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Reducing cognitive–motor declines associated with bilateral subthalamic deep brain stimulation through computational modelling in a parkinson's disease patient
  1. Jay L Alberts1,2,3,
  2. Katie Hallahan1,
  3. Anil Thota1,
  4. Angela M Noecker1,
  5. Jerrold L Vitek2,4,
  6. Cameron C McIntyre1,2,3
  1. 1Department of Biomedical Engineering, Cleveland Clinic, Cleveland, Ohio, USA
  2. 2Center for Neurological Restoration, Cleveland Clinic, Cleveland, Ohio, USA
  3. 3Cleveland FES Center, L Stokes Cleveland VA Medical Center, Cleveland, Ohio, USA
  4. 4Department of Neuroscience, Cleveland Clinic, Cleveland, Ohio, USA
  1. Correspondence to Dr Jay L Alberts, Department of Biomedical Engineering, Center for Neurological Restoration, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA; albertj{at}ccf.org

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Introduction

Bilateral subthalamic (STN) deep brain stimulation (DBS) provides symptom relief for the majority of well-screened advanced Parkinson's disease (PD) patients.1 However, we have recently shown that bilateral STN DBS may result in significant declines in cognitive–motor performance of PD patients.2 The spread of current to non-motor areas of the STN may be responsible for cognitive and cognitive–motor declines.

While guidelines exist on stimulation parameter settings that are typically effective, it is not practical to evaluate each of the thousands of stimulation parameter combinations possible. Therefore, the therapeutic benefit achieved with DBS is dependent on the intuitive skill and experience of the programming clinician. To assist the programming process, we developed Windows-based software tools that enable 3D visualisation of the volume of tissue activated (VTA) by DBS.3

The goal of this study was to compare two methods of DBS programming, the typical clinical method and our computational approach, on cognitive–motor performance in an advanced PD patient.

Case report

A 58-year-old right-handed male with an 8-year history of PD underwent simultaneous bilateral STN-DBS 14 months prior to study participation. His stimulation parameters were optimised by traditional clinical methods and were stable for the 6 months prior to study participation. This patient did not have any history of cognitive deficits or postoperative changes in cognitive function based on neuropsychological testing. Blinded UPDRS-III evaluations were performed Off DBS and On DBS using previously determined clinical DBS parameters while the patient was off antiparkinsonian medication for 12 h. Under these conditions, the patient demonstrated a 45% reduction (improvement) in the UPDRS III with DBS on when compared with off.

Cognitive–motor performance was quantified using a dual-task paradigm.2 …

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