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Deep brain implants that continuously adjust electrical stimulus to an individual’s neural activity can provide enhanced therapy for Parkinson’s disease, the first clinical trial of the technology has shown.
Researchers at the University of California San Francisco found that the approach, called adaptive deep brain stimulation, or aDBS, reduced the motor symptoms of Parkinson’s by half when compared with conventional DBS implants, which deliver steady electrical pulses.
Parkinson’s, which results from the progressive loss of neurons in brain regions responsible for movement, affects about 10mn people worldwide. Although the disease’s genetic and environmental causes remain unknown, the adaptive technology promises to relieve symptoms such as tremors, spasms, stiffness and slow movement more effectively than conventional DBS.
Philip Starr, UCSF professor of neurosurgery, said the advance resulted from combining two strands of neurotechnology. One is the well-established practice of inserting stimulating electrodes deep into the brain; the other, pioneered by several start-ups including Elon Musk’s Neuralink, uses computer interfaces to read and interpret neural activity.
“We have long had a dream of making DBS respond to brain activity, giving us a smart pacemaker for the brain,” he said. “Our study demonstrates that adaptive and self-regulating Parkinson’s therapy can be available for people to use long-term.”
The UCSF researchers inserted two stimulating electrodes into the subthalamic nucleus, the deep brain region that co-ordinates movement, and placed two sensing electrodes on the motor cortex, which initiates voluntary movement. Their study was published on Monday in Nature Medicine.
Using AI algorithms, they analysed the patterns of activity associated with each patient’s Parkinson’s symptoms to generate a personal therapy plan that automatically delivered the right amount of stimulus to control symptoms.
Four men with severe Parkinson’s took part in the trial. The researchers found that the new aDBS system reduced the patients’ most serious symptoms by 50 per cent when compared with the best conventional DBS implants.
A separate study showed that aDBS could recognise the characteristic brain activity associated with various states of sleep in Parkinson’s patients — raising the hope that neurotechnology could help to overcome the insomnia that affects most people with the condition.
The UCSF team is using “investigational” devices developed for research purposes by Medtronic, a US medical technology company.
“Adaptive stimulation is the future of DBS for Parkinson’s disease but it is not ready yet for widespread use,” said Starr. “It is still a complex therapy . . . We are working to automate the system and make it much easier to use.”
Scientists are working to develop the technology for other brain disorders. “We see that it has a profound impact on patients, with potential not just in Parkinson’s but probably for psychiatric conditions like depression and obsessive-compulsive disorder as well,” Starr said. “We are at the beginning of a new era of neurostimulation therapies.”
Claire Bale, associate director of research at the charity Parkinson’s UK, said the new technology “could help manage the fluctuating symptoms people experience and reduce the number of side-effects” in conventional DBS, which has been received by an estimated 175,000 patients over the past 30 years.
She called for larger clinical trials to “confirm the therapy’s safety and effectiveness and provide the evidence required for aDBS to become a much needed, approved new treatment for people with Parkinson’s”.
Illustration by Ian Bott
