Acute effects of adaptive Deep Brain Stimulation in Parkinson's disease

Dan Piña Fuentes, J. Marc C. van Dijk, Jonathan Zijl, van, Harmen Moes, Teus van Laar, D L Marinus Oterdoom, Simon Little, Peter Brown, Martijn Beudel*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

22 Citations (Scopus)
29 Downloads (Pure)

Abstract

BACKGROUND: Beta-based adaptive Deep Brain Stimulation (aDBS) is effective in Parkinson's disease (PD), when assessed in the immediate post-implantation phase. However, the potential benefits of aDBS in patients with electrodes chronically implanted, in whom changes due to the microlesion effect have disappeared, are yet to be assessed.

METHODS: To determine the acute effectiveness and side-effect profile of aDBS in PD compared to conventional continuous DBS (cDBS) and no stimulation (NoStim), years after DBS implantation, 13 PD patients undergoing battery replacement were pseudo-randomised in a crossover fashion, into three conditions (NoStim, aDBS or cDBS), with a 2-min interval between them. Patient videos were blindly evaluated using a short version of the Unified Parkinson's Disease Rating Scale (subUPDRS), and the Speech Intelligibility Test (SIT).

RESULTS: Mean disease duration was 16 years, and the mean time since DBS-implantation was 6.9 years. subUPDRS scores (11 patients tested) were significantly lower both in aDBS (p=<.001), and cDBS (p = .001), when compared to NoStim. Bradykinesia subscores were significantly lower in aDBS (p = .002), and did not achieve significance during cDBS (p = .08), when compared to NoStim. Two patients demonstrated re-emerging tremor during aDBS. SIT scores of patients who presented stimulation-induced dysarthria significantly worsened in cDBS (p = .009), but not in aDBS (p = .407), when compared to NoStim. Overall, stimulation was applied 48.8% of the time during aDBS.

CONCLUSION: Beta-based aDBS is effective in PD patients with bradykinetic phenotypes, delivers less stimulation than cDBS, and potentially has a more favourable speech side-effect profile. Patients with prominent tremor may require a modified adaptive strategy.

Original languageEnglish
Pages (from-to)1507-1516
Number of pages10
JournalBrain stimulation
Volume13
Issue number6
Early online date29-Jul-2020
DOIs
Publication statusPublished - 8-Sep-2020

Keywords

  • Aged
  • Aged, 80 and over
  • Beta Rhythm/physiology
  • Cross-Over Studies
  • Deep Brain Stimulation/methods
  • Female
  • Humans
  • Hypokinesia/diagnosis
  • Intraoperative Neurophysiological Monitoring/methods
  • Male
  • Middle Aged
  • Parkinson Disease/diagnosis
  • Tremor/diagnosis

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