A Novel DBS Paradigm for Axial Features in Parkinson's Disease: A Randomized Crossover Study

Area of Science:

• Neurology
• Neurosurgery
• Biomedical Engineering

Background:

• High-frequency deep brain stimulation (DBS) of the subthalamic nucleus is effective for appendicular symptoms in Parkinson's disease (PD) but not axial symptoms.
• Low-frequency stimulation (LFS) may improve gait/balance but can worsen appendicular symptoms.
• A novel dual-frequency (interleave-interlink, IL-IL) programming paradigm was developed to target both axial and appendicular symptoms simultaneously.

Purpose of the Study:

• To evaluate the efficacy of the IL-IL programming paradigm compared to conventional high-frequency stimulation (HFS) in PD patients.
• To assess the impact of IL-IL on both axial and appendicular symptoms, as well as overall quality of life.

Main Methods:

• A randomized, double-blind crossover trial was conducted with 25 PD patients.
• Patients were programmed with either IL-IL or conventional HFS for two-week periods.
• Outcomes included Modified Clinical Global Impression Severity (CGI-S), MDS-UPDRS-III, timed motor tests, patient questionnaires, and Personal KinetiGraphs (PKG).

Main Results:

• The IL-IL paradigm demonstrated significant improvements in patient/caregiver-rated CGI-S for gait/balance and appendicular symptoms.
• Blinded motor evaluations (MDS-UPDRS-III, CGI-S) and patient-reported outcomes (PDQoL, FOGQ) were significantly better with IL-IL.
• Timed-Up-and-Go test performance improved, with faster times and fewer steps, while bradykinesia and tremor showed no significant difference.

Conclusions:

• The IL-IL programming paradigm is a viable new treatment option for PD patients experiencing both axial and appendicular symptoms.
• This dual-frequency approach offers a potential solution to the limitations of conventional HFS in managing the multifaceted nature of Parkinson's disease.
• Further consideration of IL-IL is warranted for clinicians seeking to optimize DBS therapy for PD.