Julien F Bally1,2, Mohamad Rohani3, Marta Ruiz-Lopez1,4, Vijayashankar Paramanandam1, Renato P Munhoz1,5, Mojgan Hodaie6,5, Suneil K Kalia6,5, Andres M Lozano6,5, Pierre R Burkhard2, Antoine Poncet7, Alfonso Fasano8,9,10. 1. Division of Neurology, Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Centre, Toronto Western Hospital, UHN, University of Toronto, 399 Bathurst St, 7McL412, Toronto, ON, M5T 2S8, Canada. 2. Department of Neurology, University of Geneva and University Hospitals of Geneva, Geneva, Switzerland. 3. Department of Neurology, Hazrat Rasool Hospital, Iran University of Medical Sciences, Tehran, Iran. 4. University Hospital Fundación Jimenez Diaz, Madrid, Spain. 5. Krembil Brain Institute, Toronto, ON, Canada. 6. Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada. 7. CRC & Division of Clinical-Epidemiology, Department of Health and Community Medicine, University of Geneva and University Hospitals of Geneva, Geneva, Switzerland. 8. Division of Neurology, Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Centre, Toronto Western Hospital, UHN, University of Toronto, 399 Bathurst St, 7McL412, Toronto, ON, M5T 2S8, Canada. alfonso.fasano@uhn.ca. 9. Krembil Brain Institute, Toronto, ON, Canada. alfonso.fasano@uhn.ca. 10. CenteR for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, ON, Canada. alfonso.fasano@uhn.ca.
Abstract
BACKGROUND: Deep-brain stimulation (DBS) programming for dystonia patients is a complex and time-consuming task. OBJECTIVE: To analyze whether programming a programming paradigm based on patient's self-adjustment is practical, effective and time saving in dystonia. METHODS: We retrospectively compared dystonia rating scales as well as the time necessary to optimize programming and the number of in-hospital visits in all patients (n = 102) operated at our center who used simple mode (SM) or advanced mode (AM) programming; the latter uses groups of different stimulation parameters and allows the patient and their caregiver to change stimulation groups at home, using the patient remote control. RESULTS: Both AM- and SM-allocated patients improved clinically to the same extent after DBS, as assessed by the Burke-Fahn-Marsden (BFM) and the Toronto Western Spasmodic Torticollis (TWSTRS) dystonia rating scales. All subscores improved after DBS without statistically significant differences in improvement between AM and SM (BFM: - 43% vs. - 53%, p = 0.569; TWSTRS: - 63% vs. - 72%, p = 0.781). AM and SM patients reached optimization within a similar median time [5.5 months (95% CI 4.6-6.3) for AM vs. 6.2 months (4.2-7.6) for SM, p = 0.674) but patients on advanced programming needed fewer in-hospital visits to achieve the same improvement [median of 5 visits (95% CI 4-7) for AM vs. 8 visits (7-9) for SM, p = 0.008]. CONCLUSIONS: Advanced DBS programming based on patient's self-adjustment under the supervision of the treating physician is feasible, practical and significantly reduces consultation time in dystonia patients.
BACKGROUND: Deep-brain stimulation (DBS) programming for dystoniapatients is a complex and time-consuming task. OBJECTIVE: To analyze whether programming a programming paradigm based on patient's self-adjustment is practical, effective and time saving in dystonia. METHODS: We retrospectively compared dystonia rating scales as well as the time necessary to optimize programming and the number of in-hospital visits in all patients (n = 102) operated at our center who used simple mode (SM) or advanced mode (AM) programming; the latter uses groups of different stimulation parameters and allows the patient and their caregiver to change stimulation groups at home, using the patient remote control. RESULTS: Both AM- and SM-allocated patients improved clinically to the same extent after DBS, as assessed by the Burke-Fahn-Marsden (BFM) and the Toronto Western Spasmodic Torticollis (TWSTRS) dystonia rating scales. All subscores improved after DBS without statistically significant differences in improvement between AM and SM (BFM: - 43% vs. - 53%, p = 0.569; TWSTRS: - 63% vs. - 72%, p = 0.781). AM and SM patients reached optimization within a similar median time [5.5 months (95% CI 4.6-6.3) for AM vs. 6.2 months (4.2-7.6) for SM, p = 0.674) but patients on advanced programming needed fewer in-hospital visits to achieve the same improvement [median of 5 visits (95% CI 4-7) for AM vs. 8 visits (7-9) for SM, p = 0.008]. CONCLUSIONS: Advanced DBS programming based on patient's self-adjustment under the supervision of the treating physician is feasible, practical and significantly reduces consultation time in dystoniapatients.
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