Objective: We show that UPDRS-III scores after interleaving compared to those prior to interleaving reflect a gain in benefit by lowered scores.

Background: Previously, we have shown that interleaving using adjacent or near adjacent contacts to create two alternating fields that are intentionally overlapped at half the standard frequency, works effectively to conserve neurostimulator batteries. The generated two-tiered frequency fields anecdotally appear to engage multiple symptom clusters, while releasing DBS induced side-effects, notably dysarthria and gait issues.

Methods: We reviewed the charts of the 18 accepted into the original battery study and examined the charts of 32 more, for a total of 50. From these, 25 were included into the study. Those accepted into the study had been implanted bilaterally in the subthalamic nucleus (STN) for Parkinson’s Disease. UPDRS-III scores were aggregated up to 120 days prior and subsequent to interleave implementation. As before, 5 had the frequency remain the same, while the remaining 20 had the frequency substantially reduced or halved.

The main reasons for exclusion were being implanted in the GPi (n=2), no interleave (n=5), or interleave implemented too soon after contact screen for adequate accumulation of UPDRS-III measures (n=15). Remaining rejection reasons were being staged across months, or being followed outside of our center.

Results: The average score preceding interleave implementation was compared to post interleave aggregate UPDRS-III scores. For those with the halved frequency, results indicated a mean UPDRS-III of 19.31 sem=2.65 prior to interleave compared to a mean of 16.17 sem=2.27 subsequent to the interleave implementation, with a mean difference of 3.13 sem=1.28. Differences were tested with a paired t-test, using a two-tailed distribution, and revealed a statistical difference favoring the aggregate scores after the interleave implementation with lowered values (p=0.024). Although too few to analyze, those interleaves at standard frequencies exhibited increased UPDRS-III scores.

Conclusions: Results from our interleaving technique show that overlapped fields where the frequency is halved can be beneficial, as reflected in reduced UPDRS-III scores. However, this benefit is not universal, as 5 of the 20 individuals did not show decreased UPDRS-III scores subsequent to interleaving.

References: Ramirez-Zamora A, Kahn M, Campbell J,DeLaCruz P, Pilitsis J. Interleaved programing of the subthalamic deep brain stimulation to avoid adverse effects and preserve motor benefit in Parkinson’s disease. J Neurol. 2015 Mar; 262(3):578-584.

Wojtecki L, Vesper J, Schnitzler A. Interleaving programming of subthalamic deep brain stimulation to reduce side effects with good motor outcome in a patient with Parkinson’s disease. Parkinsonism Relat Disord 2011;17:293-294.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/updrs-benefit-from-dual-frequency-dbs-fields-sculpted-by-intentionally-overlapped-interleaving/