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Peer-reviewedCC BYNature Medicine

Adaptive deep brain stimulation for dynamic gait control in Parkinson’s disease: a randomized feasibility trial

  • Kenneth H. Louie1
  • Jannine P. Balakid1
  • Jessica E. Bath1,2
  • Seongmi Song1
  • Hamid Fekri Azgomi1
  • Jacob H. Marks1
  • Julia T. Choi3
  • Philip A. Starr1,4,5
  • Doris D. Wang6,7,8
8 affiliations
  1. 1Department of Neurological Surgery, University California, San Francisco, San Francisco, CA, USA
  2. 2Department of Physical Therapy and Rehabilitation Sciences, University of California, San Francisco, San Francisco, CA, USA
  3. 3Department of Applied Physiology & Kinesiology, University of Florida, Gainesville, FL, USA
  4. 4Graduate Program in Bioengineering, University of California, Berkeley and University of California, San Francisco, San Francisco, CA, USA
  5. 5Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
  6. 6Department of Neurological Surgery, University California, San Francisco, San Francisco, CA, USA. [email protected]
  7. 7Graduate Program in Bioengineering, University of California, Berkeley and University of California, San Francisco, San Francisco, CA, USA. [email protected]
  8. 8Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA. [email protected]
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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 .

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Cite

BibTeXRIS
BibTeX
@article{louie2026adaptive,
  title = {{Adaptive deep brain stimulation for dynamic gait control in Parkinson’s disease: a randomized feasibility trial}},
  author = {Kenneth H. Louie and Jannine P. Balakid and Jessica E. Bath and Seongmi Song and Hamid Fekri Azgomi and Jacob H. Marks and Julia T. Choi and Philip A. Starr and Doris D. Wang},
  journal = {Nature Medicine},
  year = {2026},
  month = jun,
  doi = {10.1038/s41591-026-04434-2},
  url = {https://doi.org/10.1038/s41591-026-04434-2},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Adaptive deep brain stimulation for dynamic gait control in Parkinson’s disease: a randomized feasibility trial
AU  - Kenneth H. Louie
AU  - Jannine P. Balakid
AU  - Jessica E. Bath
AU  - Seongmi Song
AU  - Hamid Fekri Azgomi
AU  - Jacob H. Marks
AU  - Julia T. Choi
AU  - Philip A. Starr
AU  - Doris D. Wang
PY  - 2026
DA  - 2026/06/15
JO  - Nature Medicine
DO  - 10.1038/s41591-026-04434-2
UR  - https://doi.org/10.1038/s41591-026-04434-2
AB  - 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 .
SN  - 1078-8956
SN  - 1546-170X
SN  - 1744-7933
ER  -