Voltage adjustment improves rigidity and tremor in Parkinson's disease patients receiving deep brain stimulation

Shao-Hua Xu, Chao Yang, Wen-Biao Xian, Jing Gu, Jin-Long Liu, Lu-Lu Jiang, Jing Ye, Yan-Mei Liu, Qi-Yu Guo, Yi-Fan Zheng, Lei Wu, Wan-Ru Chen, Zhong Pei, Ling Chen, Shao-Hua Xu, Chao Yang, Wen-Biao Xian, Jing Gu, Jin-Long Liu, Lu-Lu Jiang, Jing Ye, Yan-Mei Liu, Qi-Yu Guo, Yi-Fan Zheng, Lei Wu, Wan-Ru Chen, Zhong Pei, Ling Chen

Abstract

Deep brain stimulation of the subthalamic nucleus is recognized as the most effective treatment for moderate and advanced Parkinson's disease. Programming of the stimulation parameters is important for maintaining the efficacy of deep brain stimulation. Voltage is considered to be the most effective programming parameter. The present study is a retrospective analysis of six patients with Parkinson's disease (four men and two women, aged 37-65 years), who underwent bilateral deep brain stimulation of the subthalamic nucleus at the First Affiliated Hospital of Sun Yat-sen University, China, and who subsequently adjusted only the stimulation voltage. We evaluated motor symptom severity using the Unified Parkinson's Disease Rating Scale Part III, symptom progression using the Hoehn and Yahr scale, and the levodopa equivalent daily dose, before surgery and 1 and 2 years after surgery. The 2-year follow-up results show that rigidity and tremor improved, and clinical symptoms were reduced, while pulse width was maintained at 60 μs and frequency at 130 Hz. Voltage adjustment alone is particularly suitable for patients who cannot tolerate multiparameter program adjustment. Levodopa equivalent daily dose was markedly reduced 1 and 2 years after surgery compared with baseline. Our results confirm that rigidity, tremor and bradykinesia can be best alleviated by voltage adjustment. The trial was registered at ClinicalTrials.gov (identifier: NCT01934881).

Keywords: Parkinson's disease; axial symptoms; bradykinesia; deep brain stimulation; frequency; nerve regeneration; neural regeneration; pulse width; rigidity; subthalamic nucleus; tremor; voltage.

Conflict of interest statement

The abstract as written communication was presented at the 18th Zhongshan International Neurology Summit Conference at November 28, 2015

Figures

Figure 1
Figure 1
Clinical flow chart. DBS: Deep brain stimulation; UPDRS III: Unified Parkinson's Disease Rating Scale Part III.
Figure 2
Figure 2
UPDRS III of six patients at 1 and 2 years after surgery in the off-medication state. (a) Tremor score; (b) rigidity score; (c) bradykinesia score; (d) axial symptoms score. A–F: The six study patients. Higher scores indicate greater symptom severity. UPDRS III: Unified Parkinson's Disease Rating Scale Part III.
Figure 3
Figure 3
UPDRS III of six patients at 1 and 2 years after surgery in the on-medication state(a) Tremor score; (b) rigidity score; (c) bradykinesia score; (d) axial symptoms score. A–F: the six study patients. Higher scores indicate greater symptom severity. UPDRS III: Unified Parkinson's Disease Rating Scale Part III.

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