Smart brain stimulation in Parkinson’s disease

Rationale: Deep brain stimulations (DBS) is an established treatment for movement disorders like Parkinson’s Disease (PD), dystonia and Essential Tremor (ET). With DBS, small electrical pulses are applied to deep brain nuclei which lead to motor improvements in these disorders. Although DBS has been successfully applied for over 25 years there are still limitations in terms of effectiveness, side-effects and energy consumption. There is evidence that all these limitations might all be due to excessive electrical stimulation. The mechanism of the limited effectiveness and side-effects could be due to the fact that both pathological and physiological neural activity are disturbed with conventional, continuous DBS (cDBS). Very recent studies have found evidence that DBS might work better were it only to stimulate when necessary. This type of stimulation is called adaptive DBS (aDBS) and uses neurophysiological signals as indicator of symptom severity and trigger to stimulate.
Objective: Test whether aDBS is non-inferior to cDBS in terms of effectiveness and superior in terms of side-effects and energy consumption in patients with Parkinson’s disease.

Adaptive Deep Brain Stimulation (DBS) based on neurophysiological biomarkers is equally effective as continuous DBS with less side-effects and energy consumption.

Primary: after 15 minutes of stimulation

Secondary I: after 20 minutes of stimulation

Secondary II: after 15 minutes of stimulation

Secondary III: 15 minute interval

Intervention:
- application of adaptive deep
brain stimulation

Control interventions:
- continous stimulation

- no stimulation