Background: In patients with Parkinson's disease, stimulation above the subthalamic nucleus (STN) may engage the pallidofugal fibers and directly suppress dyskinesia. Objectives: The objective of this study was to evaluate the effect of interleaving stimulation through a dorsal deep brain stimulation contact above the STN in a cohort of PD patients and to define the volume of tissue activated with antidyskinesia effects. Methods: We analyzed the Core Assessment Program for Surgical Interventional Therapies dyskinesia scale, Unified Parkinson's Disease Rating Scale parts III and IV, and other endpoints in 20 patients with interleaving stimulation for management of dyskinesia. Individual models of volume of tissue activated and heat maps were used to identify stimulation sites with antidyskinesia effects. Results: The Core Assessment Program for Surgical Interventional Therapies dyskinesia score in the on medication phase improved 70.9 ± 20.6% from baseline with noninterleaved settings (P < 0.003). With interleaved settings, dyskinesia improved 82.0 ± 27.3% from baseline (P < 0.001) and 61.6 ± 39.3% from the noninterleaved phase (P = 0.006). The heat map showed a concentration of volume of tissue activated dorsally to the STN during the interleaved setting with an antidyskinesia effect. Conclusion: Interleaved deep brain stimulation using the dorsal contacts can directly suppress dyskinesia, probably because of the involvement of the pallidofugal tract, allowing more conservative medication reduction.
Bibliographical noteFunding Information:
We acknowledge the essential contribution of Desiree Davis, RN, Meghan Zorn, PA, Perla Thulin, MD, and Paolo Moretti, MD, for providing excellent care for patients with Parkinson's disease at the University of Utah. We also acknowledge the work of James Ballard, PT, DPT, and Kevin Duff, PhD, for conducting motor evaluation and neuropsychological assessments of all deep brain stimulation candidates at the University of Utah. We thank Holly Cushing, PA, for the contribution to data collection and our patients for their willingness to collaborate in the research.
© 2019 International Parkinson and Movement Disorder Society
- Parkinson's disease
- deep brain stimulation
- volume of tissue activated