Neuro X seminar: Prof Martin Moraud - Towards Brain-Controlled Neuromodulation Therapies to Alleviate Gait and Balance Deficits in Parkinson's Disease

Despite significant advances in neuromodulation therapies for Parkinson’s disease (PD), gait and balance disturbances remain a major challenge for patients in advanced stages of the disease. These deficits are often refractory to existing treatments; they significantly increase the risk of falls, exacerbate comorbidities, and severely impact independence and quality of life.

Neuromodulation therapies operating in closed-loop have the potential to harness the intrinsic dynamics of dysfunctional neuronal circuits underlying gait and balance, holding promise for more effective improvements in gait impairments. However, stimulation delivery must be controlled in real time and dynamically tuned to the fluctuating state of patients, as well as to task- and context-related constraints encountered in daily life. This requires robust, evidence-based biomarkers capable of informing locomotor activities and deficits.

We are leveraging the neural sensing capabilities of next-generation deep brain stimulation (DBS) neurostimulators, combined with continuous wireless monitoring of locomotor deficits throughout daily life, to identify and map neural and motor biomarkers of locomotor function and dysfunction in real-world settings. We are combining these clinical assessments in patients with experiments in animal models to ground clinical correlations on mechanistic evidence, and we are developing evidence-based neural decoding algorithms capable of robustly predicting gait disturbances and controlling therapies in closed-loop.

In this talk, I will present our latest developments in these areas and discuss how these advancements are enabling the personalization of closed-loop neuromodulation therapies based on brain biomarkers, ultimately improving gait function in individuals with advanced PD.