PMID- 32979290 OWN - NLM STAT- MEDLINE DCOM- 20210427 LR - 20210427 IS - 1531-8257 (Electronic) IS - 0885-3185 (Linking) VI - 35 IP - 12 DP - 2020 Dec TI - Novel Programming Features Help Alleviate Subthalamic Nucleus Stimulation-Induced Side Effects. PG - 2261-2269 LID - 10.1002/mds.28252 [doi] AB - BACKGROUND: Subthalamic nucleus deep brain stimulation (STN-DBS) is a widely used treatment for Parkinson's disease (PD) patients with motor complications, but can result in adverse effects (AEs) in a significant proportion of treated patients. The use of novel programming features including short pulse width (PW) and directional steering in alleviating stimulation-induced AEs has not been explored. OBJECTIVE: To determine if programming with short PW, directional steering, or the combination of these novel techniques can improve stimulation-induced dysarthria, dyskinesia, and pyramidal AEs. METHODS: Thirty-two consecutive PD patients who experienced reversible AEs of STN-DBS had optimization of their settings using either short PW, directional steering, or the combination, while ensuring equivalent control of motor symptoms. Pairwise comparisons of pre- and post-optimization adverse effect ratings were made. Patients were left on the alternative setting with the greatest benefit and followed up at 6 months. Modeling of volume of tissue activated (VTA) and charge per pulse (Qp) calculations were used to explore potential underlying mechanisms of any differences found. RESULTS: There were significant improvements in stimulation-induced dysarthria, dyskinesia, and pyramidal side effects after optimization. At 6 months, mean AE ratings remained significantly improved compared to pre-optimization ratings. Different patterns of shift in VTA for each AE, and Qp could be used to explain improvements using novel techniques. CONCLUSIONS: Stimulation-induced dysarthria, dyskinesia, and pyramidal AEs induced by STN-DBS can be improved by using novel programming techniques. These represent additional tools to conventional methods that can be used to address these AEs. (c) 2020 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society. CI - (c) 2020 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society. FAU - Dayal, Viswas AU - Dayal V AUID- ORCID: 0000-0002-9083-234X AD - Department of Clinical and Movement Neurosciences, University College London Institute of Neurology, London, United Kingdom. AD - Unit of Functional Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom. FAU - De Roquemaurel, Alexis AU - De Roquemaurel A AD - Unit of Functional Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom. FAU - Grover, Timothy AU - Grover T AD - Department of Clinical and Movement Neurosciences, University College London Institute of Neurology, London, United Kingdom. AD - Unit of Functional Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom. FAU - Ferreira, Francisca AU - Ferreira F AD - Department of Clinical and Movement Neurosciences, University College London Institute of Neurology, London, United Kingdom. FAU - Salazar, Maricel AU - Salazar M AD - Unit of Functional Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom. FAU - Milabo, Catherine AU - Milabo C AD - Unit of Functional Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom. FAU - Candelario-McKeown, Joseph AU - Candelario-McKeown J AD - Unit of Functional Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom. FAU - Zrinzo, Ludvic AU - Zrinzo L AUID- ORCID: 0000-0002-6013-4946 AD - Department of Clinical and Movement Neurosciences, University College London Institute of Neurology, London, United Kingdom. AD - Unit of Functional Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom. FAU - Akram, Harith AU - Akram H AD - Department of Clinical and Movement Neurosciences, University College London Institute of Neurology, London, United Kingdom. AD - Unit of Functional Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom. FAU - Limousin, Patricia AU - Limousin P AD - Department of Clinical and Movement Neurosciences, University College London Institute of Neurology, London, United Kingdom. AD - Unit of Functional Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom. FAU - Foltynie, Thomas AU - Foltynie T AUID- ORCID: 0000-0003-0752-1813 AD - Department of Clinical and Movement Neurosciences, University College London Institute of Neurology, London, United Kingdom. AD - Unit of Functional Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom. LA - eng PT - Journal Article DEP - 20200926 PL - United States TA - Mov Disord JT - Movement disorders : official journal of the Movement Disorder Society JID - 8610688 SB - IM MH - *Deep Brain Stimulation MH - *Dyskinesias MH - Humans MH - *Parkinson Disease/therapy MH - *Subthalamic Nucleus MH - Treatment Outcome OTO - NOTNLM OT - Parkinson's disease OT - deep brain stimulation OT - directional OT - pulse width OT - side effects OT - subthalamic nucleus EDAT- 2020/09/27 06:00 MHDA- 2021/04/28 06:00 CRDT- 2020/09/26 17:03 PHST- 2020/04/30 00:00 [received] PHST- 2020/07/01 00:00 [revised] PHST- 2020/08/03 00:00 [accepted] PHST- 2020/09/27 06:00 [pubmed] PHST- 2021/04/28 06:00 [medline] PHST- 2020/09/26 17:03 [entrez] AID - 10.1002/mds.28252 [doi] PST - ppublish SO - Mov Disord. 2020 Dec;35(12):2261-2269. doi: 10.1002/mds.28252. Epub 2020 Sep 26.