- More than 10 million people worldwide suffer from Parkinson’s disease, for which there is currently no cure.
- Deep brain stimulation (DBS) is a surgical treatment that helps relieve some of the movement symptoms of the disease.
- Parkinson’s patients may still experience movement problems when using current DBS systems.
- Researchers at the University of California, San Francisco, found that adaptive deep brain stimulation using artificial intelligence can reduce the time a person experiences their most distressing Parkinson’s symptom by about 50%.
More than 10 million people worldwide suffer from Parkinson’s disease, a neurological disorder that affects a person’s ability to move and balance.
Although there is currently no cure for Parkinson’s disease, intensive research is being carried out to develop ways to alleviate the symptoms of the disease.
One of these is called deep brain stimulation (DBS) – a surgical procedure in which electrodes are implanted in specific areas of a person’s brain. These are connected to an internal pulse generator (IPG) placed under the skin near the collarbone, creating a “brain pacemaker”.
DBS helps relieve movement symptoms of Parkinson’s disease, such as tremors and dyskinesia.
“Although standard treatments such as conventional DBS (cDBS) work well in reducing movement problems in Parkinson’s disease, some patients – even after optimizing the stimulation intensity for cDBS – may still experience bothersome symptom changes throughout the day, for example in response to medications used to treat Parkinson’s disease,” Stephanie Cernera, PhD, postdoctoral fellow at the University of California, San Francisco (UCSF) told Medical news today.
“As a result, patients on cDBS may experience breakthrough symptoms due to periods of under- or overstimulation,” Cernera continued.
“For this reason, current therapies are not optimal for all patients. Understimulation would occur during times when the effects of the medications are wearing off and more stimulation is required than programmed for cDBS. Overstimulation could occur during times when the medications are active and side effects induced by the stimulation would occur. These symptom fluctuations could negatively impact daily activities and quality of life,” she explained.
Along with Carina R. Oehrn, MD, PhD, and Lauren H. Hammer, MD, PhD, Cernera is co-lead author of a new study investigating the use of adaptive deep brain stimulation (aDBS) in Parkinson’s disease.
In this small study, researchers found that aDBS with
The study was recently published in the journal
For this study, Cernera and her colleagues conducted a clinical trial with four participants who had Parkinson’s disease and were already using conventional DBS.
“We knew that conventional DBS was not optimal for our four patients because they still reported bothersome motor symptoms and motor fluctuations with clinically optimized conventional DBS,” explained Cernera. “We hypothesized that adaptive DBS would reduce their movement problems throughout the day because it effectively increases and decreases stimulation when patients need it.”
“An adaptive DBS continuously monitors a brain signal that best tracks a patient’s symptoms,” she continued. “Once the algorithm detects a change in the brain signal, it adjusts the stimulation intensity in real time. This means the device delivers the right amount of stimulation the patient needs to adequately control their symptoms.”
To implement adaptive DBS, the authors developed a data-driven analysis pipeline that identifies brain signals indicative of changes in symptoms, as well as the adaptive DBS algorithms embedded in the research device.
“Current standard treatments for Parkinson’s disease – such as conventional DBS – are not optimal for every patient,” Cernera said.
She added:
“We decided to create this pipeline and algorithms because patients with Parkinson’s disease still suffer from disturbing symptom fluctuations. We wanted to create an algorithm that would use the identified brain signal to automatically adjust the stimulation amplitude in real time to meet the patient’s specific needs. Unlike standard DBS, which provides a constant stimulation intensity, adaptive DBS would adjust the stimulation intensity based on the patient’s current state as measured by the brain signal.”
During their study, researchers found that adaptive DBS helped reduce study participants’ most bothersome Parkinson’s symptoms by about 50% compared to traditional DBS.
“In our study, we found that adaptive DBS reduced the time spent with bothersome motor symptoms by half compared to conventional DBS and improved patients’ quality of life,” said Cernera.
“To ensure that adaptive DBS does not alleviate the most bothersome motor symptom at the expense of other motor or non-motor symptoms, we also monitored a range of other motor (such as speech and gait disturbances) and non-motor symptoms (sleep, mood, anxiety). We found that adaptive DBS was no different from conventional DBS and in some cases even improved other motor symptoms,” she added.
“We customized each adaptive DBS algorithm to treat each patient’s most bothersome symptom,” noted Cernera. “This led us to believe that we were changing something that really mattered to the patient and would improve their quality of life. We were excited to be able to confirm our hypotheses in our study.”
After reviewing this study, Dr. Jean-Philippe Langevin, a neurosurgeon and director of the Restorative Neurosurgery and Deep Brain Stimulation Program at the Pacific Neuroscience Institute in Santa Monica, California, who was not involved in this research, said: MNT that it was very well designed and robust as it used a blinded and crossover approach.
He added that the findings were groundbreaking on several levels.
“The authors found that the use of adaptive stimulation during DBS was superior to chronic continuous stimulation for treating the symptoms of Parkinson’s disease,” Langevin explained.
“This is a critical finding because adaptive stimulation delivers stimulation on demand, unlike continuous, constant stimulation. By delivering stimulation only when needed, DBS therapy may be improved by reducing potential side effects and extending the life of the implantable battery. For these reasons, adaptive stimulation would still make sense even if it were equivalent to continuous stimulation; however, the authors found that it may be superior because it delivers additional stimulation only when needed.”
– Dr. Jean Philippe Langevin
“Despite all available treatment options and optimized therapy, Parkinson’s disease remains a disability for patients,” he continued.
“Any new or improved therapeutic efficacy would have a direct impact on the quality of life of our patients. I believe the most important step would be to expand the study to a larger sample. The technology currently available on the market is already almost able to implement this treatment strategy,” noted Langevin.
MNT also spoke with Shabbar F. Danish, MD, FAANS, Chair of Neurosurgery at Jersey Shore University Medical Center, New Jersey, about this study.
“This represents a real advance in the field and a significant step forward in the care of these patients,” said Danish, who was not involved in the research.
“There is currently no cure for Parkinson’s disease, so we need to continue to refine our treatments so that the symptoms of the disease can be controlled. We need to better understand which signals in the brain correlate with certain symptom clusters so that we can develop more targeted treatments,” he concluded.
