Objective: To review a single center’s experience with the use of interleaving stimulation (ILS) in deep brain stimulation (DBS) for movement disorders.

Background: DBS is an effective therapy for medication refractory movement disorders including essential tremor (ET), Parkinson’s disease (PD), and dystonia (DT). Conventional programming utilizes continuous high frequency stimulation. However, some patients may experience suboptimal benefit, complete lack of benefit, or persistent stimulation induced side effects which require more sophisticated programming approaches. ILS is an advanced programming strategy that delivers alternating stimulation across two predefined programming configurations. While there are small reports of potential benefits, ILS remains underexplored in movement disorders.1

Method: We conducted a retrospective review of patients who underwent DBS surgery and programming at a single academic movement disorder center and were given ILS programs. We collected the following information: clinical demographics, DBS hardware and programming, and clinical descriptions of ILS response.

Results: 53 patients were identified with ILS programming and included in this analysis. 23 (43.40%) patients had a diagnosis of PD, 16 (30.19%) with ET, 13 (24.53%) with DT, and 1 (1.89%) with Fragile X-associated tremor/ataxia syndrome (FXTAS). The most frequent indications for employing ILS DBS were lack of benefit, loss of benefit, and stimulation induced side effects. Overall, ILS programming provided benefit over conventional DBS programming in 32 (60.38%) patients, while 16 (30.19%) did not experience benefit, 3 (5.66%) did not try ILS, and 2 (3.77%) did not have reported follow up regarding benefit. Of the 32 reporting benefit, 12 had PD, 9 had ET, 9 had DT, and 1 with FXTAS. Of the 21 who did not experience initial benefit, did not have follow up reported, or did not try ILS program, 14 retried ILS after additional optimization resulting in 9 additional patients who experienced benefit. Of the 32 patients initially experiencing benefit from ILS, 4 (12.50%) later discontinued ILS (2 of which were due to hardware exchange to an incompatible system).

Conclusion: ILS is a potential advanced programming strategy for movement disorders. Further prospective studies are needed to identify the optimal indications and configurations to best utilize ILS.

References: 1. Najera, R. A., Mahavadi, A. K., Khan, A. U., Boddeti, U., Del Bene, V. A., Walker, H. C., & Bentley, J. N. (2023). Alternative patterns of deep brain stimulation in neurologic and neuropsychiatric disorders. Frontiers in neuroinformatics, 17, 1156818. https://doi.org/10.3389/fninf.2023.1156818

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MDS Abstracts - https://www.mdsabstracts.org/abstract/the-use-of-interleaving-stimulation-as-an-advanced-dbs-programming-strategy-in-movement-disorders/