A Responsive Closed-Loop Approach to Treat Freezing of Gait in Parkinson's Disease

As a participant in the study you will have the following procedure performed:

A series of questions by interview, questionnaires, and checklists will be collected. In
addition, basic information (such as age, sex, race) and psychiatric, medical, and family
history, physical and neurological exam that will include measuring vital signs (heart rate
and blood pressure). There will be a "Falls Diary' to complete (an account of falling
incidents and the details). Specific testing will be done to evaluate the gait and balance
which will be repeated throughout the study. A psychiatric evaluation of mood and emotion
will be performed including a detailed psychological testing, consisting of perception,
learning, and memory. These psychological assessments will be repeated at every study visit.
An MRI and a CT scan will be performed to make sure of the exact location of the DBS implant.
The study will end in 24 months.

Inclusion Criteria:

1. A clinical diagnosis of idiopathic PD, without a previous DBS operation

2. Must be deemed appropriate for a GPi DBS operation by the interdisciplinary screening
team (GPi must be the target chosen as most appropriate for treatment of their PD to
qualify for this study)

3. Age 30-75 years (must meet UK Brain Bank criteria for diagnosis of idiopathic
Parkinson's disease).

4. Experiencing significant gait and postural instability despite optimal pharmacologic
management (Hoehn and Yahr Stage II or greater in the on state). 5. Best medication
"on" does not reveal meaningful improvement in posture scores (Pull Test). Patients
must be challenged in person with a suprathreshold dose of levodopa (1.5 times
optimized regular dose of levodopa) and must have poor or no improvement in postural
stability.

6. Patients must possess a clinical history of gait freezing > 2 episodes per month, to be
included, participants must also score > 1 on item #3 of the Freezing of Gait (FOG)
Questionnaire and exhibit five or more FoG episodes during the provocation protocol in on
or off state.

7. L-dopa responsive with clearly defined "on" periods. 8. Willingness and ability to
cooperate during conscious operative procedure, as well as during post-surgical
evaluations, adjustments of medications and stimulator settings.

Exclusion Criteria:

1. Clinically significant medical disease that would increase the risk of developing pre-
or postoperative complications. Clinically significant medical disease includes
uncontrolled systemic hypertension with values above 170/100mmHg; cardiac or pulmonary
disease; uncorrected coagulation abnormalities or need for therapeutic anticoagulation
which cannot be interrupted; any condition that would render the patient unable to
safely cooperate with the study tests as judged by the screening physician.

2. Evidence of secondary or atypical parkinsonism.

3. Other neurological and musculoskeletal impairments that would negatively influence
postural stability

4. Past MRI scan with significant evidence of brain atrophy or other abnormalities. 5.
Dementia as evidenced by impairment in two neuropsychological domains and a Mattis
Dementia Score <130.

6. A major untreated psychiatric disorder as revealed on psychiatric exam at screening, and
a Beck Depression Inventory Score >14.

7. Subjects with a history of seizures. 8. Subjects who may require repeat MRI scans. 9.
Subjects with a history of a cranial neurosurgical procedure. 10. Subjects with metal in
the head or another implanted stimulator (e.g. vagus nerve stimulator, spinal cord
stimulator, pacemaker, cochlear implant, etc).

11. Subjects who require treatment with Electroconvulsive therapy (ECT) or repetitive
Transcranial Magnetic Stimulation (rTMS).

12. Pregnant or nursing women or women who wish to become pregnant will be excluded.