PMID- 32738409 OWN - NLM STAT- MEDLINE DCOM- 20210329 LR - 20220129 IS - 1876-4754 (Electronic) IS - 1935-861X (Print) IS - 1876-4754 (Linking) VI - 13 IP - 6 DP - 2020 Nov-Dec TI - Acute effects of adaptive Deep Brain Stimulation in Parkinson's disease. PG - 1507-1516 LID - S1935-861X(20)30214-X [pii] LID - 10.1016/j.brs.2020.07.016 [doi] AB - 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. CI - Copyright (c) 2020. Published by Elsevier Inc. FAU - Pina-Fuentes, Dan AU - Pina-Fuentes D AD - Department of Neurosurgery, University Medical Centre Groningen, the Netherlands; Medical Research Council Brain Network Dynamics Unit at the University of Oxford, United Kingdom; Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom; Department of Neurology, Amsterdam Neuroscience Institute, Amsterdam University Medical Center, Amsterdam, The Netherlans. FAU - van Dijk, J Marc C AU - van Dijk JMC AD - Department of Neurosurgery, University Medical Centre Groningen, the Netherlands. FAU - van Zijl, Jonathan C AU - van Zijl JC AD - Department of Neurology, Amsterdam Neuroscience Institute, Amsterdam University Medical Center, Amsterdam, The Netherlans. FAU - Moes, Harmen R AU - Moes HR AD - Department of Neurology, Amsterdam Neuroscience Institute, Amsterdam University Medical Center, Amsterdam, The Netherlans. FAU - van Laar, Teus AU - van Laar T AD - Department of Neurology, Amsterdam Neuroscience Institute, Amsterdam University Medical Center, Amsterdam, The Netherlans. FAU - Oterdoom, D L Marinus AU - Oterdoom DLM AD - Department of Neurosurgery, University Medical Centre Groningen, the Netherlands. FAU - Little, Simon AU - Little S AD - Department of Movement Disorders and Neuromodulation, University of California San Francisco, USA. FAU - Brown, Peter AU - Brown P AD - Medical Research Council Brain Network Dynamics Unit at the University of Oxford, United Kingdom; Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom. FAU - Beudel, Martijn AU - Beudel M AD - Department of Neurology, Amsterdam Neuroscience Institute, Amsterdam University Medical Center, Amsterdam, The Netherlans. Electronic address: m.beudel@amsterdamumc.nl. LA - eng GR - 105804/Z/14/Z/WT_/Wellcome Trust/United Kingdom GR - MC_UU_12024/1/MRC_/Medical Research Council/United Kingdom GR - MC_UU_00003/2/MRC_/Medical Research Council/United Kingdom GR - 105804/WT_/Wellcome Trust/United Kingdom GR - WT_/Wellcome Trust/United Kingdom PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20200729 PL - United States TA - Brain Stimul JT - Brain stimulation JID - 101465726 SB - IM MH - Aged MH - Aged, 80 and over MH - Beta Rhythm/*physiology MH - Cross-Over Studies MH - Deep Brain Stimulation/*methods MH - Female MH - Humans MH - Hypokinesia/diagnosis/physiopathology/therapy MH - Intraoperative Neurophysiological Monitoring/*methods MH - Male MH - Middle Aged MH - Parkinson Disease/diagnosis/*physiopathology/*therapy MH - Tremor/diagnosis/physiopathology/therapy PMC - PMC7116216 MID - EMS97368 OTO - NOTNLM OT - Adaptive deep brain stimulation OT - Beta oscillations OT - Closed-loop OT - Dysarthria OT - Local field potentials OT - Parkinson's disease OT - Subthalamic nucleus COIS- Declaration of competing interest PB is a consultant with Medtronic. EDAT- 2020/08/02 06:00 MHDA- 2021/03/30 06:00 PMCR- 2020/10/19 CRDT- 2020/08/02 06:00 PHST- 2019/12/04 00:00 [received] PHST- 2020/07/19 00:00 [revised] PHST- 2020/07/23 00:00 [accepted] PHST- 2020/08/02 06:00 [pubmed] PHST- 2021/03/30 06:00 [medline] PHST- 2020/08/02 06:00 [entrez] PHST- 2020/10/19 00:00 [pmc-release] AID - S1935-861X(20)30214-X [pii] AID - 10.1016/j.brs.2020.07.016 [doi] PST - ppublish SO - Brain Stimul. 2020 Nov-Dec;13(6):1507-1516. doi: 10.1016/j.brs.2020.07.016. Epub 2020 Jul 29.