New Form of Parkinson's Treatment Uses Real-Time Deep-Brain Stimulation

A newly FDA-approved form of adaptive deep-brain stimulation (DBS) for Parkinson's disease adjusts electrical stimulation in real time based on an individual's brain signals, improving symptom control and reducing medication dependence. Scientific American: For decades, Keith Krehbiel took high doses of medications with a debilitating side effect -- severe nausea -- following his diagnosis with early-onset Parkinson's disease at age 42 in 1997. When each dose wore off, he experienced dyskinesia -- involuntary, repetitive muscle movements. In his case, this consisted of head bobbing and weaving. Krehbiel is among one million Americans who live with this progressive neurological disorder, which causes slowed movements, tremors and balance problems. But soon after surgery to implant electrodes into specific areas of his brain in 2020, his life dramatically improved. 'My tremor went away almost entirely,' says Krehbiel, now age 70 and a professor emeritus of political science at the Stanford Graduate School of Business, whose Parkinson's symptoms began at age 40 and were initially misdiagnosed as repetitive stress injury from computer use. 'I reduced my Parkinson's meds by more than two thirds,' he adds. 'And I no longer have a sensation of a foggy brain, nor nausea or dyskinesia.'

Krehbiel was the first participant to enroll in a clinical trial testing a new form of deep-brain stimulation (DBS), a technology that gained approval from the U.S. Food and Drug Administration for Parkinson's tremor and essential tremor in 1997 (it was later approved for other symptoms and conditions). The new adaptive system adjusts stimulation levels automatically based on the person's individual brain signals. In late February it received FDA approval for Parkinson's disease 'based on results of the international multicenter trial, which involved participants at 10 sites across a total of four countries -- the U.S., the Netherlands, Canada and France. This technology is suitable for anyone with Parkinson's, not just individuals in clinical trials, says Helen Bronte-Stewart, the recent trial's global lead investigator and a neurologist specializing in movement disorders at Stanford Medicine. 'Like a cardiac pacemaker that responds to the rhythms of the heart, adaptive deep-brain stimulation uses a person's individual brain signals to control the electric pulses it delivers,' Bronte-Stewart says. 'This makes it more personalized, precise and efficient than older DBS methods.'

'Traditional DBS delivers constant stimulation, which doesn't always match the fluctuating symptoms of Parkinson's disease,' adds neurologist Todd Herrington, another of the trial's investigators and director of the deep-brain stimulation program at Massachusetts General Hospital. With adaptive DBS, 'the goal is to adjust stimulation in real time to provide more effective symptom control, fewer side effects and improved patient quality of life.' Current FDA approval of this adaptive system is for the treatment of Parkinson's only, not essential tremor, dystonia (a neurological disorder that causes excessive, repetitive and involuntary muscle contractions) or epilepsy, which still rely on traditional, continuous DBS, Herrington says.

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