Personalized, Adaptive Deep Brain Stimulation Effective in Patients With PD
Long-term at-home adaptive deep brain stimulation (aDBS) was tolerable, effective, and safe in patients with Parkinson disease (PD) whose symptoms were previously stable with continuous deep brain stimulation (cDBS), according to study findings published in JAMA Neurology.
“Delivering adaptive neurostimulation chronically, in response to a personalized neural physiomarker, is both technically and clinically possible, laying the foundation for the wider clinical application of aDBS,” wrote corresponding author Helen M. Bronte-Stewart, MD, MSE, of the Stanford University School of Medicine, Stanford, California, and study coauthors.
The open-label, nonrandomized clinical trial compared cDBS and aDBS, which automatically adjusts deep brain stimulation parameters in response to neural activity or behavior fluctuations, in patients with PD who were stable with cDBS and medication. A referred sample of 68 patients was assessed with cDBS and then with single threshold aDBS (ST-aDBS) and dual threshold-aDBS (DT-aDBS). Those who tolerated at least 1 mode of aDBS were invited to continue it over a 10-month follow-up.
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The primary end point required at least half of the patients to achieve a performance goal of good on-time (ie, time when symptoms are well controlled) without troublesome dyskinesias during aDBS therapy relative to cDBS.
Among enrolled patients, 40 were evaluated with DT-aDBS and 35 with ST-aDBS. According to the study, 91% in the DT-aDBS group and 79% in the ST-aDBS group met the study’s primary outcome.
Compared with cDBS, the ST-aDBS group averaged a 15% decrease in total electrical energy delivered (TEED). TEED did not differ with DT-aDBS compared with cDBS.
Of 60 stimulation-related adverse events that occurred during the aDBS setup and adjustment phase, all except 1 resolved with reprogramming. The single unresolved stimulated-related adverse event was insomnia, which did not significantly interfere with patient functioning. No serious device adverse events occurred over the 10-month follow-up phase, researchers reported.
An analysis of exploratory outcomes suggested increased on- and decreased off-time with DT-aDBS compared to cDBS.
“More than two-thirds of study participants indicated a ‘strong’ or ‘somewhat’ preference for aDBS over their previous cDBS settings for improved motor symptoms or fewer symptom fluctuations,” researchers wrote.
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