Abstract
Background: Adaptive Deep Brain Stimulation (aDBS) is now considered as a new feasible and effective paradigm to deliver DBS to patients with Parkinson's disease (PD) in such a way that not only stimulation is personalized and finely tuned to the instantaneous patient's state, but also motor improvement is obtained with a lower amount of energy transferred to the tissue. Amplitude-controlled aDBS was shown to significantly decrease the amplitude-driven total electrical energy delivered to the tissue (aTEED), an objective measure of the amount of energy transferred by DBS amplitude to the patient's brain. However, there is no direct evidence of a relationship between aTEED and the occurrence of DBS-related adverse events in humans.Objective: In this work, we investigated the correlation of aTEED with the occurrence of levodopa-induced dyskinesias pooling all the data available from our previous experiments using aDBS and cDBS.Methods: We retrospectively analyzed data coming from 19 patients with PD undergoing surgery for STN-DBS electrode positioning and participating to experiments involving cDBS and aDBS delivery. Patients were all studied some days after the surgery (acute setting). The aTEED and dyskinesia assessments (Rush Dyskinesia Rating Scale, RDRS) considered in the Med ON-Stim ON condition.Results: We confirmed both that aTEED values and RDRS were significantly lower in the aDBS than in cDBS sessions (aTEED mean value, cDBS: 0.0278 ± 0.0011 j, vs. aDBS: 0.0071 ± 0.0003 j, p < 0.0001 Wilcoxon's rank sum; normalized RDRS mean score, cDBS: 0.66 ± 0.017 vs. aDBS: 0.45 ± 0.01, p = 0.025, Wilcoxon's rank sum test). In addition, we found a direct significant correlation between aTEED and RDRS (ρ = 0.44, p = 0.0032, Spearman's correlation).Conclusions: Our results provide a first piece of evidence that aTEED is correlated to the amount of levodopa-induced dyskinesias in patients with PD undergoing STN-DBS, thus supporting the role of aDBS as feasible and safe alternative to cDBS.
Highlights
Increasing evidence supports the safety, feasibility, and efficacy of new deep brain stimulation (DBS) strategies that implement closed-loop adaptive stimulation for patients with Parkinson’s Disease (PD) implanted in the subthalamic nucleus (STN) [1,2,3,4,5,6,7,8]
Adaptive DBS differs from conventional DBS because it provides electrical stimulation with parameters that are changed real-time according to the analysis of brain signals, especially local field potentials (LFPs) recorded from the same lead implanted for DBS [9, 10]
In order to provide an initial piece of evidence on the role of aTEED in the occurrence of stimulation related side effects, in this work, we investigated the correlation of aTEED with levodopa-induced dyskinesias retrospectively considering all the data available from our previous experiments using Adaptive DBS (aDBS) and conventional DBS (cDBS) [5, 6]
Summary
Increasing evidence supports the safety, feasibility, and efficacy of new deep brain stimulation (DBS) strategies that implement closed-loop adaptive stimulation for patients with Parkinson’s Disease (PD) implanted in the subthalamic nucleus (STN) [1,2,3,4,5,6,7,8]. The aDBS concept is based on a simple closed-loop model in which a feedback variable is sensed by the system in order to assess the patient’s state, and a control algorithm provides the new stimulation parameters to be delivered to the patient [9]. Adaptive Deep Brain Stimulation (aDBS) is considered as a new feasible and effective paradigm to deliver DBS to patients with Parkinson’s disease (PD) in such a way that stimulation is personalized and finely tuned to the instantaneous patient’s state, and motor improvement is obtained with a lower amount of energy transferred to the tissue. There is no direct evidence of a relationship between aTEED and the occurrence of DBS-related adverse events in humans
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