Patient-adjusted deep-brain stimulation programming is time saving in dystonia patients

• Published in: Journal of neurology 2019-10, Vol.266 (10), p.2423-2429
• Main Authors: Bally, Julien F., Rohani, Mohamad, Ruiz-Lopez, Marta, Paramanandam, Vijayashankar, Munhoz, Renato P., Hodaie, Mojgan, Kalia, Suneil K., Lozano, Andres M., Burkhard, Pierre R., Poncet, Antoine, Fasano, Alfonso
• Format: Article
• Language: English
• Subjects: Adult; Aged; Clinical decision making; Deep brain stimulation; Deep Brain Stimulation - methods; Dystonia; Dystonic Disorders - therapy; Feasibility Studies; Female; Humans; Male; Medicine; Medicine & Public Health; Middle Aged; Neurology; Neuroradiology; Neurosciences; Original Communication; Outcome Assessment, Health Care; Patients; Remote control; Retrospective Studies; Severity of Illness Index; Statistical analysis; Torticollis
• ISSN: 0340-5354; 1432-1459
• DOI: 10.1007/s00415-019-09423-9

Background Deep-brain stimulation (DBS) programming for dystonia patients is a complex and time-consuming task. Objective To analyze whether programming a programming paradigm based on patient’s self-adjustment is practical, effective and time saving in dystonia. Methods We retrospectively compared dystonia rating scales as well as the time necessary to optimize programming and the number of in-hospital visits in all patients ( n  = 102) operated at our center who used simple mode (SM) or advanced mode (AM) programming; the latter uses groups of different stimulation parameters and allows the patient and their caregiver to change stimulation groups at home, using the patient remote control. Results Both AM- and SM-allocated patients improved clinically to the same extent after DBS, as assessed by the Burke–Fahn–Marsden (BFM) and the Toronto Western Spasmodic Torticollis (TWSTRS) dystonia rating scales. All subscores improved after DBS without statistically significant differences in improvement between AM and SM (BFM: − 43% vs. − 53%, p  = 0.569; TWSTRS: − 63% vs. − 72%, p  = 0.781). AM and SM patients reached optimization within a similar median time [5.5 months (95% CI 4.6–6.3) for AM vs. 6.2 months (4.2–7.6) for SM, p  = 0.674) but patients on advanced programming needed fewer in-hospital visits to achieve the same improvement [median of 5 visits (95% CI 4–7) for AM vs. 8 visits (7–9) for SM, p  = 0.008]. Conclusions Advanced DBS programming based on patient’s self-adjustment under the supervision of the treating physician is feasible, practical and significantly reduces consultation time in dystonia patients.