Camila C Aquino1,2,3, Gordon Duffley4, David M Hedges4, Johannes Vorwerk4, Paul A House5, Henrique B Ferraz2, John D Rolston6,7, Christopher R Butson4,6,7,8,9, Lauren E Schrock10. 1. Sleep and Movement Disorder Division, University of Utah, Salt Lake City, Utah, USA. 2. Department of Neurology and Neurosurgery, Universidade Federal de Sao Paulo, Sao Paulo, Brazil. 3. Department of Health, Evidence and Impact, McMaster University, Hamilton, Minnesota, Canada. 4. Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, Utah, USA. 5. Neurosurgical Associates, LLC, Murray, Utah. 6. Department of Neurosurgery, University of Utah, Salt Lake City, Utah, USA. 7. Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah, USA. 8. Department of Neurology, University of Utah, Salt Lake City, Utah, USA. 9. Department of Psychiatry, University of Utah, Salt Lake City, Utah, USA. 10. Department of Neurology, University of Minnesota, Minneapolis, Minnesota, USA.
Abstract
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.
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 PDpatients 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.
Authors: E H Middlebrooks; R A Domingo; T Vivas-Buitrago; L Okromelidze; T Tsuboi; J K Wong; R S Eisinger; L Almeida; M R Burns; A Horn; R J Uitti; R E Wharen; V M Holanda; S S Grewal Journal: AJNR Am J Neuroradiol Date: 2020-08-13 Impact factor: 3.825
Authors: Nicoló G Pozzi; Chiara Palmisano; Martin M Reich; Philip Capetian; Claudio Pacchetti; Jens Volkmann; Ioannis U Isaias Journal: Front Hum Neurosci Date: 2022-05-16 Impact factor: 3.473
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