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- Parkinson's disease
- deep brain stimulation
- force control
- cognitive function
- computational model
- patient-specific model
- activities of daily living
- clinical neurology
- electrical stimulation
- motor control
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.
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 …
Funding This project was supported by the National Institutes of Health (R03 AG022178, R03 NS037959, R01 NS059736) and the WH Coulter Foundation.
Competing interests CCM authored intellectual property related to the project methodology and holds company shares in IntElect Medical Inc. CCM and AMN are paid consultants for IntElect Medical Inc.
Patient consent Obtained.
Ethics approval Ethics approval was provided by the Cleveland Clinic.
Provenance and peer review Not commissioned; externally peer reviewed.