Programming parameters of subthalamic deep brain stimulators in Parkinson's disease from a controlled trial
K. Knudsen
(1)
,
P. Krack
(2)
,
L. Tonder
(3)
,
J. L. Houeto
(4)
,
J. Rau
(5)
,
C. Schade-Brittinger
(5)
,
A. Hartmann
(6, 7, 8)
,
Thomas Hälbig
(6, 7, 8, 9)
,
Stephen Paschen
(1)
,
Michael Barbe
(10)
,
Andrea Kühn
(9)
,
Valerie Fraix
(11, 12)
,
Christine Brefel-Courbon
(13, 14)
,
Jan Vesper
(15)
,
David Maltête
(16, 17)
,
Friederike Sixel-Döring
(18)
,
Daniel Weiss
(19)
,
Tatiana Witjas
(20, 21)
,
Stephane Thobois
(22, 23)
,
Yves Agid
(7, 8, 6)
,
A. Schnitzler
(24)
,
W.M.M. Schuepbach
(8, 7, 6, 2, 25)
,
L. Timmermann
(26)
,
Philippe Damier
(27)
,
M. Vidailhet
(8, 7, 6)
,
G. Deuschl
(1)
1
CAU -
Christian-Albrechts-Universität zu Kiel = Christian-Albrechts University of Kiel = Université Christian-Albrechts de Kiel
2 Inselspital - Bern University Hospital [Berne]
3 Medtronic Inc [Minneapolis, MI, USA]
4 CIC 1402 - CIC Poitiers – Centre d'investigation clinique de Poitiers
5 Philipps Universität Marburg = Philipps University of Marburg
6 CHU Pitié-Salpêtrière [AP-HP]
7 ICM - Institut du Cerveau = Paris Brain Institute
8 CIC Neurosciences - Centre d'investigation clinique Neurosciences [CHU Pitié Salpêtrière]
9 Charité - UniversitätsMedizin = Berlin University Medicine
10 University Hospital of Cologne [Cologne]
11 GIN - [GIN] Grenoble Institut des Neurosciences
12 CHUGA - Centre Hospitalier Universitaire [CHU Grenoble]
13 ToNIC - Toulouse NeuroImaging Center
14 CHU Toulouse - Centre Hospitalier Universitaire de Toulouse
15 University Hospital Düsseldorf
16 CHU Rouen
17 NorDic - Neuroendocrine, Endocrine and Germinal Differentiation Communication
18 Paracelsus-Elena-Klinik, Kassel, Germany.
19 Eberhard Karls Universität Tübingen = University of Tübingen
20 TIMONE - Hôpital de la Timone [CHU - APHM]
21 INT - Institut de Neurosciences de la Timone
22 ISC-MJ - Institut des sciences cognitives Marc Jeannerod - Centre de neuroscience cognitive - UMR5229
23 Hôpital neurologique et neurochirurgical Pierre Wertheimer [CHU - HCL]
24 Heinrich Heine Universität Düsseldorf = Heinrich Heine University [Düsseldorf]
25 UNIBE - Universität Bern = University of Bern = Université de Berne
26 Universitatsklinikum Giessen und Marburg [Marburg,Germany]
27 Hôpital Guillaume-et-René-Laennec [Saint-Herblain]
2 Inselspital - Bern University Hospital [Berne]
3 Medtronic Inc [Minneapolis, MI, USA]
4 CIC 1402 - CIC Poitiers – Centre d'investigation clinique de Poitiers
5 Philipps Universität Marburg = Philipps University of Marburg
6 CHU Pitié-Salpêtrière [AP-HP]
7 ICM - Institut du Cerveau = Paris Brain Institute
8 CIC Neurosciences - Centre d'investigation clinique Neurosciences [CHU Pitié Salpêtrière]
9 Charité - UniversitätsMedizin = Berlin University Medicine
10 University Hospital of Cologne [Cologne]
11 GIN - [GIN] Grenoble Institut des Neurosciences
12 CHUGA - Centre Hospitalier Universitaire [CHU Grenoble]
13 ToNIC - Toulouse NeuroImaging Center
14 CHU Toulouse - Centre Hospitalier Universitaire de Toulouse
15 University Hospital Düsseldorf
16 CHU Rouen
17 NorDic - Neuroendocrine, Endocrine and Germinal Differentiation Communication
18 Paracelsus-Elena-Klinik, Kassel, Germany.
19 Eberhard Karls Universität Tübingen = University of Tübingen
20 TIMONE - Hôpital de la Timone [CHU - APHM]
21 INT - Institut de Neurosciences de la Timone
22 ISC-MJ - Institut des sciences cognitives Marc Jeannerod - Centre de neuroscience cognitive - UMR5229
23 Hôpital neurologique et neurochirurgical Pierre Wertheimer [CHU - HCL]
24 Heinrich Heine Universität Düsseldorf = Heinrich Heine University [Düsseldorf]
25 UNIBE - Universität Bern = University of Bern = Université de Berne
26 Universitatsklinikum Giessen und Marburg [Marburg,Germany]
27 Hôpital Guillaume-et-René-Laennec [Saint-Herblain]
J. L. Houeto
- Fonction : Auteur
- PersonId : 1260880
- ORCID : 0000-0002-6029-8289
Andrea Kühn
- Fonction : Auteur
- PersonId : 1201884
- ORCID : 0000-0002-4134-9060
Daniel Weiss
- Fonction : Auteur
- PersonId : 1201890
- ORCID : 0000-0003-0447-7132
Philippe Damier
- Fonction : Auteur
- PersonId : 760632
- ORCID : 0000-0003-3869-0564
- IdRef : 099118076
M. Vidailhet
- Fonction : Auteur
- PersonId : 758783
- ORCID : 0000-0002-2409-9143
- IdRef : 074466208
Résumé
Background: Programming algorithms have never been tested for outcome. The EARLYSTIM study showed superior outcomes of deep brain stimulation of the subthalamic nucleus (STN-DBS) over best medical treatment in early Parkinson's disease (PD). Patients were programmed according to common guidelines but customized for each patient.
Methods: Stimulation parameters were systematically documented at 1, 5, 12, and 24 month in the cohort of 114 patients who had bilateral STN-DBS at 24 month. We investigated the influence of atypical programming, changes of stimulated electrode contacts and stimulation energy delivered. Outcomes were the Unified Parkinson's Disease Rating Scale (UPDRS) motor and ADL-subscores, health-related quality of life (PDQ-39) summary index and mobility- and ADL-subscores.
Results: At 1/5/12/24 months follow up, mean amplitude (1.8/2.5/2.6/2.8 V), impedance (1107/1286/1229/1189 Ω) and TEED (33.7/69.0/84.4/93.0 V2*μs*Hz/Ω) mainly increased in the first 5 months, while mean pulse width (60.0/62.5/65.1/65.8 μs), frequency (130/137.7/139.1/142.7 Hz) remained relatively stable. Typical programming (single monopolar electrode contact) was used in 80.7% of electrodes. Double monopolar (11/114) and bipolar (2/114) stimulation was only rarely required. There was no significant difference in clinical outcomes between the patient groups requiring contact changes (n = 32/28.1%) nor between typical (n = 83/72.8%) versus non-typical programming. Energy used for STN-DBS was higher for the dominant side of PD.
Conclusion: In the first 5 months an increase in amplitude is required to compensate for various factors. Monopolar stimulation is sufficient in 80% of patients at 24 months. Homogeneous stimulation strategies can account for the favorable outcomes reported in the Earlystim study.