Deep brain stimulation for locomotor network dysfunctions in Parkinson’s disease

Gait is an automatic behavior resulting from the integration of motor, cognitive, and limbic information. In Parkinson’s disease (PD), the loss of striatal dopaminergic innervation can directly impair this integration process, possibly leading to gait disturbances. Dysfunctional synchronization can be targeted with deep brain stimulation (DBS), which has consistently been shown to allow a stable improvement of PD motor symptoms. Yet, the effect of DBS on gait impairment is still variable, ranging from improvement to worsening of gait. An unselective, continuous, high-frequency stimulation of neural ensembles may limit cortico-basal ganglia physiological synchronization processes needed for locomotion. Novel DBS approaches can dynamically adapt the stimulation delivery to defined neurophysiological biomarkers (adaptive DBS [aDBS]), possibly allowing a targeted treatment of dysfunctional network dynamics without affecting physiological synchronization processes. In this talk, I will present novel aDBS approaches and their applications in treating symptoms and gait disturbances in Parkinson’s disease.