Double blind, nonrandomized crossover study of active recharge biphasic deep brain stimulation for primary dystonia. (April 2023)

• Record Type: Journal Article
• Authors: Wong, Joshua K.; Lopes, Janine Melo Lobo Jofili; Hu, Wei; Wang, Anson; Au, Ka Loong Kelvin; Stiep, Tamara; Frey, Jessica; Toledo, Jon B.; Raike, Robert S.; Okun, Michael S.; Almeida, Leonardo
• Is Part Of: Parkinsonism & related disorders. Volume 109(2023)
• Publication Date: 2023-04
• Subjects: Deep brain stimulation -- Active recharge -- Dystonia -- Globus pallidus; Parkinson's disease -- Periodicals; Movement disorders -- Periodicals; Movement Disorders -- Periodicals; Nerve Degeneration -- Periodicals; Nervous System Diseases -- Periodicals; Parkinson Disease -- Periodicals; Tremor -- Periodicals; Parkinson, Maladie de -- Périodiques; Parkinson's disease; 616.833
• DOI: 10.1016/j.parkreldis.2023.105328
• Languages: English
• ISSNs: 1353-8020

Abstract

Abstract: Background: Deep brain stimulation (DBS) of the globus pallidus interna (GPi) is an effective therapy for select patients with primary dystonia. DBS programming for dystonia is often challenging due to variable time to symptomatic improvement or stimulation induced side effects (SISE) such as capsular or optic tract activation which can prolong device optimization. Objective: To characterize the safety and tolerability of active recharge biphasic DBS (bDBS) in primary dystonia and to compare it to conventional clinical DBS (clinDBS). Methods: Ten subjects with primary dystonia and GPi DBS underwent a single center, double blind, nonrandomized crossover study comparing clinDBS versus bDBS. The testing occurred over two-days. bDBS and clinDBS were administered on separate days and each was activated for 6 h. Rating scales were collected by video recording and scored by four blinded movement disorders trained neurologists. Results: The bDBS paradigm was safe and well-tolerated in all ten subjects. There were no persistent SISE reported. The mean change in the Unified Dystonia Rating Scale after 4 h of stimulation was greater in bDBS when compared to clinDBS (−6.5 vs 0.3, p < 0.04). Conclusion: In this pilot study, we demonstrated that biphasic DBS is a novel stimulation paradigm which can be administered safely. The biphasic waveform revealed a greater immediate improvement. Further studies are needed to determine whether this immediate improvement persists with chronic stimulation or if clinDBS will eventually achieve similar levels of improvement to bDBS over time. Highlights: Biphasic DBS is a safe and well-tolerated novel paradigm for primary dystonia. Biphasic DBS may provide faster improvement of dystonia symptoms. Certain primary dystonias may experience an acute positive response to biphasic DBS.