Short Versus Conventional Pulse-Width Deep Brain Stimulation in Parkinson's Disease: A Randomized Crossover...

Area of Science:

• Neurology
• Neurosurgery
• Biomedical Engineering

Background:

• Subthalamic nucleus deep brain stimulation (STN-DBS) effectively manages motor fluctuations in Parkinson's disease (PD).
• However, STN-DBS can worsen speech (dysarthria) and axial symptoms.
• The potential of short pulse width (PW) to mitigate these side effects in chronic STN-DBS is not well-established.

Purpose of the Study:

• To investigate if a short PW (30 μs) reduces stimulation-induced dysarthria compared to conventional PW (60 μs) in PD patients with existing STN-DBS.
• To assess the impact of short PW on motor, non-motor, and quality of life outcomes.

Main Methods:

• A single-center, double-blind, randomized crossover trial was conducted.
• 16 PD patients with moderate dysarthria and chronic STN-DBS (mean 6.5 years) were randomized to 4 weeks of 30 μs or 60 μs PW, followed by the alternative setting for 4 weeks.
• The primary outcome was speech intelligibility (Sentence Intelligibility Test); secondary outcomes included motor, non-motor, and quality of life measures.

Main Results:

• No significant difference in speech intelligibility was observed between 30 μs and 60 μs PW settings.
• Motor, non-motor, and quality of life scores also showed no significant differences between the two PW settings.
• Short PW (30 μs) was well-tolerated, with similar adverse event rates to conventional settings.

Conclusions:

• Short PW (30 μs) STN-DBS did not improve dysarthric speech in patients with chronic Parkinson's disease.
• Post hoc analysis suggests potential benefits for patients with shorter DBS duration.
• Further studies are warranted to explore short PW efficacy in specific patient subgroups.