Initial Clinical Outcome With Bilateral, Dual-Target Deep Brain Stimulation Trial in Parkinson Disease Using Summit...

Area of Science:

• Neuroscience
• Neurology
• Biomedical Engineering

Background:

• Deep brain stimulation (DBS) is an established therapy for advanced Parkinson disease (PD).
• Both subthalamic nucleus (STN) and globus pallidus (GP) DBS are effective, but potential synergism of combined stimulation is unexplored.
• Identifying biomarkers for adaptive DBS is crucial for personalized treatment.

Purpose of the Study:

• To assess the clinical benefits of combined STN and GP DBS lead stimulation in PD patients.
• To explore biomarker discovery for future adaptive DBS therapies.
• To compare the efficacy of combined DBS versus single-site STN or GP DBS.

Main Methods:

• A pilot trial involving 3 PD patients with bilateral STN and GP DBS leads implanted.
• Evaluation of 1-year outcomes including Unified PD Rating Scale (UPDRS), medication dosage, and beta frequency spectral power.
• Analysis of motor and non-motor symptoms, medication adjustments, and neurophysiological biomarkers.

Main Results:

• Combined DBS significantly improved PD symptom control, enabling over 80% reduction in levodopa dosage.
• Greater reduction in off-medication motor UPDRS was observed with combined stimulation compared to STN or GP alone.
• Combined DBS led to a more pronounced decrease in STN beta oscillations than single-site stimulation.
• Minor adverse events included cortical hemorrhage, seizure, and extension wire scarring.

Conclusions:

• Patients with Parkinson disease preferred combined STN and GP DBS stimulation in this preliminary study.
• Combined DBS demonstrates superior efficacy in motor symptom control and medication reduction.
• Further research will focus on adaptive DBS efficacy using defined biomarkers and control policies.