Abstract
Background: Deep brain stimulation (DBS) has become a standard treatment for advanced stages of Parkinson's disease, essential tremor, and dystonia. In addition to the correct surgical device implantation, effective programming is regarded to be the most important factor for clinical outcome. Despite established strategies for adjusting neurostimulation, DBS programming remains time- and resource-consuming. Although kinematic and neuronal biosignals have recently been examined as potential feedback for closed-loop DBS (CL-DBS), there is an ongoing need for programming strategies to adapt the stimulation parameters and electrode configurations accurately and effectively.Methods: Here, we tested the usefulness of a patient-rated visual analog scale (VAS) for real-time adjustment of DBS parameters. The stimulation parameters (contact and amplitude) in Parkinson's patients with STN-DBS (n = 17) were optimized based on the patient's subjective VAS rating. A Minkowski distance (Md) was calculated to compare the individual combination of contact selection and amplitude to the stimulation parameters that resulted from classical programming based on clinical signs and symptoms.Results: We found no statistically significant difference between VAS-based and classical programming in regard to the specific contact or amplitude used or in regard to the clinical disease severity (UPDRS).Conclusions: Our data suggest that VAS-based and classical programming strategies both lead to similar short-term results. Although further research will be required to assess the validity of VAS-based DBS programming, our results support the investigation of the patient's subjective rating as an additional and valid feedback signal for individualized DBS adjustment.
Highlights
Since the pioneering work of Benabid et al [1], deep brain stimulation (DBS) has become a standard treatment for advanced stages of Parkinson’s disease (PD), for medically intractable essential tremor (ET), and for complicated forms of dystonia
Once a patient has been implanted with DBS leads, adjusting stimulation parameters is the only way to optimize the clinical effect and it becomes even more important if DBS electrodes are located outside the center of the intended target structure
Disease duration was 15.76 ± 2.86 yrs with an average DBS duration of 3.29 ± 2.73 yrs. n = 3 patients had a device from Abbott R and n = 5 from Boston Scientific R, each of them with segmented electrodes. n = 9 patients had a device from Medtronic R with unsegmented electrodes
Summary
Since the pioneering work of Benabid et al [1], deep brain stimulation (DBS) has become a standard treatment for advanced stages of Parkinson’s disease (PD), for medically intractable essential tremor (ET), and for complicated forms of dystonia. Apart from the careful selection of suitable patients and the correct surgical device implantation, effective postoperative programming of DBS devices is regarded as to be the most relevant factor for the individual patient outcome [2,3,4]. Deep brain stimulation (DBS) has become a standard treatment for advanced stages of Parkinson’s disease, essential tremor, and dystonia. In addition to the correct surgical device implantation, effective programming is regarded to be the most important factor for clinical outcome. Despite established strategies for adjusting neurostimulation, DBS programming remains time- and resource-consuming. Kinematic and neuronal biosignals have recently been examined as potential feedback for closed-loop DBS (CL-DBS), there is an ongoing need for programming strategies to adapt the stimulation parameters and electrode configurations accurately and effectively
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