Thoughts on broadening Parkinson’s stimulation treatments

In recent columns, I touched on my frustrations with clinical trials and how, as a patient, I felt out of the loop regarding meaningful research and development. Despite all my efforts to get involved, I’ve realized it’s a slow-churning, big-money system. I can’t see how I can personally make any difference through the traditional channels.

I know, I’m Captain Obvious, right? I’m sure this story isn’t surprising to anyone with Parkinson’s disease.

But I refuse to accept that we patients cannot stimulate therapeutic research and development in other ways, even as so-called “outsiders.” How could that be possible? Maybe it can — with a specific perspective, combined with the right timing.

As we all know, deep brain stimulation (DBS) is a treatment option for many neurological disorders. Fundamentally, I see DBS as simply an implanted pulse generator. I view other forms of noninvasive brain stimulation (NIBS) (e.g., transcranial magnetic stimulation, transcranial direct current stimulation, and focused ultrasound) similarly — as different methods of delivering pulsed information to the brain.

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One of my big questions is how to develop optimal stimulation parameters, or the best combination of stimulation features, for each case (including functional MRI and machine learning). Regardless of the method, programming this stimulation, according to a 2024 article in Brain Stimulation, is “a challenging and time-consuming process” partly because of “the immense programming parameter space in terms of configuration, polarity, amplitude, frequency and pulse width.”

You may have seen the recent announcement that the U.S. Food and Drug Administration (FDA) has approved Medtronic’s adaptive DBS system for Parkinson’s. However, the best control strategy and additional benefits of this “adaptive” process are unclear, according to a 2024 article in Nature Medicine. How long will it take to develop better parameters?

Natural sensory pathways

Could therapeutic patterns be delivered through our sensory-signaling pathways, instead of using implanted electrodes with DBS or applied energy fields with traditional NIBS?

Vibratory tactile stimulation of the fingertips is one example of sensory input delivered this way. Perhaps natural sensory stimuli could be a more precise method of working with these parameters of stimulation. Perhaps they could be a simple and practical approach to controlling our brain-body connections.

I’m not the first to consider building a set of DIY vibratory gloves for personal use. An engineering team at Rice University posted their glove-design plans online, as have others. But even with device design specs, in my opinion, one of the biggest challenges remains developing and optimizing stimulation parameters. Another concern is that these plans are limited to the single sensory mode of touch.

Our place in history

With recent technological advances, including the debut of Apple Vision Pro, do we now have access to a platform capable of delivering precision temporal-spatial pulse training that easily allows robust programming? Would it be better to coordinate signals among the three primary sensory regions (vision, hearing, and touch) with virtual reality instead of just one sensory mode of vibratory tactile stimulation of the fingertips?

Can we build an app with tuning controls so that users can individually manipulate their settings, based on personal experience and collaboration with others? Can we develop a community to learn from one another proactively instead of waiting on clinical trials? Can we leverage powerful machine learning and artificial intelligence models that weren’t previously available to enable better experiences?

I think the answers to those questions is yes. But of course, there are no guarantees, and we won’t know until we’ve tested everything. We can’t now make any claims about therapeutic results. I’ve decided to develop this prototype spatial computing app, Brainstorm, for Apple Vision Pro as a sensory-training general wellness product, not as an FDA-approved medical device.

Later I’ll discuss some problems we encountered while developing the initial proof-of-concept for Brainstorm. I’ll also offer updates on how we’ve assembled a team and changed directions as we pursue our goals.

Note: Parkinson’s News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Parkinson’s News Today or its parent company, Bionews, and are intended to spark discussion about issues pertaining to Parkinson’s disease.