Researchers at the University of California, San Francisco have developed a new form of deep brain stimulation (DBS) that adjusts in real time to a person’s gait, improving gait and reducing falls in people with Parkinson’s disease.
The study was published on June 15th. natural medicinedemonstrated for the first time that an implantable brain stimulator can detect neural signals associated with each step and automatically adjust stimulation within a fraction of a fraction of a second. The new system responds to the brain’s walking rhythm in the same way that a cardiac pacemaker responds to the rhythm of the heart.
Difficulty walking is one of the most disabling symptoms of Parkinson’s disease and one of the most difficult to treat. Walking is a highly dynamic movement that requires precise timing on both sides of the body. We have developed a system that can recognize these movement patterns and respond in real time, allowing us to effectively deliver stimulation that matches the patient’s movements. ”
Doris D. Wang, MD, PhD, UCSF Associate Professor of Neurosurgery and senior author of the study
Smarter brain stimulation
More than 10 million people worldwide live with Parkinson’s disease. Although deep brain stimulation can dramatically improve tremor, stiffness, and slowness, many patients continue to suffer from symptoms such as gait disturbances, freezing feet, and falls, which are among the leading causes of disability and loss of independence.
The UCSF team believed that one reason that standard DBS has limited impact on gait is because gait itself is constantly changing. Every step requires rapid coordination between the brain, spinal cord, and muscles. However, traditional or continuous DBS provides a fixed pattern of stimulation regardless of what the person is doing.
To address this challenge, researchers developed an individually adaptive DBS (aDBS) system that identifies brain signals related to left and right leg movements. These signals are embedded directly into the implanted neurostimulator, allowing the device to automatically adjust stimulation during each step of gait, without the need for an external computer.
“The brain contains an incredibly rich amount of information about movement,” said lead author Kenneth H. Louie, Ph.D., a UCSF postdoctoral fellow. “We found that we could identify the neural signature associated with each step and use that to guide stimulation in real time.”
From continuous treatment to highly responsive treatment
The study enrolled five patients with Parkinson’s disease who had undergone DBS surgery and were participating in a UCSF research program using an investigational DBS system. In addition to therapeutic DBS leads implanted deep in the brain, participants had research electrodes placed in movement-related areas of the brain. By combining these devices, researchers can now program the stimulator to identify personalized neural signals (brain signals) during walking and automatically adjust treatment in real time.
In clinical testing, the aDBS system improved measurements of gait symmetry, which is indicative of a more stable and efficient gait, and reduced variability in gait patterns.
Participants then completed a blinded, multi-day crossover study in daily life. During periods when the adaptive system was active, participants reduced the number of falls while maintaining overall control of their Parkinson’s disease symptoms. No serious adverse events occurred and patients tolerated the rapid stimulation adjustment well.
Although larger studies are needed, the present findings provide initial evidence that behaviorally timed stimulation may improve outcomes beyond what was possible with traditional sequential stimulation.
New frontiers in personalized neuromodulation
This study represents a shift in the way scientists think about brain stimulation therapy. Most aDBS systems developed to date respond to slowly changing disease indicators. UCSF’s approach instead addresses directly the behavior itself.
“This research is about more than just walking,” Wang said. “This shows that brain stimulation can adapt to a person’s behavior in real time. This opens the door to future treatments that dynamically respond to movement, speech, mood, cognition, and other brain functions.”
Researchers envision a future where implanted devices continuously sense and respond to neural activity, delivering personalized treatments only when and where they are needed.
“This is an important step toward a new generation of brain treatments,” said Dr. Wang. “Rather than delivering the same stimulation throughout the day, future devices may listen to the brain continuously and respond immediately to a patient’s needs. Intelligent neurostimulators may change the way brain diseases are treated, just as pacemakers changed the way heart disease is treated.”
sauce:
University of California, San Francisco
Reference magazines:
Louis, K.H. others. (2026). Adaptive deep brain stimulation for dynamic gait control in Parkinson’s disease: A randomized feasibility trial. natural medicine. DOI: 10.1038/s41591-026-04434-2. https://www.nature.com/articles/s41591-026-04434-2
