costs expected to remain similar to traditional DPS.
“Once these challenges are resolved, I am very confident that adaptive DBS will become a more effective alternative to standard DBS. [Parkinson’s] and potentially other neurological and psychiatric conditions, and provide more consistent and personalized symptom control, with the potential to significantly improve patient outcomes,” said Dr. Karina O’Hearn of the University of California, San Francisco, lead author of the research.
Writing in the journal Nature Medicine, O’Hearn and colleagues describe how a pilot study involved four men with Parkinson’s disease who were fitted with a DPS device provided by an organization for research.
“This device can sense brain activity and provide stimulation at the same time. Our job was to develop algorithms for the software that runs on this device,” O’Hearn said.
The team found that an increase in a specific type of brain signal was associated with rising levels of dopamine as the participants’ drugs kicked in and eased their motor symptoms.
O’Hearn said that allowed the team to develop algorithms that could increase DPS stimulation when this signal is low and decrease it when this signal is high.
The team developed algorithms tailored to each individual based on their most troubling symptoms, resulting in participants’ brain signals being constantly monitored and electrical stimulation automatically adjusted to their needs.
Four participants received traditional DBS and this new approach for one month each, but were not told which technique was used.
Results revealed that participants spent 50% less time awake when receiving adaptive DBS compared to traditional DBS, while three out of four reported a better quality of life.
The team says drugs will be needed with adaptive DBS, though probably at lower doses.
“Drugs are often needed to support mood and movement in Parkinson’s disease, so should not be stopped completely,” said Dr. Simon Little of the University of California, San Francisco.
Claire Bale, Associate Director of Research at Parkinson’s UK, welcomed the research.
“Current DPS can be life-changing, but this important step can help people manage the fluctuating symptoms they experience and reduce the number of side effects,” he said.
However, Bale said the study involved only a small number of participants.
“The promising results support the need for larger clinical trials to confirm the safety and efficacy of the treatment and provide the evidence needed for ‘adaptive’ DBS to become a much-needed, approved new treatment for Parkinson’s patients,” he added.
