Two New Studies Show Adaptive Deep Brain Stimulation May Improve Walking in Parkinson’s

Deep brain stimulation (DBS) is the most common surgical treatment for Parkinson’s disease (PD). It uses continuous electrical pulses to help control movement symptoms like tremor, stiffness and slowness. For many, DBS can be life changing. Its big shortfall is that it delivers the same stimulation all the time, which does not help with walking difficulties — including unsteady gait, freezing of gait (a sudden inability to move when walking) and falls. These are among the most disabling and dangerous PD symptoms with limited treatment options.

Recently, major advancements have been made in adaptive DBS (aDBS), which is when a DBS device adjusts its stimulation in real time based on a person’s symptoms or behavior. Studies show that aDBS is more helpful for controlling typical “on/off” symptoms (such as tremor and rigidity) compared to traditional DBS treatment. Now, two new studies published in Nature Medicine suggest that aDBS may also hold promise for treating gait impairment in people with Parkinson’s. 

1. One study, conducted by a team at Lausanne University Hospital in Switzerland, developed a system that uses brain signals to detect which locomotor (the ability to move) activity a person is performing — such as sitting, standing, walking or turning — and selects stimulation settings optimized for that specific activity.
2. The other study, led by a team at the University of California, San Francisco (UCSF), took a different approach: timing stimulation to specific phases of the walking cycle, footstep by footstep, guided by brain signals unique to each individual participant.

Both studies were small and early-stage but highlight that adaptive DBS could improve walking in ways that traditional DBS cannot. 

Study Results

The primary focus of both studies was whether adaptive DBS settings that target gait are feasible and safe, and whether they could improve walking compared to traditional continuous stimulation. Encouragingly, neither study reported negative events. 

Adaptive DBS was well tolerated in all participants, and both studies found that it still helped manage the movement symptoms — like tremors and stiffness — that traditional DBS provides. Beyond safety, both teams also tracked changes in participants’ walking patterns, including step consistency, symmetry and falls.

The Swiss study enrolled six people with Parkinson’s who had DBS implants in the subthalamic nucleus. The team used recordings from the implanted DBS device, combined with detailed motion tracking, to develop algorithms that could detect which activity a person was performing — walking on flat ground, avoiding obstacles, turning, etc. — and automatically adjust stimulation settings to match.

• This approach improved movement across multiple daily activities while preserving the benefits of traditional DBS for other movement symptoms.
• This system successfully decoded and adjusted to locomotor activities in real time, even as participants’ symptoms changed or took levodopa medication throughout the day — a key challenge for adaptive approaches.

The UCSF study enrolled five people with Parkinson’s who received DBS implants in the globus pallidus region, along with additional recording devices in other brain regions. Using those recordings, they found that the brain produces distinct electrical patterns during specific phases of walking — for example, when the leg swings forward. 

These patterns were unique to each participant, appearing at different frequencies and brain locations. By identifying each person’s individual ‘gait signature,’ the researchers were able to program the neurostimulator to deliver brief boosts of stimulation timed to match each step.

• During in-clinic testing, this adaptive DBS strategy improved step variability and step symmetry compared to traditional DBS stimulation.
• Three participants completed a multi-day trial in their own homes, where neither the participants nor the researchers knew which type of stimulation was being used. In this real-world setting, adaptive DBS maintained general movement symptom control and reduced falls.

While these are early results need to be confirmed in larger studies, they offer a promising glimpse into a fundamentally new way to address one of the most challenging aspects of Parkinson’s: walking difficulties.

Highlights

• Two studies, both published in Nature Medicine, tested adaptive DBS systems designed to target movement symptoms that automatically adjust to what a person is doing in real time.
• Both studies used personalized brain signals, unique to each participant, that specifically indicated different types of movement or activity. 
• The Swiss study used activity states— for example, recognizing whether a person was sitting, walking, or turning — to switch between optimized stimulation settings.
• The UCSF study used step-level precision — synchronizing stimulation pulses to the exact rhythm of each individual step – to make adjustments.
• Both approaches improved walking measures while maintaining the benefits of traditional DBS for other movement symptoms like tremor and stiffness.
• Neither study reported negative events and showed that these aDBS techniques were well tolerated.
• Both studies were small (six and five participants). Larger trials are needed to confirm these findings.

What Does This Mean?

Falls are a leading cause of injury and hospitalization for people with Parkinson’s. Since walking is a highly complex activity that requires precise coordination, traditional DBS with consistent stimulation often does not address balance and walking issues. Instead of delivering the same stimulation all the time, adaptive DBS devices adjust in real-time based on the brain’s activity. These studies leveraged this concept to specifically target gait impairment, indicating an important shift in how DBS could help walking symptoms. 

If larger studies confirm these findings, adaptive DBS could offer a meaningful improvement in daily life for people living with Parkinson’s — especially those experiencing gait and balance challenges.

These studies worked by identifying unique, personalized brain signals that were specific to each participant. The algorithms for adaptive DBS were then optimized based on this brain activity — a form of individualized, precision medicine. In addition, the physical location of the participants’ DBS implant varied between studies; the success of both platforms indicates that these treatments can be effective regardless of the DBS implant location, offering hope for more people with Parkinson’s.  

What Does This Mean for People with Parkinson’s?

These studies are in the early stages and have only been tested on a very small number of people. Neither paradigm is ready for widespread clinical use. However, hope lies in the fact that these studies have already moved beyond the lab and are being tested in people living with Parkinson’s. Additionally, the Swiss study used a commercially available DBS neurostimulation device, removing an important barrier to access and suggesting that widespread implementation in the near future may be feasible. 

Next, larger trials will need to confirm the findings to improve features for long-term use and to better understand who would benefit most. People experiencing walking difficulties and falls related to Parkinson’s should talk to their doctor about current treatments and keep an eye out for future adaptive DBS clinical trials. 

Learn More

The Parkinson’s Foundation Helpline (1-800-4PD-INFO) provides answers to questions about PD symptoms and management. Learn more about this topic with the below resources: 

• Deep Brain Stimulation (DBS)
• Considering Deep Brain Stimulation
• Advanced Treatment Options: A Guide to Deep Brain Stimulation, Pump Medications & Focused Ultrasound