Interleaving subthalamic nucleus deep brain stimulation to avoid side effects while achieving satisfactory motor benefits in Parkinson disease: A report of 12 cases

Shizhen Zhang, Peizhi Zhou, Shu Jiang, Wei Wang, Peng Li, Shizhen Zhang, Peizhi Zhou, Shu Jiang, Wei Wang, Peng Li

Abstract

Background: Deep brain stimulation (DBS) of the subthalamic nucleus is an effective treatment for advanced Parkinson disease (PD). However, achieving ideal outcomes by conventional programming can be difficult in some patients, resulting in suboptimal control of PD symptoms and stimulation-induced adverse effects. Interleaving stimulation (ILS) is a newer programming technique that can individually optimize the stimulation area, thereby improving control of PD symptoms while alleviating stimulation-induced side effects after conventional programming fails to achieve the desired results.

Methods: We retrospectively reviewed PD patients who received DBS programming during the previous 4 years in our hospital. We collected clinical and demographic data from 12 patients who received ILS because of incomplete alleviation of PD symptoms or stimulation-induced adverse effects after conventional programming had proven ineffective or intolerable. Appropriate lead location was confirmed with postoperative reconstruction images. The rationale and clinical efficacy of ILS was analyzed.

Results: We divided our patients into 4 groups based on the following symptoms: stimulation-induced dysarthria and choreoathetoid dyskinesias, gait disturbance, and incomplete control of parkinsonism. After treatment with ILS, patients showed satisfactory improvement in PD symptoms and alleviation of stimulation-induced side effects, with a mean improvement in Unified PD Rating Scale motor scores of 26.9%.

Conclusions: ILS is a newer choice and effective programming strategy to maximize symptom control in PD while decreasing stimulation-induced adverse effects when conventional programming fails to achieve satisfactory outcome. However, we should keep in mind that most DBS patients are routinely treated with conventional stimulation and that not all patients benefit from ILS. ILS is not recommended as the first choice of programming, and it is recommended only when patients have unsatisfactory control of PD symptoms or stimulation-induced side effects after multiple treatments with conventional stimulation. A return to conventional stimulation may be required if ILS induces new side effects or the needs of the patient change.

Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Algorithm for interleaving stimulation. ILS = interleaving stimulation, PD = Parkinson disease.

References

    1. Benabid AL, Chabardes S, Mitrofanis J, et al. Deep brain stimulation of the subthalamic nucleus for the treatment of Parkinson's disease. Lancet Neurol 2009;8:67–81.
    1. Miocinovic S, Khemani P, Whiddon R, et al. Outcomes, management, and potential mechanisms of interleaving deep brain stimulation settings. Parkinsonism Relat Disord 2014;20:1434–7.
    1. Volkmann J, Moro E, Pahwa R. Basic algorithms for the programming of deep brain stimulation in Parkinson's disease. Mov Disord 2006;21:S284–9.
    1. Pollak P, Krack P, Fraix V, et al. Intraoperative micro- and macrostimulation of the subthalamic nucleus in Parkinson's disease. Mov Disord 2002;17:S155–61.
    1. Krack P, Fraix V, Mendes A, et al. Postoperative management of subthalamic nucleus stimulation for Parkinson's disease. Mov Disord 2002;17:S188–97.
    1. Ramirez-Zamora A, Kahn M, Campbell J, et al. Interleaved programming of subthalamic deep brain stimulation to avoid adverse effects and preserve motor benefit in Parkinson's disease. J Neurol 2015;262:578–84.
    1. Wojtecki L, Vesper J, Schnitzler A. Interleaving programming of subthalamic deep brain stimulation to reduce side effects with good motor outcome in a patient with Parkinson's disease. Parkinsonism Relat Disord 2011;17:293–4.
    1. Baumann CR, Imbach LL, Baumann-Vogel H, et al. Interleaving deep brain stimulation for a patient with both Parkinson's disease and essential tremor. Mov Disord 2012;27:1700–1.
    1. Kovács N, Janszky J, Nagy F, et al. Changing to interleaving stimulation might improve dystonia in cases not responding to pallidal stimulation. Mov Disord 2012;27:163.
    1. Moreau C, Defebvre L, Destee A, et al. STN-DBS frequency effects on freezing of gait in advanced Parkinson disease. Neurology 2008;71:80–4.
    1. Weiss D, Breit S, Wächter T, et al. Combined stimulation of the substantia nigra pars reticulata and the subthalamic nucleus is effective in hypokinetic gait disturbance in Parkinson's disease. J Neurol 2011;258:1183–5.
    1. Barbe MT, Dembek TA, Becker J, et al. Individualized current-shaping reduces DBS-induced dysarthria in patients with essential tremor. Neurology 2014;82:614–9.

Source: PubMed

Sponsorer og samarbeidspartnere

Medisinsk tilstand

Legemiddelintervensjoner

3
Abonnere