Gaurav Mohit Chattree

All Publications

• Long-Term Personalized Adaptive Deep Brain Stimulation in Parkinson Disease: A Nonrandomized Clinical Trial. JAMA neurology Bronte-Stewart, H. M., Beudel, M., Ostrem, J. L., Little, S., Almeida, L., Ramirez-Zamora, A., Fasano, A., Hassell, T., Mitchell, K. T., Moro, E., Gostkowski, M., Chattree, G., de Bie, R. M., de Neeling, M., Pina-Fuentes, D., Swinnen, B., Starr, P. A., Hammer, L. H., Foote, K. D., Richardson, R. M., Flaherty, A., Boogers, A., Sa'di, Q., Meoni, S., Castrioto, A., Stanslaski, S., Summers, R. L., Tonder, L., Tan, Y., Berrier, H., Goble, T. J., Raike, R. S., Herrington, T. M., ADAPT-PD Investigators, Schuurman, P. R., Shuaib, U., Phibbs, F., Darrio, E., Lynch, S., Cooney, J., Turner, D., Fraix, V., Zahed, H., Sarangmat, N. 2025

  Abstract

  Importance: Adaptive deep brain stimulation (aDBS) automatically adjusts stimulation amplitude in response to changes in relevant neural activity in people with Parkinson disease (PD). Whether long-term at-home aDBS is safe and delivers effective therapy in people with PD remains unknown.Objective: To determine the tolerability, efficacy, and safety of long-term aDBS in people with PD who were previously stable receiving continuous DBS (cDBS).Design, Setting, and Participants: This international, open-label, prospective, pivotal trial enrolled participants from December 2020 to July 2022 in the US, Canada, and Europe. Referred participants with PD were first assessed while receiving stable cDBS and those who tolerated 2 aDBS modes were randomized and blinded to 30 days in each mode (single-blind crossover design); those who tolerated only 1 mode were assessed in that mode only; assessments completed holding medication stable. Participants were given the option to continue their selected mode of aDBS for long-term follow-up (10 months). Data used for analysis were from March 2024. Multiple imputation was used if more than 5% of data was missing for the primary or secondary end points. A referred sample of 68 participants with PD, stable while receiving cDBS and medication, was included.Interventions: Two modes of aDBS controlled by an embedded closed-loop stimulation system: single threshold (ST-aDBS) and dual threshold (DT-aDBS).Main Outcomes and Measures: The primary end point required that at least 50% of participants meet a performance goal of on-time (ie, time when symptoms were well controlled) without troublesome dyskinesias with no less than 1-SD reduction (and post hoc threshold less than 2 hours per day reduction) reported during aDBS therapy compared to cDBS, determined from a self-reported motor diary. The secondary end point was total electrical energy delivered (TEED) compared between aDBS and cDBS. Safety assessments were conducted by characterizing adverse events (AEs), stimulation-related AEs, serious AEs, and device deficiencies.Results: A total of 68 participants enrolled (mean [SD] age, 62.2 [8.4] years; 48 [70.6%] male); 40 and 35 were evaluated with DT-aDBS and ST-aDBS, respectively. The primary end point performance goal was met in the DT-aDBS group (91% of participants) and ST-aDBS (79% of participants) with the post hoc performance threshold; no difference between aDBS modes (chi21=1.0; P=.51). TEED was reduced during ST-aDBS compared to cDBS (mean change, -15%; nominal P=.01) and not different from DT-aDBS. All but 1 stimulation-related AE resolved during the aDBS setup and adjustment phase with no serious device AEs through long-term follow-up. Exploratory analyses suggested improvement in on-time without troublesome dyskinesias with DT-aDBS compared to cDBS.Conclusions and Relevance: In this study, long-term aDBS was tolerable, effective, and safe in people with PD who were previously stable while receiving cDBS.Trial Registration: ClinicalTrials.gov Identifier: NCT04547712.

  View details for DOI 10.1001/jamaneurol.2025.2781

  View details for PubMedID 40982287

• Remote real time digital monitoring fills a critical gap in the management of Parkinson's disease. NPJ Parkinson's disease Negi, A. S., Karjagi, S., Parisi, L., Daley, K. W., Abay, A. K., Gala, A. S., Wilkins, K. B., Hoffman, S. L., Ferris, M. S., Zahed, H., Chattree, G. M., Palushaj, B., Bronte-Stewart, H. M. 2025; 11 (1): 239

  Abstract

  People with Parkinson's disease (PWP) face significant gaps in care. Limited neurologist access, infrequent clinic visits, and inadequate symptom measurement culminate in suboptimal therapy and high morbidity. Quantitative Digitography (QDG) provides validated, digital metrics of the three cardinal motor signs in Parkinson's disease (PD) in real-time from 30 seconds of a mobility task on a digitography device and can be used remotely or in clinical settings. This study demonstrates the feasibility and clinical relevance of 30-day remote QDG monitoring. Participants showed excellent compliance and found the system easy to use. The QDG Mobility Score demonstrated meaningful correlation with Activities of Daily Living (ADLs), captured motor complexities across a broad PD duration, and tracked motor changes from small therapy adjustments. QDG offers providers and PWP an accessible, objective, and real-time tool to remotely monitor motor symptoms, optimize treatment, and address care gaps created by infrequent clinic visits and subjective symptom assessment.

  View details for DOI 10.1038/s41531-025-01101-0

  View details for PubMedID 40796568

  View details for PubMedCentralID 7884982

• Striatal neural ensemble codes for voluntary locomotor and involuntary dyskinetic movements bioRxiv Chattree, G., Chrapkiewicz, R., Zhang, Y., Li, J., Schnitzer, M. J. 2025

  View details for DOI 10.1101/2025.04.01.646527

• Video Teaching NeuroImages: Atypical abnormal eye movements in PNPO-related Epilepsy. Neurology Pavitt, S., Karamian, A. G., Chattree, G., Klotz, J., Beres, S. 2020

  View details for DOI 10.1212/WNL.0000000000010861

  View details for PubMedID 32913027

• A Basal Ganglia Circuit Sufficient to Guide Birdsong Learning. Neuron Xiao, L., Chattree, G., Oscos, F. G., Cao, M., Wanat, M. J., Roberts, T. F. 2018; 98 (1): 208-221.e5

  Abstract

  Learning vocal behaviors, like speech and birdsong, is thought to rely on continued performance evaluation. Whether candidate performance evaluation circuits in the brain are sufficient to guide vocal learning is not known. Here, we test the sufficiency of VTA projections to the vocal basal ganglia in singing zebra finches, a songbird species that learns to produce a complex and stereotyped multi-syllabic courtship song during development. We optogenetically manipulate VTA axon terminals in singing birds contingent on how the pitch of an individual song syllable is naturally performed. We find that optical inhibition and excitation of VTA terminals are each sufficient to reliably guide learned changes in song. Inhibition and excitation have opponent effects on future performances of targeted song syllables, consistent with positive and negative reinforcement of performance outcomes. These findings define a central role for reinforcement mechanisms in learning vocalizations and demonstrate minimal circuit elements for learning vocal behaviors. VIDEO ABSTRACT.

  View details for DOI 10.1016/j.neuron.2018.02.020

  View details for PubMedID 29551492

  View details for PubMedCentralID PMC5918681

• Identification of a motor-to-auditory pathway important for vocal learning. Nature neuroscience Roberts, T. F., Hisey, E., Tanaka, M., Kearney, M. G., Chattree, G., Yang, C. F., Shah, N. M., Mooney, R. 2017

  Abstract

  Learning to vocalize depends on the ability to adaptively modify the temporal and spectral features of vocal elements. Neurons that convey motor-related signals to the auditory system are theorized to facilitate vocal learning, but the identity and function of such neurons remain unknown. Here we identify a previously unknown neuron type in the songbird brain that transmits vocal motor signals to the auditory cortex. Genetically ablating these neurons in juveniles disrupted their ability to imitate features of an adult tutor's song. Ablating these neurons in adults had little effect on previously learned songs but interfered with their ability to adaptively modify the duration of vocal elements and largely prevented the degradation of songs' temporal features that is normally caused by deafening. These findings identify a motor to auditory circuit essential to vocal imitation and to the adaptive modification of vocal timing.

  View details for DOI 10.1038/nn.4563

  View details for PubMedID 28504672