Adaptive deep brain stimulation for Parkinson
Journal of Neurology, Neurosurgery, and Psychiatry
Little S, Tripoliti E, Beudel M, Pogosyan A, Cagnan H, Herz D, Bestmann S, Aziz T, Cheeran B, Zrinzo L, Hariz M, Hyam J, Limousin P, Foltynie T, Brown P. Adaptive deep brain stimulation for Parkinson Journal of Neurology, Neurosurgery, and Psychiatry, 2016 Aug 16. pii: jnnp-2016-313518. doi: 10.1136/jnnp-2016-313518
Introduction: Deep brain stimulation (DBS) is a treatment for Parkinson’s disease (PD) that improves tremor but can cause unintelligibility in speech. The authors discuss using adaptive deep brain stimulation (aDBS), instead of conventional DBS (cDBS). Adaptive DBS uses specific feedback from the brain to guide stimulation settings in real time so that the brain isn’t receiving constant stimulation when it may not need it. The purpose of this study was to look at the aDBS approach with a biomarker (e.g. ? oscillatory activity) compared to cDBS in hope that it would be more effective and efficient in reducing motor symptoms but also reduce the likelihood of speech challenges in people with PD (PWP).
Method: Eight PWP that underwent bilateral DBS STN were studied 3-6 days after electrode placement. They were evaluated in the aDBS, cDBS, and OFF conditions. Adaptive DBS stimulation was provided only when the biomarker exceeded a set threshold. Two outcome measures were studied, speech and motor impairment. A speech language pathologist evaluated the PWP speech and movements were evaluated via video by two movement disorder specialists that were not involved in their treatment.
Results: The authors found that speech was more intelligible with the aDBS condition than cDBS. They also found that aDBS was comparable with speech to the OFF condition but cDBS was worse than OFF. They found a similar finding with motor scores where aDBS evidenced more improvement in motor scores than cDBS.
Conclusion: The authors suggest that aDBS may more effectively improve motor symptoms in PWP after DBS. They also found less speech changes with the aDBS. The authors acknowledge that there are multiple limitations within the study including limited sample size, the evaluation taking place so quickly after surgery, and that effects were not evaluated longitudinally to see if the benefits remained over time. They quickly note that this is a concept study that shows potential but requires more clinical trial investigation to determine efficacy and ability to chronically reduce a disabling adverse event from cDBS.