Objective: We aim to evaluate the effectiveness of single threshold adaptive deep brain stimulation (aDBS) for freezing of gait (FOG) in Parkinson’s disease (PD). We hypothesize that rapidly changing stimulation amplitude using single-threshold aDBS in response to patient-specific beta band power will disrupt the paroxysmal oscillatory dysfunction (“beta bursts”) and improve FOG episodes and gait

Background: With the advent of sensing-enabled DBS, it has become possible to record and analyze brain local field potentials (LFPs) in clinic and to utilize closed-loop aDBS to change DBS parameters in real-time. Both higher beta-STN power and longer beta-STN burst duration were found in patients with FOG and during FOG episodes. Hence, beta power could be used as a neural input for aDBS in treating FOG

Method: We have initiated a pilot clinical trial to evaluate the effectiveness of single-threshold aDBS to acutely improve FOG and gait abnormalities in patients with PD. We will recruit 20 patients with STN or GPi DBS and a Percept™ device. We will compare FOG severity and gait kinematics during aDBS, cDBS, and OFF-DBS in the OFF-medication state using walking tasks known to induce FOG, including timed up and go (TUG), 360-degree turns, and walking through a doorway with and without motor and cognitive tasks. Programming aDBS will be patient-specific based on beta peak power. Inertial measurement units will measure gait kinematics and video recordings will be annotated for FOG. LFPs will be recorded during all conditions and walking tasks. Statistical significance will be assessed using Kruskal–Wallis tests and one-way ANOVA for non-parametric and parametric outcomes, respectively

Results: The primary outcomes will be percentage of time spent freezing for each walking task; and gait speed during straight walking. Secondary outcomes will include TUG duration; 360-degree turn durations and turning speed; other gait kinematics including the domains of pace, rhythm, symmetry, postural control, and variability during straight walking and turning; and LFP (beta and gamma power) correlates with primary outcomes. We expect that aDBS will decrease the percentage of time spent freezing and improve gait speed and kinematics as compared to cDBS and OFF-DBS

Conclusion: Our study will evaluate safety, tolerability, and effectiveness of single-threshold aDBS using Percept in the treatment of FOG and gait dysfunction

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MDS Abstracts - https://www.mdsabstracts.org/abstract/protocol-for-rapidly-adaptive-deep-brain-stimulation-to-improve-freezing-of-gait-in-patients-with-parkinsons-disease/