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At home adaptive dual target deep brain stimulation in Parkinson's disease with proportional control.

Publication ,  Journal Article
Schmidt, SL; Chowdhury, AH; Mitchell, KT; Peters, JJ; Gao, Q; Lee, H-J; Genty, K; Chow, S-C; Grill, WM; Pajic, M; Turner, DA
Published in: Brain
March 1, 2024

Continuous deep brain stimulation (cDBS) of the subthalamic nucleus (STN) or globus pallidus is an effective treatment for the motor symptoms of Parkinson's disease. The relative benefit of one region over the other is of great interest but cannot usually be compared in the same patient. Simultaneous DBS of both regions may synergistically increase the therapeutic benefit. Continuous DBS is limited by a lack of responsiveness to dynamic, fluctuating symptoms intrinsic to the disease. Adaptive DBS (aDBS) adjusts stimulation in response to biomarkers to improve efficacy, side effects, and efficiency. We combined bilateral DBS of both STN and globus pallidus (dual target DBS) in a prospective within-participant, clinical trial in six patients with Parkinson's disease (n = 6, 55-65 years, n = 2 females). Dual target cDBS was tested for Parkinson's disease symptom control annually over 2 years, measured by motor rating scales, on time without dyskinesia, and medication reduction. Random amplitude experiments probed system dynamics to estimate parameters for aDBS. We then implemented proportional-plus-integral aDBS using a novel distributed (off-implant) architecture. In the home setting, we collected tremor and dyskinesia scores as well as individualized β and DBS amplitudes. Dual target cDBS reduced motor symptoms as measured by Unified Parkinson's Disease Rating Scale (UPDRS) to a greater degree than either region alone (P < 0.05, linear mixed model) in the cohort. The amplitude of β-oscillations in the STN correlated to the speed of hand grasp movements for five of six participants (P < 0.05, Pearson correlation). Random amplitude experiments provided insight into temporal windowing to avoid stimulation artefacts and demonstrated a correlation between STN β amplitude and DBS amplitude. Proportional plus integral control of aDBS reduced average power, while preserving UPDRS III scores in the clinic (P = 0.28, Wilcoxon signed rank), and tremor and dyskinesia scores during blinded testing at home (n = 3, P > 0.05, Wilcoxon ranked sum). In the home setting, DBS power reductions were slight but significant. Dual target cDBS may offer an improvement in treatment of motor symptoms of Parkinson's disease over DBS of either the STN or globus pallidus alone. When combined with proportional plus integral aDBS, stimulation power may be reduced, while preserving the increased benefit of dual target DBS.

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Published In

Brain

DOI

EISSN

1460-2156

Publication Date

March 1, 2024

Volume

147

Issue

3

Start / End Page

911 / 922

Location

England

Related Subject Headings

  • Tremor
  • Prospective Studies
  • Parkinson Disease
  • Neurology & Neurosurgery
  • Humans
  • Female
  • Dyskinesias
  • Deep Brain Stimulation
  • 52 Psychology
  • 42 Health sciences
 

Citation

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Chicago
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Schmidt, S. L., Chowdhury, A. H., Mitchell, K. T., Peters, J. J., Gao, Q., Lee, H.-J., … Turner, D. A. (2024). At home adaptive dual target deep brain stimulation in Parkinson's disease with proportional control. Brain, 147(3), 911–922. https://doi.org/10.1093/brain/awad429
Schmidt, Stephen L., Afsana H. Chowdhury, Kyle T. Mitchell, Jennifer J. Peters, Qitong Gao, Hui-Jie Lee, Katherine Genty, et al. “At home adaptive dual target deep brain stimulation in Parkinson's disease with proportional control.Brain 147, no. 3 (March 1, 2024): 911–22. https://doi.org/10.1093/brain/awad429.
Schmidt SL, Chowdhury AH, Mitchell KT, Peters JJ, Gao Q, Lee H-J, et al. At home adaptive dual target deep brain stimulation in Parkinson's disease with proportional control. Brain. 2024 Mar 1;147(3):911–22.
Schmidt, Stephen L., et al. “At home adaptive dual target deep brain stimulation in Parkinson's disease with proportional control.Brain, vol. 147, no. 3, Mar. 2024, pp. 911–22. Pubmed, doi:10.1093/brain/awad429.
Schmidt SL, Chowdhury AH, Mitchell KT, Peters JJ, Gao Q, Lee H-J, Genty K, Chow S-C, Grill WM, Pajic M, Turner DA. At home adaptive dual target deep brain stimulation in Parkinson's disease with proportional control. Brain. 2024 Mar 1;147(3):911–922.
Journal cover image

Published In

Brain

DOI

EISSN

1460-2156

Publication Date

March 1, 2024

Volume

147

Issue

3

Start / End Page

911 / 922

Location

England

Related Subject Headings

  • Tremor
  • Prospective Studies
  • Parkinson Disease
  • Neurology & Neurosurgery
  • Humans
  • Female
  • Dyskinesias
  • Deep Brain Stimulation
  • 52 Psychology
  • 42 Health sciences