Researchers at the University of California, San Francisco have taken a step toward a long-sought goal in treating Parkinson’s disease: a brain implant that can adapt to a patient’s movements in real time. In a study published Monday in the journal Nature Medicine, UCSF scientists reported th at a new form of adaptive deep brain stimulation, or DBS, helped improve walking patterns and reduce falls among a small group of people living with Parkinson’s disease. Unlike traditional DBS, which delivers a steady stream of electrical pulses, the new system continuously listens to the brain and adjusts its output as a person walks. For many people with Parkinson’s, walking can become one of the most frustrating and disabling symptoms of the disease. Patients may freeze in place without warning, lose their balance or fall. While DBS has transformed treatment for tremors, stiffness and slowness, walking difficulties have remained difficult to treat. “Difficulty walking is one of the most disabling symptoms of Parkinson’s disease and one of the hardest to treat,” Doris Wang, associate professor of neurological surgery at the university and the study’s senior author, said in a statement released by UCSF Health. “Walking is a highly dynamic behavior that requires precise timing across both sides of the body. We developed a system that can recognize those movement patterns and respond in real time, effectively allowing the stimulation to work with the patient as they move.” The UCSF scientists believed one reason standard DBS has had limited success in improving gait is that walking constantly changes. Every step requires rapid coordination between the brain, spinal cord and muscles. Conventional stimulators, however, deliver the same therapy regardless of what a person is doing. To address that challenge, they developed a personalized adaptive system that identifies brain signals associated with movement of the left and right legs. Those signals were embedded directly into an implanted neurostimulator, allowing the device to automatically adjust stimulation during each phase of walking without relying on an external computer. “The brain contains remarkably rich information about movement,” said Kenneth Louie, a UCSF postdoctoral scholar and the study’s first author. “We found that we could identify neural signatures linked to each step and use them to guide stimulation in real time.” The study involved five people with Parkinson’s disease who had previously undergone DBS surgery and were participating in a UCSF research program. In addition to therapeutic electrodes implanted deep within the brain, participants had research electrodes placed over movement-related areas, allowing scientists to identify personalized neural signatures of walking and program the device to respond automatically. In laboratory testing, the adaptive system improved gait symmetry and reduced variability in walking patterns, both signs of more stable and efficient movement. Participants then tested the technology in their daily lives during a blinded, multi-day study. Researchers found that falls occurred less often when the adaptive system was active while overall control of Parkinson’s symptoms was maintained. No serious adverse events were reported, and participants tolerated the rapid stimulation adjustments, according to the study. The findings are preliminary, and researchers cautioned that larger studies will be needed. Still, the work points toward a future in which implanted devices continuously monitor brain activity and deliver personalized therapy only when needed. “This study is about more than walking,” Wang said. “It demonstrates that brain stimulation can adapt to what a person is doing in real time. That opens the door to future therapies that respond dynamically to movement, speech, mood, cognition, and other brain functions.” Researchers say the approach could eventually reshape how neurological disorders are treated. “This is an important step toward a new generation of brain therapies,” Wang said. “Instead of delivering the same stimulation all day long, future devices may continuously listen to the brain and immediately respond to a patient’s needs. Just as pacemakers transformed the treatment of heart disease, intelligent neurostimulators may transform how we treat disorders of the brain.” ...read more read less