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

Brain Stimulation

Harmen R. Moes¹  J. Marc C. van Dijk²  Jonathan C. van Zijl³  Simon Little⁴  Peter Brown⁴  D.L.Marinus Oterdoom⁴  Dan Piña-Fuentes⁵  Martijn Beudel⁵  Teus van Laar⁵ 

[1] Department of Neurology, Amsterdam Neuroscience Institute, Amsterdam University Medical Center, Amsterdam, The Netherlans;Medical Research Council Brain Network Dynamics Unit at the University of Oxford, United Kingdom;Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom;Department of Neurology, Amsterdam Neuroscience Institute, Amsterdam University Medical Center, Amsterdam, The Netherlans;Department of Neurosurgery, University Medical Centre Groningen, the Netherlands;

关键词: Parkinson’s disease;    Adaptive deep brain stimulation;    Subthalamic nucleus;    Local field potentials;    Beta oscillations;    Closed-loop;   

DOI  :  

来源: DOAJ

【 摘 要 】

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.

【 授权许可】

Unknown