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Neurology. 2018 Mar 13;90(11):e971-e976. doi: 10.1212/WNL.0000000000005121. Epub 2018 Feb 14.

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

Author information

1
From the Clinical Center for Neurotechnologies, Neuromodulation, and Movement Disorders (M.A., S.M., F.C., T.B., F.C., P.R., S.B.), Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milano; Dipartimento di Ingegneria e Architettura (S.M., M.P.), Università degli Studi di Trieste, Italy; CINAC (G.F.), Hospital Universitario HM Puerta del Sur, and Hospital Nacional de Parapléjicos, Toledo, Spain; Department of Neurology (J.V.), University of Wurzburg, Germany; Division of Neurosurgery (A.M.L.), University of Toronto, ON, Canada; Division of Neurology (E.M.), Centre Hospitalier Universitaire de Grenoble, France; Department of Medico-Surgical Sciences and Biotechnologies (F.C.), Sapienza University Rome Polo Pontino, Rome; and "Aldo Ravelli" Research Center (A.P.), Department of Health Sciences, University of Milan & Ospedale San Paolo, Milan, Italy.
2
From the Clinical Center for Neurotechnologies, Neuromodulation, and Movement Disorders (M.A., S.M., F.C., T.B., F.C., P.R., S.B.), Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milano; Dipartimento di Ingegneria e Architettura (S.M., M.P.), Università degli Studi di Trieste, Italy; CINAC (G.F.), Hospital Universitario HM Puerta del Sur, and Hospital Nacional de Parapléjicos, Toledo, Spain; Department of Neurology (J.V.), University of Wurzburg, Germany; Division of Neurosurgery (A.M.L.), University of Toronto, ON, Canada; Division of Neurology (E.M.), Centre Hospitalier Universitaire de Grenoble, France; Department of Medico-Surgical Sciences and Biotechnologies (F.C.), Sapienza University Rome Polo Pontino, Rome; and "Aldo Ravelli" Research Center (A.P.), Department of Health Sciences, University of Milan & Ospedale San Paolo, Milan, Italy. alberto.priori@unimi.it.

Abstract

OBJECTIVES:

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.

METHODS:

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.

RESULTS:

The beta band power correlated in both experimental sessions with the patient's clinical state (Pearson correlation coefficient r = 0.506, p < 0.001, and r = 0.477, p < 0.001). aDBS after LFP changes was effective (30% improvement without medication [3-way analysis of variance, interaction day × medication p = 0.036; 30.5 ± 3.4 vs 22.2 ± 3.3, p = 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 t test p = 0.046), and this automatic adjustment of STN-DBS prevented dyskinesias.

CONCLUSIONS:

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.

CLASSIFICATION OF EVIDENCE:

This study provides Class IV evidence that for patients with advanced PD, aDBS is safe, well tolerated, and effective in controlling PD motor symptoms.

PMID:
29444973
PMCID:
PMC5858949
DOI:
10.1212/WNL.0000000000005121
[Indexed for MEDLINE]
Free PMC Article

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