Volitional deep brain stimulation following brain-computer interface training for Parkinson's disease

Deep brain stimulation (DBS) is transforming from a static therapy toward adaptive systems that adjust stimulation based on neural biomarkers. However, the detection of reliable biomarkers that capture the multi-dimensional nature of complex symptoms is often challenging. Here we demonstrate volitional DBS (vDBS)--a paradigm in which patients use brain-computer interface (BCI) training to learn self-regulation of a neural signal that then controls closed-loop DBS. Two patients with Parkinson's disease implanted with sensing-enabled neurostimulators completed chronic, at-home BCI training by playing an airplane simulation game. Through training, they were able to effectively down-regulate their cortical beta signal (p's < 1e-10), represented as the real-time position of a plane in the BCI game. Following training, this cortical beta signal served as the input to a closed-loop DBS algorithm. By modulating their beta signal to cross personalized thresholds, patients voluntarily increased or decreased neurostimulation amplitude at will, in the absence of physical movement (p's < 1e-10). This proof-of-principle demonstration establishes that volitional control of intracranial neurostimulation is achievable without the need of an externalized manual controller. BCI-vDBS could potentially be used for a range of neuropsychiatric conditions and brain rehabilitation to support personalized control of neurostimulation.