Eight-hours adaptive deep brain stimulation in patients with Parkinson disease

TLDR

The study assessed the feasibility and clinical efficacy of LFP‑based adaptive deep brain stimulation in advanced Parkinson’s disease patients during daily activities. The authors monitored neurophysiologic and clinical fluctuations over two 8‑hour perioperative sessions, comparing medication alone to medication plus subthalamic nucleus aDBS driven by LFP beta‑band power. Beta‑band power correlated with clinical state, and aDBS produced a 30 % improvement without medication, safely reduced stimulation amplitude during motor‑on states, prevented dyskinesias, and proved feasible, well tolerated, and effective in everyday life.

Abstract

<h3>Objectives</h3> To assess the feasibility and clinical efficacy of local field potentials (LFPs)–based adaptive deep brain stimulation (aDBS) in patients with advanced Parkinson disease (PD) during daily activities in an open-label, nonblinded study. <h3>Methods</h3> We monitored neurophysiologic and clinical fluctuations during 2 perioperative experimental sessions lasting for up to 8 hours. On the first day, the patient took his/her daily medication, while on the second, he/she additionally underwent subthalamic nucleus aDBS driven by LFPs beta band power. <h3>Results</h3> The beta band power correlated in both experimental sessions with the patient9s clinical state (Pearson correlation coefficient <i>r</i> = 0.506, <i>p</i> &lt; 0.001, and <i>r</i> = 0.477, <i>p</i> &lt; 0.001). aDBS after LFP changes was effective (30% improvement without medication [3-way analysis of variance, interaction day × medication <i>p</i> = 0.036; 30.5 ± 3.4 vs 22.2 ± 3.3, <i>p</i> = 0.003]), safe, and well tolerated in patients performing regular daily activities and taking additional dopaminergic medication. aDBS was able to decrease DBS amplitude during motor "on" states compared to "off" states (paired <i>t</i> test <i>p</i> = 0.046), and this automatic adjustment of STN-DBS prevented dyskinesias. <h3>Conclusions</h3> The main findings of our study are that aDBS is technically feasible in everyday life and provides a safe, well-tolerated, and effective treatment method for the management of clinical fluctuations. <h3>Classification of evidence</h3> This study provides Class IV evidence that for patients with advanced PD, aDBS is safe, well tolerated, and effective in controlling PD motor symptoms.