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Adaptive deep brain stimulation for Parkinson's disease demonstrates reduced speech side effects compared to conventional stimulation in the acute setting
  1. Simon Little1,
  2. Elina Tripoliti1,
  3. Martijn Beudel2,
  4. Alek Pogosyan3,
  5. Hayriye Cagnan3,
  6. Damian Herz3,
  7. Sven Bestmann1,
  8. Tipu Aziz4,
  9. Binith Cheeran4,
  10. Ludvic Zrinzo1,
  11. Marwan Hariz1,
  12. Jonathan Hyam1,
  13. Patricia Limousin1,
  14. Tom Foltynie1,
  15. Peter Brown3
  1. 1 Sobell Department of Motor Neuroscience & Movement Disorders, UCL Institute of Neurology, London, UK
  2. 2 Department of Neurology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
  3. 3 MRC Brain Network Dynamics Unit (BNDU), Department of Pharmacology and Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
  4. 4 Nuffield Department of Surgical Sciences, John Radcliffe Hospital, University of Oxford, Oxford, UK
  1. Correspondence to Professor Peter Brown, Nuffield Department of Clinical Neurosciences, University of Oxford, Level 6, West Wing, John Radcliffe Hospital, Oxford OX3 9DU, UK; peter.brown{at}ndcn.ox.ac.uk

http://dx.doi.org/10.1136/jnnp-2016-313518

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    Introduction

    Deep brain stimulation (DBS) for Parkinson's disease (PD) is currently limited by costs, partial efficacy and surgical and stimulation-related side effects. This has motivated the development of adaptive DBS (aDBS) whereby stimulation is automatically adjusted according to a neurophysiological biomarker of clinical state, such as β oscillatory activity (12–30 Hz). aDBS has been studied in parkinsonian primates and patients and has been reported to be more energy efficient and effective in alleviating motor symptoms than conventional DBS (cDBS) at matched amplitudes.1 ,2

    However, these studies have not considered whether side effects can also be avoided with clinically effective stimulation. In PD, it is well recognised that a significant proportion of patients develop speech deterioration following DBS of the subthalamic nucleus (STN), which may be reversible.3

    Here we test bilateral stimulation, optimising parameters for aDBS, and evaluate speech intelligibility. We hypothesised that acute aDBS would be more effective and more efficient than cDBS at matched stimulation parameters while causing less speech impairment.

    Methods

    We recruited 10 patients with advanced idiopathic PD following implantation of DBS electrodes into the STN.2 Recordings took place 3–6 days following electrode placement during a temporary period of externalisation. All participants gave informed written consent, and were tested following overnight withdrawal of dopaminergic medication (see online supplementary material). Two patients were excluded due to external stimulator failure leading to no voltage delivery under aDBS and cDBS conditions.

    supplementary data

    [jnnp-2016-313518supp.pdf]

    aDBS stimulation was delivered bilaterally, only when β amplitude exceeded a threshold as previously described.2 aDBS contacts, voltages and trigger thresholds were independently set for the two sides according to motor benefit versus induced paraesthesiae, with the same contacts/voltages used for cDBS.

    Stimulation in each block continued for 15 min prior to evaluation. Participants were assessed …

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    Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/ This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/