Deep brain stimulation (DBS) has shown promising results in treating some symptoms of Parkinson’s disease (PD), although not all symptoms improve equally well with this treatment. Researchers from Mass General Brigham studied PD patients treated with DBS at five different centers to create an “atlas” mapping four major PD symptoms onto different regions of the brain. By pinpointing the precise location of DBS electrodes in each patient, the team developed an algorithm capable of generating personalized, symptom-specific DBS treatment plans. Published in Nature Communications, the findings demonstrate the algorithm’s potential to improve patients’ symptoms beyond standard-of-care approaches.
Senior author Andreas Horn, MD, PhD, emphasizes the need to move away from a “one-size-fits-all” approach to DBS treatment and to tailor treatment to each patient’s specific needs. By studying a total of 237 PD patients treated with DBS, the researchers identified specific tracts associated with tremor, bradykinesia, rigidity, and axial symptoms in PD. Tremor was improved with stimulation of tracts connected to the primary motor cortex and cerebellum, while bradykinesia was associated with the supplementary motor cortex. Rigidity improved with stimulation of the premotor cortex, and axial symptoms improved with stimulation of tracts connected to the supplementary motor cortex and brainstem.
The creation of Cleartune, an algorithm that suggests optimal stimulation parameters for DBS treatment, allowed the researchers to provide personalized treatment for five PD patients in Germany undergoing DBS. In four of the five patients, Cleartune settings led to greater improvements in PD symptoms compared to standard-of-care protocols. The fifth patient showed comparable improvements with Cleartune versus standard treatments. This research is a significant step towards refining personalized, symptom-specific treatment for PD and other diseases, such as OCD, in collaboration with researchers awarded major National Institutes of Health funding to map the brain’s circuitry using advanced imaging technologies.
First and corresponding author Nanditha Rajamani, PhD, highlights the interdisciplinary effort involved in creating the most precise atlas of symptom-specific pathways for DBS treatment. The researchers utilized anatomical information from various sources and collaborated with skilled neuroanatomists to produce and validate the research. Moving forward, this approach can serve as a framework for improving DBS treatments for other disorders as well. Overall, the findings shed light on the potential of personalized, symptom-specific DBS treatment plans to improve outcomes for patients with PD and other neurological disorders, moving away from a generalized treatment approach towards tailored, individualized care.
