By info@ico28.com 
A recent feasibility study funded by the National Institutes of Health (NIH) has demonstrated that an implantable device, which adjusts its operation based on real-time brain activity, may help better manage Parkinson’s disease (PD) symptoms for certain people.
This method, known as adaptive deep brain stimulation (aDBS), improves on traditional deep brain stimulation (DBS) that has been used for years to treat PD and other neurological disorders. The study revealed that aDBS provides better control of PD symptoms compared to conventional deep brain stimulation (DBS).
DBS involves placing small electrodes in specific areas of the brain to send electrical signals that reduce symptoms of disorders like PD. Traditional DBS provides constant stimulation, which can sometimes cause side effects because the brain doesn’t always need the same amount of stimulation. In contrast, aDBS uses real-time feedback from the brain, coupled with machine learning algorithms, to dynamically adjust the intensity of stimulation in response to the patient’s changing needs.
In the study, four participants who were already receiving conventional DBS were asked to identify their most troublesome symptom, which typically involved involuntary movements or difficulty initiating movement. The aDBS system was then set up to target these specific symptoms. After several months of algorithm training, the participants were sent home, where the effectiveness of aDBS was compared to their existing treatment. The study employed a crossover design, with participants alternating between aDBS and conventional DBS every two to seven days.
Results showed that aDBS improved the most bothersome symptoms by approximately 50% compared to conventional DBS. Interestingly, even though the participants were not informed about which treatment they were receiving at any given time, three out of the four were able to identify when they were using aDBS due to noticeable improvements in their symptoms.
This study builds on years of research led by Philip Starr, M.D., PhD, and his team at the University of California, San Francisco. In 2018, they introduced an early version of the aDBS system, which adjusted its operation based on feedback from brain activity – a system known as “closed-loop” DBS. Further developments in 2021 enabled the recording of brain activity during normal daily activities. The current study combines these advancements, utilising brain activity data recorded during daily life to inform the operation of the aDBS system. However, they found that DBS itself changes brain activity so much that the expected signal was hard to detect. So, they used a data-driven approach to find a new signal in the brains of people with PD who were receiving DBS.
Parkinson’s disease is often treated with the drug levodopa, which compensates for dopamine loss in the brain. However, the drug’s effectiveness fluctuates, peaking shortly after administration and gradually diminishing as it is metabolised. aDBS could help smooth out these fluctuations by increasing stimulation when drug levels are high and reducing it when they’re low, making it a good option for people who need high doses of levodopa.
Although these findings are promising, there are still challenges to making aDBS more widely available. The initial setup of the device demands extensive input from specialised clinicians. But researchers hope that, in the future, the device could manage itself more, reducing the need for frequent clinic visits to adjust settings. This kind of automation is important for more people to be able to use aDBS in a clinical setting.
Addressing the challenges of accessibility and training for DBS is important because the therapy requires specialised expertise that is not widely available. Automating aDBS could make this treatment easier to access for more patients.
Original article source:
FAQ
- What is an adaptive brain pacemaker?
An adaptive brain pacemaker, also known as an adaptive deep brain stimulator (aDBS), is a device that provides electrical stimulation to specific areas of the brain. Unlike traditional DBS, which delivers continuous stimulation, an adaptive pacemaker adjusts the stimulation in real-time based on the patient’s brain signals.
- How does an adaptive brain pacemaker differ from a traditional DBS device?
Traditional DBS devices deliver constant electrical stimulation, regardless of the patient’s current brain activity. In contrast, an adaptive brain pacemaker monitors brain signals, such as local field potentials, and adjusts the stimulation accordingly. This approach can potentially reduce side effects and improve symptom control.
- What symptoms of Parkinson’s disease can an adaptive brain pacemaker help alleviate?
Adaptive brain pacemakers are primarily used to reduce motor symptoms of Parkinson’s disease, such as tremors, rigidity, bradykinesia (slowness of movement), and dyskinesia (involuntary movements). Some studies suggest that aDBS may also improve non-motor symptoms, but this is still an area of active research.
- What are the potential benefits of using an adaptive brain pacemaker?
– Improved Symptom Control: By adjusting stimulation based on real-time brain activity, adaptive devices may provide better control over motor symptoms.
– Reduced Side Effects: Adaptive stimulation can potentially minimize side effects, such as dyskinesia, that may occur with constant stimulation.
– Energy Efficiency: Because adaptive devices deliver stimulation only when needed, they may use less battery power, potentially extending the life of the device.
- Are adaptive brain pacemakers widely available?
As of now, adaptive brain pacemakers are primarily available in clinical trials or specialized research settings. They are not yet widely available as standard treatment for Parkinson’s disease.
- What are the risks associated with adaptive brain pacemakers?
The risks of adaptive brain pacemakers are similar to those of traditional DBS, including infection, bleeding, and hardware-related complications. However, because aDBS is a newer technology, long-term data on its safety and efficacy are still being collected.
- How effective are adaptive brain pacemakers in reducing Parkinson’s symptoms?
Early studies suggest that adaptive brain pacemakers can be more effective than traditional DBS in reducing motor symptoms and minimizing side effects. However, more research is needed to confirm these findings and determine the long-term benefits.