Objective: To compare the clinical efficacy of unilateral conventional DBS (cDBS) vs adaptive DBS (aDBS) based on local field potentials (LFP) delivered for 8 hours in Parkinson’s disease patients.

Background: DBS innovation for PD claims for higher personalization and more targeted therapeutic strategy. Recently proposed closed-loop aDBS strategies are able to adapt stimulation parameters to patient’s clinical state and are considered the cutting-edge technologies to achieve better personalization and efficacy. LFPs, representing the synchronous pre- and post-synaptic activity of neuronal populations recorded using the same lead delivering DBS are the most promising feedback variable for aDBS. Despite several preliminary studies in humans, long-term comparison of aDBS vs cDBS outcomes on patients is still lacking.

Method: Eight 8 PD patients undergoing surgery for subthalamic DBS electrode implant were enrolled. Implanted DBS leads were externalized for a week. During two eight-hours experimental sessions lasting 8 hours hospitalized patients were free to move, to take their normal medications, and to conduct their normal activities while wearing a portable aDBS device [1,2] which delivered, in the first session cDBS, and, in the second session, aDBS. A blinded neurologist assessed the clinical state and fluctuations through the Unified Parkinson’s Disease Rating Scale part III (UPDRS III) and the Rush scale. For the analysis, UPDRS III was normalized to the maximum and minimum values difference reported for each patient during the two days.

Results: aDBS produced significantly lower UPDRS III scores than cDBS (normalized UPDRS, cDBS vs aDBS [mean±SE] 0.46 ± 0.05 vs 0.33 ± 0.04, t-test p=0.013) and a better control of dyskinesias than cDBS (Rush scale, cDBS vs aDBS 2.79 ± 0.39 vs 1.57 ± 0.23, p=0.036), thus suggesting a better control of motor symptoms and side effects.

Conclusion: These results are in line with previous findings showing that aDBS is superior to cDBS, especially in controlling stimulation side effects. However, in this experiment, the two conditions were not randomized (cDBS was administered always the first day, and aDBS the second day). This was done to mimic the future practice of aDBS: data collected during cDBS were necessary to personalize aDBS therapy, as it will happen in future practice. Our findings support the superiority of aDBS vs cDBS in controlling motor symptoms in Parkinson’s disease.

References: [1] Arlotti M, Marceglia S, Fo”ani G, Volkmann J, Lozano AM, Moro E, Cogiamanian F, Prenassi M, Bocci T, Cortese F, Rampini P, Barbieri S, Priori A. Eight-hours adaptive deep brain stimulation in patients with Parkinson disease. Neurology. 2018 Mar 13;90(11):e971-e976. doi: 10.1212/WNL.0000000000005121. [2] Rosa M, Arlotti M, S. Marceglia, Cogiamanian F, Ardolino G, Fonzo AD, Lopiano L, Scelzo E, Merola A, Locatelli M, Rampini PM, Priori A. Adaptive deep brain stimulation controls levodopa induced side effects in Parkinsonian patients. Mov Disord. 2017Apr;32(4):628-629. doi: 10.1002/mds.26953

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MDS Abstracts - https://www.mdsabstracts.org/abstract/adaptive-vs-conventional-deep-brain-stimulation-for-parkinsons-disease-a-eight-hours-study/