Deep brain stimulation (DBS) is a surgical procedure in which thin electrodes are implanted into parts of the brain to alter brain circuitry. It is used in the treatment of several neurologic conditions including Parkinson’s disease (PD), in which the electricity disrupts abnormal brain signals that allows the brain to restore more normal movement.
Currently, after the DBS system is implanted, different parameters of the delivered electrical signal are programmed for each person and can be adjusted and customized to maximize the benefit of the DBS. The customization is achieved by trial and error – a setting is selected, and the person determines whether that setting works well or not, and adjustments are made until the desired outcome is achieved.
However, now a new type of electrode is commercially available that not only delivers electricity to the brain but can sense the brain’s electric signals as well. In theory, this capability would allow the system to respond to the sensed signal and optimize the electricity delivery. This system, of using brain sensing to guide delivery, is known as adaptive DBS (aDBS). Although these sensing electrodes have been implanted in people, they have so far been used clinically as standard electrodes. Research into how best to use the sensing mechanisms of the electrodes has been underway and a paper was recently published in Nature Medicine that explains just that.
In a small group of four patients, adaptive deep brain stimulation (aDBS) was able to improve the residual motor symptoms of PD that were not controlled with a standard, non-adaptive DBS system. Adaptive DBS decreased the time spent with each person’s self-reported most bothersome symptom and improved overall quality of life. Although other studies have been published that investigated the use of aDBS, most were unblinded and took place in a highly controlled lab or clinic setting, whereas this study was blinded and examined aDBS’s effects in the home environment.
Although the results will need to be replicated in more people, they demonstrate that aDBS is extremely promising, not only as it will give more options to people who are not fully satisfied with their symptom control after standard DBS, but likely will provide better symptom control from DBS from the get-go.
APDA is excited to see this new era in DBS unfold, with more personalized treatment provided to people with PD, leading to more precise symptom management. Congratulations specifically to Dr. Jill Ostrem, one of the authors of this paper, and member of APDA’s Scientific Advisory Board.
