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

A 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. ### Competing Interest Statement IUI is Newronika S.p.A. consultant. IUI is Adjunct Professor at the Department of Neurology, NYU Grossman School of Medicine. LB received research fundings (paid to the Institution) by Newronika S.p.A.. ### Clinical Trial NCT04681534 ### Funding Statement This study was funded by the European Union - Next Generation EU - NRRP M6C2 - Investment 2.1 Enhancement and strengthening of biomedical research in the NHS, and by the Fondazione Grigioni per il Morbo di Parkinson. CP and IUI were supported by the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation) Project-ID 424778381 - TRR 295. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ethics committee of Milano area 2 gave ethical approval for this work (code: 165-2020). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes