{
  "abstract": "A randomized crossover study of five patients with Parkinson's disease (PD) demonstrates that gait-synchronized adaptive deep brain stimulation is feasible and safe, and reduces falls compared with continuous stimulation. Gait dysfunction in PD is a major source of disability and is often insufficiently treated by continuous deep brain stimulation (cDBS). Although adaptive DBS (aDBS) has shown efficacy for other motor symptoms using β-based, state-driven neural signals, gait is a dynamic, cyclical behavior that may require temporally precise modulation. Here we evaluated a behavior-contingent aDBS approach that synchronizes stimulation to gait phase. We reported a single-center, blinded, randomized, crossover study evaluating the feasibility of identifying patient-specific biomarkers to drive aDBS. The primary outcome was feasibility of successful identification of gait-phase biomarkers to implement aDBS. Five participants with PD undergoing pallidal DBS and subdural electrode paddle implantation were enrolled. We successfully identified personalized gait-phase biomarkers from cortical or pallidal field potentials in all five patients and embedded them into a bidirectional neurostimulator. During acute in-clinic testing, aDBS improved step variability and step symmetry versus cDBS. Three participants subsequently completed a double-blinded, multi-day crossover phase. In this setting, aDBS maintained general motor symptom control, reduced falls and yielded patient-specific gait improvements. No adverse events occurred and aDBS was well tolerated. These findings establish the feasibility of biomarker-driven, movement-synchronized neuromodulation and support the development of a larger randomized trial to determine clinical efficacy. ClinicalTrial.gov registration: NCT04675398 .",
  "abstract_shown": true,
  "affiliations": [
    "Department of Neurological Surgery, University California, San Francisco, San Francisco, CA, USA",
    "Department of Physical Therapy and Rehabilitation Sciences, University of California, San Francisco, San Francisco, CA, USA",
    "Department of Applied Physiology & Kinesiology, University of Florida, Gainesville, FL, USA",
    "Graduate Program in Bioengineering, University of California, Berkeley and University of California, San Francisco, San Francisco, CA, USA",
    "Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA",
    "Department of Neurological Surgery, University California, San Francisco, San Francisco, CA, USA. doris.wang@ucsf.edu",
    "Graduate Program in Bioengineering, University of California, Berkeley and University of California, San Francisco, San Francisco, CA, USA. doris.wang@ucsf.edu",
    "Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA. doris.wang@ucsf.edu"
  ],
  "article_type": null,
  "arxiv": null,
  "author_total": 9,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Kenneth H. Louie",
      "orcid": "0000-0003-1702-1521"
    },
    {
      "affs": [
        0
      ],
      "name": "Jannine P. Balakid",
      "orcid": "0009-0005-4988-0509"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Jessica E. Bath",
      "orcid": "0000-0001-8696-8503"
    },
    {
      "affs": [
        0
      ],
      "name": "Seongmi Song"
    },
    {
      "affs": [
        0
      ],
      "name": "Hamid Fekri Azgomi",
      "orcid": "0000-0001-8463-004X"
    },
    {
      "affs": [
        0
      ],
      "name": "Jacob H. Marks"
    },
    {
      "affs": [
        2
      ],
      "name": "Julia T. Choi"
    },
    {
      "affs": [
        0,
        3,
        4
      ],
      "name": "Philip A. Starr",
      "orcid": "0000-0003-2733-4003"
    },
    {
      "affs": [
        5,
        6,
        7
      ],
      "name": "Doris D. Wang",
      "orcid": "0000-0001-6112-3002"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/3bd190bj7xcdm.bib",
  "cited_by": 13,
  "doi": "10.1038/s41591-026-04434-2",
  "fulltext_url": null,
  "id": "3bd190bj7xcdm",
  "issns": [
    "1078-8956",
    "1546-170X",
    "1744-7933"
  ],
  "landing_url": "https://doi.org/10.1038/s41591-026-04434-2",
  "language": "en",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "journal",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2728|Deep Brain Stimulation and Movement Disorders"
    ]
  ],
  "openalex": "W7164815873",
  "pdf_url": "https://www.nature.com/articles/s41591-026-04434-2.pdf",
  "pmcid": "PMC12393632",
  "pmid": "40894140",
  "published": "2026-06-15",
  "publisher": "Nature Portfolio",
  "ris": "https://research.draconitic.com/paper/3bd190bj7xcdm.ris",
  "sources": [
    {
      "first_seen": "2026-11-04T13:21:14Z",
      "native_id": "W7164815873",
      "source": "openalex",
      "url": "https://doi.org/10.1038/s41591-026-04434-2"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2728|Deep Brain Stimulation and Movement Disorders",
      "subfield": "neurology"
    }
  ],
  "title": "Adaptive deep brain stimulation for dynamic gait control in Parkinson’s disease: a randomized feasibility trial",
  "title_text": "Adaptive deep brain stimulation for dynamic gait control in Parkinson’s disease: a randomized feasibility trial",
  "type": "peer-reviewed",
  "updated_at": "2026-11-05T13:21:08Z",
  "url": "https://research.draconitic.com/paper/3bd190bj7xcdm",
  "venue": "Nature Medicine",
  "versions": []
}