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University of Florida Health University of Florida
Norman Fixel Institute for
Neurological Diseases
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principal investigator

study rationale

Impulse control disorders (ICDs) affect 18-27% of Parkinson’s disease (PD) patients and significantly reduce quality of life. These behaviors are linked to basal ganglia dysfunction and are influenced by dopaminergic medication and deep brain stimulation (DBS). Despite growing interest in ICDs, their underlying pathophysiology and changes with neuromodulation therapy remain poorly understood. This study seeks to identify neural markers of ICDs and evaluate how they evolve with DBS therapy, aiming to inform personalized treatment strategies​

hypothesis

Pre-DBS valence-related neural activity in the subthalamic nucleus (STN) and globus pallidus internus (GPi) can serve as biomarkers for ICD severity.DBS at reward-sensitive electrode sites will reduce ICD symptoms and Pavlovian bias in patients with preoperative ICDs, while also altering biomarkers in patients who develop de novo ICDs post-DBS​

study design

Aim 1: Identify patient-specific neural correlates of action-reward processing in the STN and GPi during intraoperative recordings.

Aim 2: Track ICD progression and neural biomarkers longitudinally over one year post-DBS, using sensing-enabled neurostimulators to evaluate changes in ICD symptoms and biomarkers​

Impact

This study will establish a causal relationship between neural biomarkers and ICD progression, enabling targeted DBS therapy that balances motor symptom relief with ICD management. The findings could revolutionize DBS programming strategies and improve the quality of life for PD patients with ICDs​

next steps for development

Data from this study will support an NIH R01 proposal under the BRAIN Initiative, focusing on distributed circuits involved in reward and motivational states. The findings will guide next-generation therapeutic strategies for ICDs in PD, leveraging advanced neural recording and stimulation technologies​.

additional information

A budget of $2,500 per patient is requested for surgical research and material costs. Ten PD patients undergoing DBS surgery will be recruited over one year at the Fixel Institute, which performs 3 DBS surgeries weekly​(Gunduz_FixelAIPilotGrant)

collaboration

The study integrates expertise from multiple disciplines:

  • Dr. Aysegul Gunduz (Biomedical Engineering): Supervises data collection and analysis with extensive experience in electrophysiology and clinical research.
  • Dr. Dawn Bowers (Neuropsychology): Conducts neuropsychological evaluations of study patients pre- and post-DBS.
  • Dr. Joshua Wong (Neurology): Performs longitudinal neurological examinations, leveraging AI for clinical insights.
  • Dr. Kelly Foote (Neurosurgery): Conducts DBS implantation surgeries and ensures patient safety during intraoperative procedures​(Gunduz_FixelAIPilotGrant).