Objective: We reported three cases of subthalamic deep brain stimulation (STN-DBS) of Parkinson’s disease (PD), with successful management of challenging issues during programing.

Background: Proper programming is an essential for the best outcome and overcoming side effects of STN-DBS of PD.

Method: We describe three male PD patients (42, 66, 67 years old) who underwent STN DBS (Activa PC, Medtronic) due to wearing off of levodopa response, medication resistant tremor for two patients (A &B) and drug induced dyskinesia (C). Proper electrodes localization with postoperative imaging was confirmed.

Results: Initial programing demonstrated marked improvement of bradykinesia and rigidity, unsatisfactory improvement of tremor for all patients, ipsilateral stimulation-related dyskinesia for patients A & C, and impaired balance for patient B, in the best contacts that limited increasing voltage to improve tremor. We applied certain strategies to overcome this issue. Gradual increasing of amplitude (over 2-3 months), changing the contact to more dorsal contacts, lowering levodopa daily dosage and adding amantadine. Bipolar montage with increasing pulse width was used in one side to markedly ameliorate tremor for patient A. For all patients, increasing pulse width and frequency was used to achieve marked improvement of tremor. postoperative total MDS-UPDRS III 82.1,, 86.7, 77.2% and tremor were 86.7, 88, 83.3% for patients A,B and C, respectively. Dyskinesia of patient B improved by 94.5%. Consequently, all patients had marked improvement with no stimulation-related side effects.

Conclusion: Applying different strategies of programing could achieve best outcome of STN-DBS, including marked improvement of motor symptoms and overcoming stimulation related side effect.

References: Picillo M, Lozano AM, Kou N, Puppi Munhoz R, Fasano A. Programming deep brain stimulation for Parkinson’s disease: the toronto western hospital algorithms. Brain Stimul. (2016) 9:425–37. doi: 10.1016/j.brs.2016.02.004 Volkmann J, Herzog J, Kopper F, Deuschl G. Introduction to the programming of deep brain stimulators. Mov Disord. (2002) 17(Suppl. 3):S181–7. doi: 10.1002/mds.10162

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MDS Abstracts - https://www.mdsabstracts.org/abstract/overcoming-stimulation-related-side-effects-and-improving-outcome-by-proper-programing-of-subthalamic-stimulation-of-parkinsons-disease-cases-report/