Objective: To compare the efficacy of adaptive deep brain stimulation (aDBS) to conventional DBS (cDBS) in Parkinson’s disease through a double-blind, cross-over pilot study.

Background: Beta oscillations recorded from DBS electrodes are a strong biomarker for bradykinesia and rigidity in Parkinson’s disease. aDBS, utilizing beta oscillations, was developed to reduce motor complications. However, the optimal algorithm for medication and stimulation settings remains unclear.

Method: Nine patients (4 females, aged 51-70) with Parkinson’s disease and significant wearing-off were enrolled. All underwent bilateral STN DBS surgery with Percept PC implantation. The study consisted of four periods: Period I (pre-surgery, 1 month); Period II (stimulation adjustment, 4 months); Periods III and IV (randomized 1-month sessions of aDBS or cDBS). In Period II, the sensing contact was chosen unilaterally, and stimulation contacts were bilateral. The stimulation parameters included 60 μsec pulse duration and 130 Hz frequency, with the stimulation current adjusted for maximum effect without adverse effects for cDBS. For aDBS, the current was set equal to or 20% lower than cDBS. ON Time, OFF Time, and dyskinesia were assessed via Patient Diaries over 7 days in Periods I, III, and IV. The PDQ-39 was completed in Periods I, III, and IV. The ethics committee at Aizawa Hospital approved the study, and informed consent was obtained from all participants.

Results: The decrease in OFF Time from Period I to aDBS was smaller than that from Period I to cDBS in 8 out of 9 patients. The mean change in OFF Time was -1.5 hours for aDBS and -2.9 hours for cDBS (p = 0.05). The increase in ON Time from Period I to aDBS was also smaller than that to cDBS in 8 out of 9 patients, with a mean change of 1.4 hours for aDBS and 2.9 hours for cDBS (p = 0.05). Dyskinesia Time decreased by 1.4 hours for aDBS and 1.1 hours for cDBS (p = 0.59). The mean PDQ-39 score change was -14 for aDBS and -24 for cDBS (p = 0.11).

Conclusion: This study did not show superior efficacy of aDBS over cDBS. Factors such as the correlation between beta oscillations and ON/OFF states, medication, stimulation adjustments, and electrical noise may influence aDBS outcomes. Further validation of the aDBS algorithm is required to achieve better clinical benefits than cDBS.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/a-double-blind-cross-over-pilot-study-comparing-adaptive-deep-brain-stimulation-adbs-to-conventional-dbs-in-parkinsons-disease/