Programming parameters of subthalamic deep brain stimulators in Parkinson's disease from a controlled trial

K Knudsen; P Krack; L Tonder; J-L Houeto; J Rau; C Schade-Brittinger; A Hartmann; Thomas D Hälbig; Stephen Paschen; Michael T Barbe; Andrea Kühn; Valerie Fraix; Christine Brefel-Courbon; Jan Vesper; David Maltête; Friederike Sixel-Döring; Daniel Weiss; Tatiana Witjas; Stephane Thobois; Yves Agid; A Schnitzler; W M M Schuepbach; L Timmermann; Philippe Damier; M Vidailhet; G Deuschl; EARLYSTIM study group

doi:10.1016/j.parkreldis.2019.05.023

Programming parameters of subthalamic deep brain stimulators in Parkinson's disease from a controlled trial

Parkinsonism Relat Disord. 2019 Aug:65:217-223. doi: 10.1016/j.parkreldis.2019.05.023. Epub 2019 Jun 18.

Authors

K Knudsen¹, P Krack², L Tonder³, J-L Houeto⁴, J Rau⁵, C Schade-Brittinger⁵, A Hartmann⁶, Thomas D Hälbig⁷, Stephen Paschen¹, Michael T Barbe⁸, Andrea Kühn⁹, Valerie Fraix¹⁰, Christine Brefel-Courbon¹¹, Jan Vesper¹², David Maltête¹³, Friederike Sixel-Döring¹⁴, Daniel Weiss¹⁵, Tatiana Witjas¹⁶, Stephane Thobois¹⁷, Yves Agid⁶, A Schnitzler¹⁸, W M M Schuepbach¹⁹, L Timmermann²⁰, Philippe Damier²¹, M Vidailhet⁶, G Deuschl²²; EARLYSTIM study group

Affiliations

¹ Department of Neurology, Christian-Albrechts-University, Kiel, Germany.
² Department of Neurology, Division of Movement Disorders, Inselspital, University Hospital Bern, Switzerland.
³ Medtronic, Minneapolis, MN, USA.
⁴ Service de Neurologie, CIC INSERM-1402 INSERM, Centre Expert Regional pour la maladie de Parkinson, Poitiers, France.
⁵ The Coordinating Center for Clinical Trials, Philipps University, Marburg, Germany.
⁶ Assistance Publique Hôpitaux de Paris, Institut National de Santé et en Recherche Médicale, Institut du Cerveau et de la Moelle Epinière, Centre d'Investigation Clinique 1422, Département de Neurologie, Hôpital Pitié-Salpêtrière, F-75013, Paris, France.
⁷ Assistance Publique Hôpitaux de Paris, Institut National de Santé et en Recherche Médicale, Institut du Cerveau et de la Moelle Epinière, Centre d'Investigation Clinique 1422, Département de Neurologie, Hôpital Pitié-Salpêtrière, F-75013, Paris, France; Charité - Universitätsmedizin Berlin, Campus Mitte, NeuroCure Clinical Research Center, Germany.
⁸ University Hospital Cologne, Dept. of Neurology, Cologne, Germany.
⁹ Charité - Universitätsmedizin Berlin, Campus Mitte, NeuroCure Clinical Research Center, Germany.
¹⁰ Grenoble Institut des Neurosciences GIN; INSERM U1216; Université Grenoble Alpes; F-Grenoble, France; Centre Hospitalo-Universitaire, Grenoble, Hôpital Michallon. Service de Neurologie, France.
¹¹ Department of Neurology, University Hospital of Toulouse, France; Department of Neurology, Department of Clinical Pharmacology, University Hospital of Toulouse, and ToNIC, Toulouse Neuroimaging Center, University of Toulouse, Inserm, UPS, France.
¹² Department of Neurosurgery, Universitätsklinikum Düsseldorf, Germany.
¹³ Department of Neurology, Rouen University Hospital and University of Rouen; and INSERM U1239, Laboratory of Neuronal and Neuroendocrine Differentiation and Communication, Mont-Saint-Aignan, France.
¹⁴ Paracelsus-Elena-Klinik Kassel, Germany.
¹⁵ Department for Neurodegenerative Diseases and Hertie Institute for Clinical Brain Research. University of Tübingen, Tübingen, Germany.
¹⁶ Department of Neurology, Timone University Hospital, UMR 7289, CNRS, Marseille, France.
¹⁷ Univ Lyon, Institut des Sciences Cognitives Marc Jeannerod, CNRS, UMR 5229, BRON, France and Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Service de Neurologie C, Centre Expert Parkinson, BRON, France.
¹⁸ Institute of Clinical Neuroscience and Medical Psychology, Heinrich-Heine University, Duesseldorf, Germany.
¹⁹ Assistance Publique Hôpitaux de Paris, Institut National de Santé et en Recherche Médicale, Institut du Cerveau et de la Moelle Epinière, Centre d'Investigation Clinique 1422, Département de Neurologie, Hôpital Pitié-Salpêtrière, F-75013, Paris, France; Institute of Neurology, Konolfingen, Switzerland; Department of Neurology, University Hospital Bern and University of Bern, Switzerland.
²⁰ Universitätsklinikum Giessen und Marburg, Marburg Campus, Germany.
²¹ CHU Nantes, Hôpital Laënnec, Service de Neurologie, Nantes, France.
²² Department of Neurology, Christian-Albrechts-University, Kiel, Germany. Electronic address: g.deuschl@neurologie.uni-kiel.de.

PMID: 31257096
DOI: 10.1016/j.parkreldis.2019.05.023

Abstract

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.

Publication types

Controlled Clinical Trial
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Deep Brain Stimulation / methods*
Deep Brain Stimulation / standards
Female
Follow-Up Studies
Humans
Male
Middle Aged
Outcome and Process Assessment, Health Care*
Parkinson Disease / therapy*
Subthalamic Nucleus* / surgery