Adaptive Deep Brain Stimulating, a Promising Therapy for Parkinson's Disease

"Five years later, I'm taking only one pill a day, whereas I used to take five or six."

"It's not a cure or miracle, but it's definitely a game changer in the sense of feeling better day-to-day."

"The tremor's gone, dyskinesia is gone, and I don't have that brain fog that I used to have when I was taking so many meds." 

Professor Keith Krehbiel, political scientist, Parkinson's patient

"For some patients, especially people who have more severe symptoms, standard DBS that is always on at one constant setting doesn't give them enough benefit. The needs of the brain change depending on their activity level, such as when they're awake versus asleep, and particularly according to their medication cycle."

"One way to develop this kind of algorithm is to first do some studies of brain signals in known conditions. Then you can train an artificial intelligence algorithm on this known data, so that the AI program learns what combinations of brain signals are associated with different states."

Professor Philip Starr, neurological surgery, University of California, San Francisco

 

"Imagine you're in a crowd, and there's a hum of conversation, but you can easily hear yourself talk -- that's the normal broadband neural activity situation."

"But with oscillopathy, it's as if you're in a protest march where everybody's chanting the same thing, and  you can't hear yourself speak."

Dr. Helen Bronte-Stewart, professor of neurology and neurological sciences, Stanford School of Medicine 

Five years ago Keith Krehbiel, along with others volunteered to take part in an innovative non-pharmacological treatment for Parkinson's disease; Adaptive deep brain stimulation whose purpose is to enhance deep brain stimulation -- an existing treatment for the condition -- but with the addition of artificial intelligence. Their most debilitating motor symptoms has been virtually eliminated with the emerging therapy, their quality of life considerably improved.

 

At the same time they have been enabled with the use of the therapy to reduce their medication intake and with it, they have experienced a decrease in corresponding negative side-effects. The scientists probing the Adaptive deep brain stimulation therapy with the intention of improving its effects hope that it will in time help other Parkinson's patients aside from their test subjects.  

DBS (Deep Brain Stimulation) has been in use since 1997 as an established surgical therapy for the treatment of symptoms of Parkinson's. A device similar to a heart pacemaker is implanted in the brain with DBS, to deliver electrical pulses. Conventional DBS is regarded as a one-size-fits-all approach to ameliorating the devastating effects of Parkinson's. Adaptive DBS on the other hand, personalizes therapy based on brain activity in real time for patients, with the help of AI. 

The brain, like the heart, produces patterns of electrical activity produced by neurons; in other words, normal rhythms. Epilepsy and schizophrenia are medical conditions associated with abnormal brain rhythms, with a similarity to cardiac arrhythmias. Neurons become overly synchronized in Parkinson'sin what is recognized as oscillopathy, with its potential of interfering with the normal transfer of information, and lead to symptoms like tremors and stiffness.

 

Parkinson's medications and DBS dampen oscillopathy in the brain. Steady electrical pulses from DBS help to pace the neuronal firing in a manner overriding hyper-synchronization of oscillopathy, restoring brain rhythms to normal. Conventional DBS delivers electrical stimulation at a constant -- "always on" -- setting where periods of under-stimulation and over-stimulation can occur, that result in slowness of movement, or dyskinesias (respectively).

 

On the other hand, Adaptive DBS detects real-time neural signals and automatically adjusts stimulation in response to oscillopathy or other biomarkers. An algorithm delivering the right amplitude or 'dose' of stimulation when it is needed in an adaptive manner, to provide a more stable therapeutic experience for patients is achieved with Adaptive DBS when AI modelling is used to develop an algorithm. 

 

Adaptive DBS is associated with greater motor symptom control, fewer side-effects, and lower electrical energy delivered in comparison to conventional DBS, as has been demonstrated through early studies. In 2024, Professor Starr and colleagues conducted a pilot study of four participants with Parkinson's to discover that Adaptive DBS improved motor symptoms and quality of life, far in excess of what conventional DBS delivers. 

The Starr team of scientists personalized algorithms for each of their study patients, bringing them into the clinic and measuring their brain rhythms, on or off levodopa, a Parkinson's medication used to increase levels of dopamine. 68 patients with Parkinson's were included in the ADAPT-PD clinical trials, (leading to the FDA approval), which included Krehbiel, with a previously implanted conventional DBS system. Dr. Bronte-Stewart and colleagues provided the patients with Adaptive DBS and the participants were sent home for 30 days.

 

Full results of the study not yet published, preliminary data reveals no serious adverse device events, and 98 percent of participants decided to remain on Adaptive DBS, in long-term followup. The therapy is not meant for everyone with Parkinson's. A good response to dopaminergic medications such as levodopa is a requisite, while patients considered for the therapy should not be too advanced in Parkinson's.

 

Andrew O'Keefe, a researcher and neurosurgical trainee at King's College London and colleagues are experimenting with stimulating various areas of the brain with directional electrodes to stimulate forward or backward; targeting and precisely controlling stimulation has the potential to improve DBS effectiveness. He hopes to optimize not only when, but where to deliver therapy, according to which biomarkers are involved, highlighting the complexity involved.

"It's like the hardest Sudoku problem you've ever tried to solve in three dimensions. It's insoluble for a human."

"But for an AI program, that's like grist to its mill. AI is incredibly good at sorting those complicated problems out."

Dr. Andrew O'Keefe

Playing golf study    Credit:  Mike Ehrmann/Getty

"We know that people with Parkinson's disease benefit from exercise, but not enough people with the disease get enough exercise as therapy."

"Golf is popular -- the most popular sport for people over the age of 55 -- which might encourage people to try it and stick with it. We decided to compare golf to Tai Chi in our study because
Tai Chi is the gold standard for balance and preventing falls in people with Parkinson's."

"Our finding that golfers were much more likely to continue with their sport is exciting because it doesn't matter how beneficial an exercise is on paper if people don't actually do it."

Dr.Anne-Marie Wills, Massachusetts General Hospital, Boston

Exercise is an important part of healthy living for everyone. For people with Parkinson’s disease (PD), exercise is more than healthy — it is a vital component to maintaining balance, mobility and activities of daily living. Exercise and physical activity can improve many PD symptoms. These benefits are supported by research.  Parkinson's Foundation

An industry of offerings for exercise treatment for Parkinson's focus on Tai Chi classes. Tai Chi is known for its role in improving balance and mobility, according to studies. According to Richard Selby who instructs in Tai Chi at the Central London Community Health-care NHS [British National Health Service] Trust's Parkinson's Day Unit, patients are given a "sense of well-being which helps them manage their condition better". 

Twice-weekly Tai Chi training, according to a previous study reported in the New England Journal of Medicine, led to improved postural stability, walking ability, and fewer falls on the part of patients. Now another research project has surfaced with interesting conclusions. The research is to be presented at the annual meeting of the American Academy of Neurology where the finding that people who practise golf swings at a driving range appear quicker and more mobile following ten weeks of practise than those who practised Tai Chi is to be released.

John Hopkins Medicine

 

Not a particularly large study, with twenty participants with moderate Parkinson's disease. The study participants were divided into two groups where eight people were randomly assigned to practise golf, a dozen others did Tai Chi. Both groups completed the assigned ten weeks of two one-hour group classes weekly. Researchers tested patients' balance, walking ability and risk of falling, both at the start and the finish of the study.

Study participants  were timed in one test that had them rising from a chair, walking ten feet, and then returning to the chair and seating themselves. Those who practised golfing, were timed at 0.96 seconds faster at the end of the test, than at the beginning. Those who practised Tai Chi were 0.33 seconds slower in response, while no difference was seen between the two groups in risk of falls or adverse effects.

Over four in five of the people who were assigned golf felt they were likelier to continue golfing, in comparison with a third of those who practised Tai Chi, feeling they would be interested in continuing with it. Perhaps it would be best not to overlook the fact that exercise of any kind is beneficial to those with Parkinson's; some types more effective overall, but all choices render benefits.

 

"Although Tai Chi shows statistically significant improvements on motor function and balance for patients with PD in the current meta-analyses, there is indeed not enough evidence to conclude that Tai Chi is effective for PD because of the small treatment effect, methodological flaws of the eligible studies, and insufficient follow-up. Consequently, large-scale, high-quality RCTs with long follow-up are warranted to confirm current findings of Tai Chi for PD."

Conclusion: A Meta-Analysis on the Efficacy of Tai Chi in Patients with Parkinson's Disease 

Ji Zhou,¹ Tao Yin,² Qian Gao,³ and Xiao Cun Yang³

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"We found that a program of twice-weekly tai chi for 24 weeks, as compared with a resistance-training program or a stretching program, was effective in improving postural stability and other functional outcomes in patients with mild-to-moderate Parkinson's disease. Tai chi training also significantly reduced the incidence of falls, as compared with the stretching program. Improvements in primary and secondary outcomes were maintained 3 months after the intervention, a finding that is consistent with prior research involving adults 70 years of age or older.¹³ No serious adverse events were observed during tai chi training, indicating the safety and usefulness of this intervention for persons with Parkinson's disease."

Tai Chi and Postural Stability in Patients with Parkinson's Disease

Fuzhong Li, Ph.D., Peter Harmer, Ph.D., M.P.H., Kathleen Fitzgerald, M.D., Elizabeth Eckstrom, M.D., M.P.H., Ronald Stock, M.D., Johnny Galver, P.T., Gianni Maddalozzo, Ph.D., and Sara S. Batya, M.D.

 

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