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JAMA Neurol. 2013 Jan;70(1):95-9. doi: 10.1001/jamaneurol.2013.581.

Association of deep brain stimulation washout effects with Parkinson disease duration.

Author information

1
Center for Neurological Restoration, Department of Neurology, Cleveland Clinic, Cleveland, Ohio 44195, USA. coopers2@ccf.org

Abstract

BACKGROUND:

Deep brain stimulation (DBS) of the subthalamic nucleus (STN) improves symptoms of Parkinson disease (PD), including bradykinesia. When stimulation ceases abruptly, bradykinesia returns gradually. The duration of the gradual, slow washout varies across patients, and although the origin of this variability is unclear, it is hypothesized to be related to 1 or more clinical characteristics of patients.

OBJECTIVE:

To determine if a correlation exists between clinical characteristics of patients with Parkinson disease (age, age at disease onset, disease severity, disease duration, medication dose, or time since surgery) and the washout rate for bradykinesia when STN DBS is discontinued.

DESIGN:

Serial quantitative assessments of bradykinesia were performed during a defined period following cessation of STN DBS.

SETTING:

Academic research.

PATIENTS:

Twenty-four patients with Parkinson disease who underwent STN DBS were enrolled in the study. Patients were assessed while off medication (medication had been discontinued 10½ to 16½ hours before testing), and stimulator settings were unchanged for a mean (median) of 20 (14) months.

MAIN OUTCOME MEASURES:

We measured bradykinesia in the dominant hand by assessing finger tapping (item 23 on the Unified Parkinson Disease Rating Scale), which was quantified using an angular velocity transducer strapped on the index finger. Finger tapping was assessed every 2 minutes for 20 seconds at a time. This was performed during a 20-minute period with DBS on (baseline period), during a 50-minute period following discontinuation of STN DBS for the dominant hand, and again during a 20-minute period after turning on the device.

RESULTS:

When STN DBS was turned off, an initial fast but partial loss of benefit was observed, which was followed by a further slow washout of the residual therapeutic effect. The half-life of the slow washout phase varied significantly across patients, and this variation was strongly related to disease duration: patients with shorter disease duration experienced slower washout, while patients with longer disease duration experienced faster washout.

CONCLUSIONS:

Washout of STN DBS effects varies with Parkinson disease duration. Estimates of proper washout time based on one patient population may not apply to populations with different disease durations. In DBS clinical trials, washout intervals should be chosen conservatively or adjusted for individual variation in the rate at which washout occurs.

PMID:
23070397
PMCID:
PMC5148628
DOI:
10.1001/jamaneurol.2013.581
[Indexed for MEDLINE]
Free PMC Article

Conflict of interest statement

Disclosures: Dr McIntyre is a consultant for IntElect Medical and Boston Scientific Neuromodulation. Dr Fernandez has received research support from Abbott, Acadia, Biotie Therapeutics, EMD-Serono, Huntington Study Group, Ipsen, Merz Pharmaceuticals, Michael J. Fox Foundation, Movement Disorders Society, National Parkinson Foundation, NINDS of the NIH, Novartis, Parkinson Study Group, and Teva; honoraria from University of South Florida Continuing Medical Education (CME), Cleveland Clinic CME, Medical Communications Media, Health Professions Conferencing, Ipsen, Merz Pharmaceuticals, and US World Meds; and royalty payments from Demos Publishing, Manson Publishing, and Springer Publishing; he is also a consultant for Merz Pharmaceuticals, Ipsen Pharmaceuticals, and United Biosource Corporation and received a stipend from the Movement Disorders Society for serving as medical editor of the Movement Disorders Society website. Dr Vitek has received research grant funding from the NINDS of the NIH, NeuroNexus, and Great Lake NeuroTech (doing business as Cleveland Medical); he has also received consulting fees from Medtronic, Boston Scientific, St Jude Medical, and Ceregene, along with an honorarium for speaking for Teva Neuroscience.

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