Adaptive Deep Brain Stimulation as an Advanced Parkinson’s disease Treatment (ADAPT): a pseudorandomised clinical trial

Pina-Fuentes, D.; van Dijk, M. J. M. C.; van Zijl, J. C.; Moes, H. R.; Oterdoom, M. D. L. M.; Little, S.; Brown, P.; Beudel, M.

doi:10.1101/749903

bioRxiv · 10.1101/749903

Adaptive Deep Brain Stimulation as an Advanced Parkinson’s disease Treatment (ADAPT): a pseudorandomised clinical trial

Pina-Fuentes, D.·van Dijk, M. J. M. C.·van Zijl, J. C.·Moes, H. R.·Oterdoom, M. D. L. M.·Little, S.·Brown, P.·Beudel, M.

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Abstract

BackgroundBeta-based adaptive Deep Brain Stimulation (aDBS) is effective in Parkinsons disease (PD), when assessed in the immediate post-implantation phase. However, the potential benefits of aDBS in patients with electrodes chronically implanted, in whom the benefits of the microlesion effect have disappeared, are yet to be assessed. MethodsTo 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, in- to three conditions (NoStim, aDBS or cDBS). Patient videos were blindly evaluated using a short version of the Unified Parkinsons Disease Rating Scale (subUPDRS) and the Speech Intelligibility Test (SIT). ResultsPatients had a mean disease duration of 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), but not in cDBS (p=.08), when compared to NoStim. Two patients presented re-emerging tremor during NoStim. SIT scores of patients with stimulation-induced dysarthria (11 patients tested) 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. ConclusionBeta oscillations 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 control strategy.

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Pina-Fuentes, D., van Dijk, M. J. M. C., van Zijl, J. C., Moes, H. R., Oterdoom, M. D. L. M., Little, S., Brown, P., Beudel, M.. 2019-08-29. Adaptive Deep Brain Stimulation as an Advanced Parkinson’s disease Treatment (ADAPT): a pseudorandomised clinical trial. https://doi.org/10.1101/749903

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