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Adaptive Cortical Neuromodulation Using a Brain-machine Interface to Treat Freezing of Gait in Parkinson’s Disease

Study Rationale: Difficulties with walking can have significant impacts on the quality of life of people with Parkinson’s (PwP). One of the most serious is freezing of gait (FOG), which are brief but severe episodes of inability to walk. Walking is controlled by a brain region called the motor cortex. Changes in brain activity here are known to relate to how the legs move as measured with electrodes on the brain called “electrocorticography” (ECoG). Studies have shown that ECoG electrodes can detect abnormal brain signals that happen during FOG. However, brain cortex stimulation has been poorly studied to treat FOG, and never on demand (when FOG is happening).

Hypothesis: We aim to design a new brain stimulation system that can detect FOG episodes from brain activity alone, and then treat them either before they occur or as they happen by electrically stimulating the brain’s cortex. We will implant ECoG electrodes on the cortex of PwP receiving standard-of-care Deep Brain Stimulation (a routinely performed procedure not very effecting in treating FOG).

Study Design: First, we will better understand what happens in the motor cortex during walking by recording brain activity while patients walk on a specially designed treadmill. We have shown that this treadmill can be used to reliably trigger FOG, so brain activity during normal walking and FOG can be recorded and compared.

Next, we will see the effects on leg movements and walking of stimulating the motor cortex, and see which stimulation best stops FOG. Finally, we’ll use our method to detect FOG in the brain to determine when best to stimulate the cortex and see if we can stop or prevent FOG.

Impact on Diagnosis/Treatment of Parkinson’s Disease: We hope that our brain stimulation method will be a new proof-of-concept treatment for FOG, an undertreated and serious problem in PwP.

Next Steps for Development: We hope that our proof-of-concept will guide future studies on treating FOG with cortical brain stimulation and will be integrated together with Deep Brain Stimulation as a more complete treatment for PD and its symptoms.

Trial Phase: Phase 1


Researchers

  • Alfonso Fasano, MD, PhD

    Toronto ON Canada


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