Burst-type deep brain stimulation of the subthalamic nucleus in Parkinson's disease: A case series on tolerability...

Deep brain stimulation (DBS) has become an evidence-based treatment for movement disorders such as Parkinson's disease (PD). Recent animal studies of DBS suggest that burst-type DBS may specifically activate neuronal subpopulations and that this type of electrical stimulation programing may improve the efficacy and durability of DBS. Burst type DBS is defined as a novel stimulation protocol in which intermittent bursts of traditional high-frequency rectangular wave stimulation are delivered. Implanted pulse generators can deliver such stimulation by setting specific "on" and "off " times; however, there is limited published human data on the results of such programming in patients undergoing DBS for movement disorders such as PD. Herein, we discuss our experience using burst-type DBS of the bilateral subthalamic nucleus (STN) in PD in two patients.

We conducted a case series with two patients implanted with bilateral STN DBS, tested the burst intermittent stimulation parameters, and assessed United Parkinson's Disease Rating Scale scores to determine the effect of therapy and patient tolerance. A 72-year-old man with bilateral STN DBS for bradykinesia/rigidity predominant PD tolerated the burst pattern stimulation for a total of 1 year; parameters were changed within this period, and he was ultimately switched back to continuous stimulation after the 1-year mark. The second patient, a 65-year-old man with bilateral STN DBS for tremor predominant PD, started on the Burst protocol but immediately did not tolerate the programming change due to a significant recurrence of tremor and was subsequently switched to a continuous cycle.

Burst programming provided variable results in therapeutic effect for the patient's bilateral STN DBS of differing Parkinson's phenotypes. Further investigation is needed to assess the efficacy of various programming modalities for patients with PD.