Study Rationale:
Walking impairment in people with Parkinson’s disease (PD) often arises from difficulties in coordinating leg movements in response to environment changes. Continuous stimulation of deep brain structures may fail to improve walking as it does not change with gait. By recording brain activities from PD patients implanted with brain electrodes used for deep brain stimulation (DBS) therapy, our study seeks to understand the neural activities that controls the gait cycle in PD. DBS may be able to target those activities to ease gait problems.
Hypothesis:
Our hypothesis is that electrical stimulation during different phases of the walking cycle can enhance the walking functions in patients with PD.
Study Design:
Patients undergoing DBS for treatment of their PD will be implanted with an electrode spanning the striatum and the conventional therapeutic target (the pallidum). This electrode will be connected to a specialized DBS device that can record neural signals in addition to providing therapeutic stimulation. We will record brain activities from the striatum and pallidum while patients engage in a task where they learn a sequence of steps. We will then test whether stimulation of the striatum during different parts of walking can improve learning of these step sequences.
Impact on Diagnosis/Treatment of Parkinson’s Disease:
This study will allow us to define and test individualized stimulation parameters to improve the effect of gait rehabilitation in patients with Parkinson’s disease. This novel strategy has the potential to address the critical need for improving gait in Parkinson’s disease.
Next Steps for Development:
Positive results from this study will allow us to test these novel individualized stimulation strategies in a larger clinical trial to measure gait improvements over traditional DBS therapy. Eventually, we hope to make these novel stimulation strategies standard of care for treating gait disturbances in PD.