For people living with Parkinson’s disease, the symptoms experienced can change by the minute. Parkinson’s is a neurological condition, and as it progresses, patients can start to lose control of their movements. Symptoms include tremors, muscle rigidity, and difficulty with balance and speech. And because those symptoms can change in an instant, it’s very difficult to capture the many things that can happen between doctor’s appointments.
In a Canadian first, neurologist Alfonso Fasano and neurosurgeon Suneil Kalia at the Krembil Brain Institute are using a new pacemaker-like device can track patient brain activity around the clock, logging a real-time digital diary. The same device can also deliver adjustable electrical stimulation to counter symptoms.
Patients who receive the device also keep a journal to record times that their symptoms are the most severe, and when they take their medications. These data help their doctors match brain activity patterns to moments where symptoms are well controlled, versus flare-ups when stimulation might need tweaking.
“This is the first time we can chronically record brain activity,” said Fasano in a video interview with the Krembil Brain Institute.
“In the past this was possible only leaving electrodes outside the body, so only for a few days, max. Now we can access the brain anytime we want.”
The researchers note that the device can stay active for years after surgical implantation. That’s a lot of data that they can use to react and improve patient quality of life.
The device has two main parts. The first is a pair of thin electrodes, inserted deep into either side of the brain through small holes drilled through the skull. These are connected by wires just under the skin that travel through the neck to a stimulator in the chest that can deliver electrical impulses to disrupt abnormal brain activity, in the same way that a pacemaker can correct abnormal heart rhythms.
Until now, the device could only be turned on and off with an external controller, but with the added introduction of a way to record brain activity comes the potential to regulate treatment in smarter ways.
Understanding patterns could help doctors adjust medication schedules. And being able to see real-time brain activity can also help doctors adjust levels of electrical stimulation. Eventually, the hope is that patients will be able to make adjustments from home with remote supervision by their healthcare team. The data will also shed light on how brain patterns change over time as the disease progresses.
The ultimate hope is that a future generation of the device could incorporate machine learning to predict when symptoms are about to flare, automatically intervening with just the right amount of electrical stimulation.
While it’s not a cure, devices like these can offer patients more independence and stability. With more applications on the horizon, such as similar devices to help control epileptic seizures, the field is open for innovation.