Successful Adaptive DBS for Parkinson’s Disease Offers Promise for Neurological Disorders
A team of investigators at University of California, San Francisco led by past DMRF Medical & Scientific Advisory Council Member Dr. Philip Starr has made a groundbreaking step toward a next-generation approach to deep brain stimulation. They have successfully tested a fully implanted adaptive deep brain stimulation system in Parkinson’s disease patients that senses brain activity and automatically makes adjustments to stimulation parameters according to a patient’s needs. This pioneering study was conducted in two patients.
Deep brain stimulation (DBS) is a proven effective therapy for Parkinson’s disease, dystonia, and a growing list of neurological and psychiatric disorders. In current DBS systems, an implanted medical device delivers continuous stimulation to the brain and adjustments to the stimulation must be made using a remote control device in the hands of a highly trained clinician. Symptoms of Parkinson’s disease can fluctuate dramatically, so there may be times when the DBS system delivers more stimulation than a patient needs. This can result in stimulation-induced adverse effects including abnormal, involuntary movements referred to as dyskinesia. By contrast, an adaptive DBS system, which requires implantation of an additional brain ‘sensor,’ can detect specific brain activity signatures associated with DBS-induced side-effects and adjust the stimulation parameters in real-time, without the need for an external device.
The goal of the study was not to demonstrate that adaptive DBS is therapeutically superior to current DBS, but to demonstrate that this new approach is feasible without losing efficacy. Both patients in the study retained the clinical benefits of their original DBS system. One of the advantages of adaptive DBS is energy savings to the stimulator battery, resulting in fewer stimulator replacement surgeries. Additional advantages are that adaptive DBS is adjusted without the need for a clinic appointment and/or the need for patients to adjust their devices manually.
This study is one example of ongoing research efforts to make DBS systems more customized to a patient’s individual needs and to reduce the frequency of adverse effects. Additional examples of technology advancements in DBS were highlighted in this year’s Promise & Progress newsletter.
Swann NC, de Hemptinne C, Thompson MC, Miocinovic S, Miller AM, Gilron R, Ostrem JL, Chizeck HJ, Starr PA. Adaptive deep brain stimulation for Parkinson's disease using motor cortex sensing. J Neural Eng. 2018 Aug;15(4):046006.
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