Eight-hours adaptive deep brain stimulation in patients with Parkinson disease

Abstract

ObjectivesTo assess the feasibility and clinical efficacy of local field potentials (LFPs)–based adaptive deep brain stimulation (aDBS) in patients with advanced Parkinson disease (PD) during daily activities in an open-label, nonblinded study.MethodsWe monitored neurophysiologic and clinical fluctuations during 2 perioperative experimental sessions lasting for up to 8 hours. On the first day, the patient took his/her daily medication, while on the second, he/she additionally underwent subthalamic nucleus aDBS driven by LFPs beta band power.ResultsThe beta band power correlated in both experimental sessions with the patient's clinical state (Pearson correlation coefficient r = 0.506, p < 0.001, and r = 0.477, p < 0.001). aDBS after LFP changes was effective (30% improvement without medication [3-way analysis of variance, interaction day × medication p = 0.036; 30.5 ± 3.4 vs 22.2 ± 3.3, p = 0.003]), safe, and well tolerated in patients performing regular daily activities and taking additional dopaminergic medication. aDBS was able to decrease DBS amplitude during motor “on” states compared to “off” states (paired t test p = 0.046), and this automatic adjustment of STN-DBS prevented dyskinesias.ConclusionsThe main findings of our study are that aDBS is technically feasible in everyday life and provides a safe, well-tolerated, and effective treatment method for the management of clinical fluctuations.Classification of evidenceThis study provides Class IV evidence that for patients with advanced PD, aDBS is safe, well tolerated, and effective in controlling PD motor symptoms.

Monitoring subthalamic oscillations for 24 hours in a freely moving Parkinson's disease patient

“…This approach is not yet suitable for clinical practice, and groundwork is needed. The first essential steps for establishing adaptive DBS comprise the capacity for measurements in chronically implanted patients (to avoid the “stunning effect”) and for prolonged recordings not corrupted by artifacts …”

“…The recordings were performed in a 55‐year‐old woman suffering from akinetic‐rigid PD for 8 years and admitted to the hospital for battery replacement after 4 years of subthalamic DBS (Activa PC, lead model 3389; Medtronic). After 30‐minute recordings (baseline) in stim‐off/meds‐off condition (overnight pausing of all dopaminergic medication), we set the new AlphaDBS device (Newronika Srl) to the chronically active parameters (left: 3‐C+, 4.8 V, 60 μs, 170 Hz; right: 11‐C+, 5.5 V, 60 μs, 170 Hz). Recordings lasted for 24 hours continuously over 2 days, during which the patient freely performed everyday life activities and had approximately 6 hours of sleep at night.…”

“…Recordings lasted for 24 hours continuously over 2 days, during which the patient freely performed everyday life activities and had approximately 6 hours of sleep at night. Recordings were performed during active stimulation in a differential configuration (left: contacts 0‐1; right: contacts 8‐9) and stored on the device . We chose these contacts as they showed the highest peak in the β‐frequency range.…”

An update on adaptive deep brain stimulation in Parkinson's disease

“…Moreover, a recent study demonstrated the feasibility and beneficial effects on motor symptoms of aDBS over the course of 8 hours in akinetic-rigid PD patients. 21 Previous studies had already shown that aDBS was applicable and effective in a freely moving 22 and a chronically implanted PD patient. 23 Nevertheless, beta-LFPs in the STN are not (easily) detectable in all patients, 8 although this long-standing assumption has been contradicted recently.…”

“…A number of proof‐of‐concept studies using beta‐LFPs to modify aDBS have shown motor improvement, less speech impairment, and less levodopa‐induced dyskinesia compared to cDBS, which suggests that this is a more efficient and effective method of stimulation. Moreover, a recent study demonstrated the feasibility and beneficial effects on motor symptoms of aDBS over the course of 8 hours in akinetic‐rigid PD patients . Previous studies had already shown that aDBS was applicable and effective in a freely moving and a chronically implanted PD patient …”