At home adaptive dual target deep brain stimulation in Parkinson ’s disease with proportional control

AbstractContinuous deep brain stimulation (cDBS) of the subthalamic nucleus (STN) or globus pallidus is an effective treatment for the motor symptoms of Parkinson ’s disease. The relative benefit of one region over the other is of great interest but cannot usually be compared in the same patient. Simultaneous DBS of both regions may synergistically increase the therapeutic benefit. Continuous DBS is limited by a lack of responsiveness to dynamic, fluctuatin g symptoms intrinsic to the disease. Adaptive DBS (aDBS) adjusts stimulation in response to biomarkers to improve efficacy, side effects, and efficiency. We combined bilateral DBS of both STN and globus pallidus (dual target DBS) in a prospective within-participant, clinical trial in six patients wi th Parkinson’s disease (n = 6, 55 –65 years,n = 2 females).Dual target cDBS was tested for Parkinson ’s disease symptom control annually over 2 years, measured by motor rating scales, on time without dyskinesia, and medication reduction. Random amplitude experiments probed system dynamics to estimate parameters for aDBS. We then implemented proportional-plus-integral aDBS using a novel distribute d (off-implant) architecture. In the home setting, we collected tremor and dyskinesia scores as well as individualized β and DBS amplitudes.Dual target cDBS reduced motor symptoms as measured by Unified Parkinson’s Disease Rating Scale (UPDRS) to a greater degree than either region alone (P< 0.05, linear mixed model) in t...
Source: Brain - Category: Neurology Source Type: research