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Movement disorders
Research paper
Bilateral adaptive deep brain stimulation is effective in Parkinson's disease
  1. Simon Little1,
  2. Martijn Beudel1,2,
  3. Ludvic Zrinzo3,
  4. Thomas Foltynie3,
  5. Patricia Limousin3,
  6. Marwan Hariz3,
  7. Spencer Neal3,
  8. Binith Cheeran1,
  9. Hayriye Cagnan1,
  10. James Gratwicke3,
  11. Tipu Z Aziz1,4,
  12. Alex Pogosyan1,5,
  13. Peter Brown1,5
  1. 1Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK
  2. 2Department of Neurology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
  3. 3Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience & Movement Disorders, UCL Institute of Neurology, London, UK
  4. 4Nuffield Department of Surgical Sciences, John Radcliffe Hospital, University of Oxford, Oxford, UK
  5. 5The Medical Research Council Brain Networks Dynamics Unit, University of Oxford, Oxford, UK
  1. Correspondence to Professor Peter Brown, The Medical Research Council Brain Networks Dynamics Unit at the University of Oxford, Oxford OX1 3TH, UK; peter.brown{at}ndcn.ox.ac.uk

Abstract

Introduction & objectives Adaptive deep brain stimulation (aDBS) uses feedback from brain signals to guide stimulation. A recent acute trial of unilateral aDBS showed that aDBS can lead to substantial improvements in contralateral hemibody Unified Parkinson’s Disease Rating Scale (UPDRS) motor scores and may be superior to conventional continuous DBS in Parkinson’s disease (PD). We test whether potential benefits are retained with bilateral aDBS and in the face of concurrent medication.

Methods We applied bilateral aDBS in 4 patients with PD undergoing DBS of the subthalamic nucleus. aDBS was delivered bilaterally with independent triggering of stimulation according to the amplitude of β activity at the corresponding electrode. Mean stimulation voltage was 3.0±0.1 volts. Motor assessments consisted of double-blinded video-taped motor UPDRS scores that included both limb and axial features.

Results UPDRS scores were 43% (p=0.04; Cohen’s d=1.62) better with aDBS than without stimulation. Motor improvement with aDBS occurred despite an average time on stimulation (ToS) of only 45%. Levodopa was well tolerated during aDBS and led to further reductions in ToS.

Conclusion Bilateral aDBS can improve both axial and limb symptoms and can track the need for stimulation across drug states.

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/

https://doi.org/10.1136/jnnp-2015-310972

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