Acute effects of adaptive Deep Brain Stimulation in Parkinson's disease

Brain Stimul. 2020 Nov-Dec;13(6):1507-1516. doi: 10.1016/j.brs.2020.07.016. Epub 2020 Jul 29.


Background: Beta-based adaptive Deep Brain Stimulation (aDBS) is effective in Parkinson's disease (PD), when assessed in the immediate post-implantation phase. However, the potential benefits of aDBS in patients with electrodes chronically implanted, in whom changes due to the microlesion effect have disappeared, are yet to be assessed.

Methods: To determine the acute effectiveness and side-effect profile of aDBS in PD compared to conventional continuous DBS (cDBS) and no stimulation (NoStim), years after DBS implantation, 13 PD patients undergoing battery replacement were pseudo-randomised in a crossover fashion, into three conditions (NoStim, aDBS or cDBS), with a 2-min interval between them. Patient videos were blindly evaluated using a short version of the Unified Parkinson's Disease Rating Scale (subUPDRS), and the Speech Intelligibility Test (SIT).

Results: Mean disease duration was 16 years, and the mean time since DBS-implantation was 6.9 years. subUPDRS scores (11 patients tested) were significantly lower both in aDBS (p=<.001), and cDBS (p = .001), when compared to NoStim. Bradykinesia subscores were significantly lower in aDBS (p = .002), and did not achieve significance during cDBS (p = .08), when compared to NoStim. Two patients demonstrated re-emerging tremor during aDBS. SIT scores of patients who presented stimulation-induced dysarthria significantly worsened in cDBS (p = .009), but not in aDBS (p = .407), when compared to NoStim. Overall, stimulation was applied 48.8% of the time during aDBS.

Conclusion: Beta-based aDBS is effective in PD patients with bradykinetic phenotypes, delivers less stimulation than cDBS, and potentially has a more favourable speech side-effect profile. Patients with prominent tremor may require a modified adaptive strategy.

Keywords: Adaptive deep brain stimulation; Beta oscillations; Closed-loop; Dysarthria; Local field potentials; Parkinson’s disease; Subthalamic nucleus.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Beta Rhythm / physiology*
  • Cross-Over Studies
  • Deep Brain Stimulation / methods*
  • Female
  • Humans
  • Hypokinesia / diagnosis
  • Hypokinesia / physiopathology
  • Hypokinesia / therapy
  • Intraoperative Neurophysiological Monitoring / methods*
  • Male
  • Middle Aged
  • Parkinson Disease / diagnosis
  • Parkinson Disease / physiopathology*
  • Parkinson Disease / therapy*
  • Tremor / diagnosis
  • Tremor / physiopathology
  • Tremor / therapy