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Adaptive Cortical and Subcortical Brain Stimulation to Improve Motor Behaviors and Gait in Parkinson’s Disease


Brief Summary:

This is a single-center phase I clinical study aiming to improve gait functions in patients
with Parkinson’s disease (PD) by using adaptive neurostimulation to the pallidum. The
investigators will use a bidirectional deep brain stimulation device with sensing and
stimulation capabilities to 1) decode the physiological signatures of gait and gait
adaptation by recording neural activities from the motor cortical areas and the globus
pallidus during natural walking and a gait adaptation task, and 2) develop an adaptive deep
brain stimulation (DBS) paradigm to selectively stimulate the pallidum during different
phases of the gait cycle and measure improvements in gait parameters. This is the first
exploration of network dynamics of gait in PD using chronically implanted cortical and
subcortical electrodes. In addition to providing insights into a fundamental process, the
proposed therapy will deliver personalized neurostimulation based on individual physiological
biomarkers to enhance locomotor skills in patients with PD. Ten patients with idiopathic
Parkinson’s disease undergoing evaluation for DBS implantation will be enrolled in this
single treatment arm study.


Inclusion Criteria:

– Ability to give informed consent for the study

– Movement disorder symptoms that are sufficiently severe, in spite of best medical
therapy, to warrant surgical implantation of deep brain stimulators according to
standard clinical criteria

– Patient has requested surgical intervention with deep brain stimulation for their

– No movement -elated abnormalities that suggest an alternative diagnosis or
contraindicate surgery

– Absence of significant cognitive impairment (score of 21 or greater on the Montreal
Cognitive Assessment (MoCA),

– Signed informed consent

– Ability to comply with study follow-up visits for brain recording, testing of adaptive
stimulation, and clinical assessment.

– Age 21-75

– Diagnosis of idiopathic PD with duration of motor symptoms for 3 years or greater

– Patient has undergone appropriate therapy with oral medications with inadequate relief
as determined by a movement disorders neurologist.

– UPDRS-III score off medication between 20 and 80 and an improvement of at least 30% in
the baseline UPDRS-III on medication score, compared to the baseline off-medication
score, and motor fluctuations with at least 2 hours per day of on time without
dyskinesia or with non-bothersome dyskinesia. OR Patients with tremor-dominant PD (a
tremor score of at least 2 on a UPDRS-III sub-score for tremor), treatment resistant,
with significant functional disability despite maximal medical management

– Patients with gait impairments: slowed gait, shuffling steps, postural instability, or
freezing of gait off medication.

– Ability of patient and/or caregivers to recharge the system evaluated by all
clinicians and study personnel.

– Geographical proximity and/or ability to travel to study sites for patient to receive
re-programming via investigational devices (e.g. Summit Research Laboratory

Exclusion Criteria:

– Coagulopathy, anticoagulant medications, uncontrolled hypertension, history of
seizures, heart disease, or other medical conditions considered to place the patient
at elevated risk for surgical complications

– Evidence of a psychogenic movement disorder: Motor symptoms that remit with suggestion
or “while unobserved”, symptoms that are inconsistent over time or incongruent with
clinical condition, plus other manifestation such as “false” signs, multiple
somatizations, or obvious psychiatric disturbance.

– Pregnancy: all women of child bearing potential will have a negative urine pregnancy
test prior to undergoing their surgical procedure.

– Significant untreated depression (BDI-II score >20). History of suicidal attempt or
active suicidal ideation (Yes to #2-5 on C-SSRS)

– Any personality or mood symptoms that study personnel believe will interfere with
study requirements.

– Subjects who require electroconvulsive therapy (ECT), repetitive transcranial magnetic
stimulation (rTMS) or diathermy

– Implanted stimulation systems such as; cochlear implant, pacemaker, defibrillator, or

– Previous cranial surgery

– Drug or alcohol abuse

– Meets criteria for Parkinson’s disease with mild cognitive impairment (PD-MCI). These
criteria are: performance of more than two standard deviations below appropriate
norms, for tests from two or more of these five cognitive domains: attention,
executive function, language, memory, and visuospatial tests.

– Known allergies to the implantable device components including titanium, polyurethane,
silicone, and nylon.


  • UCSF, San Francisco, California, United States, 94134
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