Long-term improvement of gait with adaptive deep brain stimulation in a patient with Parkinson’s disease

Abstract

ABSTRACTA major limitation of conventional deep brain stimulation (cDBS) of the subthalamic nucleus (STN) for Parkinson’s disease (PD) is poor efficacy and, in some cases, worsening of gait disturbances. We applied a novel DBS paradigm, which adjusts the current amplitude linearly with respect to subthalamic beta power (adaptive DBS, aDBS), in one parkinsonian patient with gait impairment and chronically stimulated with bilateral STN-cDBS. When in aDBS mode, the patient showed a consistent improvement in walking while retaining benefit on other PD-related symptoms. Spatiotemporal gait parameters and anticipatory postural adjustments, particularly the imbalance phase, significantly improved with aDBS mode. This improvement was maintained for more than five months of follow-up. Adaptive DBS can benefit gait in PD by possibly avoiding overstimulation and dysfunctional entrainment of the supraspinal locomotor network.