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Mov Disord. 2019 Sep 30. doi: 10.1002/mds.27853. [Epub ahead of print]

Dyskinesia-inducing lead contacts optimize outcome of subthalamic stimulation in Parkinson's disease.

Author information

1
Department of Neurology, Geneva University Hospital, Geneva, Switzerland.
2
Department of Basic Neuroscience, University of Geneva, Geneva, Switzerland.
3
Department of Neurosurgery, Geneva University Hospital, Geneva, Switzerland.

Abstract

BACKGROUND:

Acute dyskinesias elicited by STN-DBS, here referred to as stimulation-induced dyskinesias, predict optimal clinical outcome in PD. However, it remains elusive whether stimulation-induced dyskinesias can guide DBS programming.

OBJECTIVES:

Here, we characterized stimulation-induced dyskinesias clinically and anatomically. We then tested whether dyskinesia-inducing contacts could be effectively programmed using independent current source technology.

METHODS:

We characterized stimulation-induced dyskinesias with directional and ring stimulation retrospectively in 20 patients. We then localized dyskinesia-inducing contacts by imaging coregistration and eventually programmed those contacts.

RESULTS:

We elicited dyskinesias in half of our patients. Dyskinesia-inducing contacts were mainly directional and were all located ventrally within the dorsolateral motor STN. When these dyskinesia-inducing contacts were programmed using independent current source technology, dyskinesia disappeared and robust antibradykinetic effects were obtained.

CONCLUSION:

We confirm that stimulation-induced dyskinesias are helpful clinical observations, which may guide programming of directional STN-DBS in PD. © 2019 International Parkinson and Movement Disorder Society.

KEYWORDS:

Parkinson's disease; deep brain stimulation; directional; stimulation-induced dyskinesia; subthalamic nucleus

PMID:
31571277
DOI:
10.1002/mds.27853

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