Novel Programming Features Help Alleviate Subthalamic Nucleus Stimulation‐Induced Side Effects

• Published in: Movement disorders 2020-12, Vol.35 (12), p.2261-2269
• Main Authors: Dayal, Viswas, De Roquemaurel, Alexis, Grover, Timothy, Ferreira, Francisca, Salazar, Maricel, Milabo, Catherine, Candelario‐McKeown, Joseph, Zrinzo, Ludvic, Akram, Harith, Limousin, Patricia, Foltynie, Thomas
• Format: Article
• Language: English
• Subjects: Deep Brain Stimulation; directional; Dysarthria; Dyskinesia; Dyskinesias; Electrical stimuli; Humans; Motor task performance; Movement disorders; Neurodegenerative diseases; Optimization; Parkinson Disease - therapy; Parkinson's disease; Parkinsonʼs disease; pulse width; Side effects; Solitary tract nucleus; Subthalamic Nucleus; Treatment Outcome
• ISSN: 0885-3185; 1531-8257
• DOI: 10.1002/mds.28252

ABSTRACT Background Subthalamic nucleus deep brain stimulation (STN‐DBS) is a widely used treatment for Parkinsonʼs disease (PD) patients with motor complications, but can result in adverse effects (AEs) in a significant proportion of treated patients. The use of novel programming features including short pulse width (PW) and directional steering in alleviating stimulation‐induced AEs has not been explored. Objective To determine if programming with short PW, directional steering, or the combination of these novel techniques can improve stimulation‐induced dysarthria, dyskinesia, and pyramidal AEs. Methods Thirty‐two consecutive PD patients who experienced reversible AEs of STN‐DBS had optimization of their settings using either short PW, directional steering, or the combination, while ensuring equivalent control of motor symptoms. Pairwise comparisons of pre‐ and post‐optimization adverse effect ratings were made. Patients were left on the alternative setting with the greatest benefit and followed up at 6 months. Modeling of volume of tissue activated (VTA) and charge per pulse (Qp) calculations were used to explore potential underlying mechanisms of any differences found. Results There were significant improvements in stimulation‐induced dysarthria, dyskinesia, and pyramidal side effects after optimization. At 6 months, mean AE ratings remained significantly improved compared to pre‐optimization ratings. Different patterns of shift in VTA for each AE, and Qp could be used to explain improvements using novel techniques. Conclusions Stimulation‐induced dysarthria, dyskinesia, and pyramidal AEs induced by STN‐DBS can be improved by using novel programming techniques. These represent additional tools to conventional methods that can be used to address these AEs. © 2020 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society