Parkinson Disease Symptom Fluctuations Well-Managed With Adaptive Deep Brain Stimulation

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The small study “is a step forward in the development of the new generation of implantable aDBS devices for treating PD,” the investigators said.
The small study “is a step forward in the development of the new generation of implantable aDBS devices for treating PD,” the investigators said.

Local field potentials (LFPs)-based adaptive deep brain stimulation (aDBS) is a safe, tolerable, and effective treatment strategy for managing clinical fluctuations associated with Parkinson disease (PD), according to findings from a small study published in Neurology.

A total of 11 patients with rigid-akinetic advanced PD were included in this study, all of whom had undergone surgical intervention for implantation of a DBS electrode in the subthalamic nucleus. The experiment, which took place following DBS surgery and prior to connection of the leads to the subcutaneous pulse generator, consisted of 2 sessions conducted with a portable aDBS prototype device for 8 hours per session, per day. On day 1, each patient took their daily medication, and on day 2 each patient received subthalamic nucleus aDBS by means of LFPs beta band power.

On the first experimental day, beta power correlated with levodopa administration dose (mean decrease of 18.0±0.03% [peak dose] vs 8.3 ± 0.03% [end dose]; P =.009) with regard to baseline values (medication “off,” stimulation “off,” 12-hour post-levodopa withdrawal). As measured by the Unified Parkinson's Disease Rating Scale, part III, motor part, beta band power was associated with each patient's clinical state (Pearson correlation coefficient r = 0.506, P <.001, and r = 0.477, P <.001) and was found to be specifically modulated during walking with regard to relaxing and talking (beta power change from baseline during walking -14.0±4.212%, talking -11.2±2.724%, relaxing -8.8±2.418%, 1-way analysis of variance; P <.0001).

Additionally, post-LFP change aDBS was deemed safe, tolerable, and effective among patients performing regular daily activities who were also taking additional dopaminergic drugs (30% improvement without medication [3-way analysis of variance, interaction day × medication P =.036; 30.5±3.4 vs 22.2±3.3, P =.003]). The use of aDBS was also associated with a decrease in DBS amplitude during motor on states vs off states (paired t test P =.046), ultimately playing a role in the prevention of dyskinesias.

Investigators relied on a self-reported diary and an accelerometer to analyze daily life activities such as talking, sleeping, and relaxing, which may have resulted in inaccurate results. In addition, the small number of patients and the lack of a comparator arm may also limit the findings.

The findings from this small study are “a step forward in the development of the new generation of implantable aDBS devices for treating PD.”

Reference

Arlotti M, Marceglia S, Foffani G, et al. Eight-hours adaptive deep brain stimulation in patients with Parkinson disease [published online February 14, 2018]. Neurology. doi:10.1212/WNL.0000000000005121

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