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Novel Programming Features Help Alleviate Subthalamic Nucleus Stimulation-Induced Side Effects.

Viswas Dayal1,2, Alexis De Roquemaurel2, Timothy Grover1,2

  • 1Department of Clinical and Movement Neurosciences, University College London Institute of Neurology, London, United Kingdom.

Movement Disorders : Official Journal of the Movement Disorder Society
|September 26, 2020
PubMed
Summary
This summary is machine-generated.

Novel programming techniques like short pulse width and directional steering can significantly reduce adverse effects from subthalamic nucleus deep brain stimulation (STN-DBS) in Parkinson's disease patients. These methods offer improved management of stimulation-induced side effects.

Keywords:
Parkinsonʼs diseasedeep brain stimulationdirectionalpulse widthside effectssubthalamic nucleus

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Area of Science:

  • Neurology
  • Neurosurgery
  • Biomedical Engineering

Background:

  • Subthalamic nucleus deep brain stimulation (STN-DBS) is a common treatment for Parkinson's disease (PD) motor complications.
  • Adverse effects (AEs) occur in a significant number of patients undergoing STN-DBS.
  • The efficacy of novel programming features like short pulse width (PW) and directional steering for alleviating AEs is unexplored.

Purpose of the Study:

  • To evaluate if short PW, directional steering, or their combination can improve stimulation-induced dysarthria, dyskinesia, and pyramidal AEs.
  • To assess the long-term effectiveness of these novel programming techniques.
  • To explore the mechanisms underlying AE improvement using VTA and Qp modeling.

Main Methods:

  • Thirty-two Parkinson's disease patients with reversible STN-DBS AEs underwent programming optimization.
  • Settings were adjusted using short PW, directional steering, or both, maintaining motor symptom control.
  • Adverse effect ratings were compared pre- and post-optimization, with follow-up at 6 months. VTA and Qp modeling were employed.

Main Results:

  • Significant improvements were observed in stimulation-induced dysarthria, dyskinesia, and pyramidal AEs post-optimization.
  • Mean AE ratings remained significantly improved at the 6-month follow-up.
  • VTA shifts and Qp calculations provided insights into the mechanisms of improvement.

Conclusions:

  • Novel programming techniques effectively improve stimulation-induced AEs in STN-DBS for Parkinson's disease.
  • These techniques offer valuable additions to conventional methods for managing AEs.
  • Optimized programming enhances the therapeutic utility of STN-DBS by mitigating side effects.