Abstract
This study compares the effects on motor symptoms between conventional deep brain stimulation (cDBS) and closed-loop adaptive deep brain stimulation (aDBS) in patients with Parkinson’s Disease. The aDBS stimulation is controlled by the power in the beta band (12–35 Hz) of local field potentials recorded directly by subthalamic nucleus electrodes. Eight subjects were assessed in two 8-h stimulation sessions (first day, cDBS; second day, aDBS) with regular levodopa intake and during normal daily activities. The Unified Parkinson’s Disease Rating Scale (UPDRS) part III scores, the Rush scale for dyskinesias, and the total electrical energy delivered to the tissues per second (TEEDs) were significantly lower in the aDBS session (relative UPDRS mean, cDBS: 0.46 ± 0.05, aDBS: 0.33 ± 0.04, p = 0.015; UPDRS part III rigidity subset mean, cDBS: 2.9143 ± 0.6551 and aDBS: 2.1429 ± 0.5010, p = 0.034; UPDRS part III standard deviation cDBS: 2.95, aDBS: 2.68; p = 0.047; Rush scale, cDBS 2.79 ± 0.39 versus aDBS 1.57 ± 0.23, p = 0.037; cDBS TEEDs mean: 28.75 ± 3.36 µj s−1, aDBS TEEDs mean: 16.47 ± 3.33, p = 0.032 Wilcoxon’s sign rank test). This work further supports the safety and effectiveness of aDBS stimulation compared to cDBS in a daily session, both in terms of motor performance and TEED to the patient.
Highlights
In recent years, closed-loop systems have been used in clinical trials for the treatment of Parkinson’s Disease (PD)
Our primary outcome was motor improvement comparing adaptive Deep Brain Stimulation (aDBS) with conventional DBS (cDBS), in terms of both dyskenisias and motor scores, as assessed by Unified Parkinson’s Disease Rating Scale (UPDRS)-III; the secondary outcome referred to changes in TEEDs
The main results are that aDBS reduced dyskenisias, improved “rigidity” subscores and delivered a lower total energy when compared to cDBS
Summary
In recent years, closed-loop systems have been used in clinical trials for the treatment of Parkinson’s Disease (PD). No study has compared to date the effects of aDBS and cDBS in a daytime window both on dyskinesia and on the three cardinal signs of PD (tremor, rigidity and bradykinesia), maintaining a regular levodopa intake, and with the patient free to move and to conduct normal activities. In this open-label, nonblinded pilot study, we aimed at investigating whether aDBS provides a better control than cDBS on the clinical motor conditions during an 8-h stimulation protocol, in conjunction of chronic levodopa assumption and without restriction on patient’s activities
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