Movement-responsive deep brain stimulation for Parkinson's disease using a remotely optimized neural decoder.

Deep brain stimulation (DBS) has garnered widespread use as an effective treatment for advanced Parkinson's disease. Conventional DBS (cDBS) provides electrical stimulation to the basal ganglia at fixed amplitude and frequency, yet patients' therapeutic needs are often dynamic with residual symptom fluctuations or side effects. Adaptive DBS (aDBS) is an emerging technology that modulates stimulation with respect to real-time clinical, physiological or behavioural states, enabling therapy to dynamically align with patient-specific symptoms. Here we report an aDBS algorithm intended to mitigate movement slowness by delivering targeted stimulation increases during movement using decoded motor signals from the brain. Our approach demonstrated improvements in dominant hand movement speeds and study participant-reported therapeutic efficacy compared with an inverted control, as well as increased typing speed and reduced dyskinesia compared with cDBS. Furthermore, we demonstrate proof of principle of a machine learning pipeline capable of remotely optimizing aDBS parameters in a home setting. This work illustrates the potential of movement-responsive aDBS as a promising therapeutic approach and highlights how machine learning-assisted programming can simplify complex optimization to facilitate translational scalability.