Subthalamic nucleus deep brain stimulation programming settings do not correlate with Parkinson's disease severity

Rena Far; Ignacio Saez; Angela Sardo; Eric Ovruchesky; Laura Sperry; Lin Zhang; Kiarash Shahlaie; Fady Girgis

doi:10.1007/s00701-022-05279-7

Subthalamic nucleus deep brain stimulation programming settings do not correlate with Parkinson's disease severity

Acta Neurochir (Wien). 2022 Sep;164(9):2271-2278. doi: 10.1007/s00701-022-05279-7. Epub 2022 Jun 25.

Authors

Rena Far¹, Ignacio Saez², Angela Sardo³, Eric Ovruchesky³, Laura Sperry⁴, Lin Zhang⁴, Kiarash Shahlaie², Fady Girgis⁵

Affiliations

¹ Department of Clinical Neurosciences, University of Calgary, 1403 29 Street NW, Calgary, AB, T2N 2T9, Canada. rena.far@ucalgary.ca.
² Department of Neurological Surgery, University of California Davis, Sacramento, CA, USA.
³ School of Medicine, University of California Davis, Sacramento, CA, USA.
⁴ Department of Neurology, University of California Davis, Sacramento, CA, USA.
⁵ Department of Clinical Neurosciences, University of Calgary, 1403 29 Street NW, Calgary, AB, T2N 2T9, Canada.

PMID: 35751700
DOI: 10.1007/s00701-022-05279-7

Abstract

Background: Deep brain stimulation (DBS) is a well-established treatment for Parkinson's disease (PD). While the success of DBS is dependent on careful patient selection and accurate lead placement, programming parameters play a pivotal role in tailoring therapy on the individual level. Various algorithms have been developed to streamline the initial programming process, but the relationship between pre-operative patient characteristics and post-operative device settings is unclear. In this study, we investigated how PD severity correlates with DBS settings.

Methods: We conducted a retrospective review of PD patients who underwent DBS of the subthalamic nucleus at one US tertiary care center between 2014 and 2018. Pre-operative patient characteristics and post-operative programming data at various intervals were collected. Disease severity was measured using the Unified Parkinson's Disease Rating Scale score (UPDRS) as well as levodopa equivalent dose (LED). Correlation analyses were conducted looking for associations between pre-operative disease severity and post-operative programming parameters.

Results: Fifty-six patients were analyzed. There was no correlation between disease severity and any of the corresponding programming parameters. Pre-operative UPDRS scores on medication were similar to post-operative scores with DBS. Settings of amplitude, frequency, and pulse width increased significantly from 1 to 6 months post-operatively. Stimulation volume, inferred by the distance between contacts used, also increased significantly over time.

Conclusions: Interestingly, we found that patients with more advanced disease responded to electrical stimulation similarly to patients with less advanced disease. These data provide foundational knowledge of DBS programming parameters used in a single cohort of PD patients over time.

Keywords: Deep brain stimulation; Dyskinesias; Electric stimulation; Electrodes; Implanted; Parkinson’s disease; Subthalamic nucleus.

MeSH terms

Deep Brain Stimulation*
Humans
Levodopa / therapeutic use
Parkinson Disease* / drug therapy
Severity of Illness Index
Subthalamic Nucleus*
Treatment Outcome

Substances

Levodopa