Session Information
Date: Wednesday, September 25, 2019
Session Title: Non-Pharmacological Interventions
Session Time: 1:15pm-2:45pm
Location: Les Muses Terrace, Level 3
Objective: To mitigate levodopa (LD) and/or deep brain stimulation (DBS) induced dystonia while maintaining optimized tremor and bradykinesia control
Background: DBS is an adjunct to medical therapy for Parkinson disease (PD) allowing for LD equivalent dose reduction, minimizing LD induced side effects of dystonia and dyskinesia. In some cases, DBS settings that improve one symptom, such as tremor, can worsen another, such as dystonia. Resulting in a DBS population with suboptimal control of dystonia and/or tremor because of theses stimulation-induced side effects and limited control over tissue activation.
Method: A case report of mitigating LD and DBS induced dystonia with interleave and fractional current steering.
Results: A 59-year old left-handed former professional table tennis player with 30 years of PD history, dominated by severe resting tremor and LD-induced dystonia and dyskinesia, was implanted bilaterally in the subthalamic nucleus (STN). Motoric response to deep brain stimulation (DBS) was hindered by optimal setting for tremor and bradykinesia causing severe stimulation-induced dystonia, which worsened with LD. Interleaving configuration improved tremor control and minimized dystonia. Over time his DBS-ON and LD-induced dystonia became more painful, debilitating, and present more often. 6 years after the initial surgery, the implantable pulse generator (IPG) was replaced with an IPG capable of fractionalized current steering, allowing for more targeted tissue stimulation. Combining current fractionalization and interleaving in the STN allowed for optimized tremor control and mitigated the LD and stimulation-induced dystonia. Image 1: Interleaved DSB settings. Image 2: Interleaved combined with fractionalized current steering
Conclusion: Fractionalized current steering parameters may provide benefit for patients with severe LD and/or stimulation induced dystonia while maintaining optimal motoric benefit from DBS.
To cite this abstract in AMA style:
A. Mammis, E. Feinstein. Controlling levodopa and deep brain stimulation induced dystonia with interleaving and fractionalized current steering [abstract]. Mov Disord. 2019; 34 (suppl 2). https://www.mdsabstracts.org/abstract/controlling-levodopa-and-deep-brain-stimulation-induced-dystonia-with-interleaving-and-fractionalized-current-steering/. Accessed June 15, 2025.« Back to 2019 International Congress
MDS Abstracts - https://www.mdsabstracts.org/abstract/controlling-levodopa-and-deep-brain-stimulation-induced-dystonia-with-interleaving-and-fractionalized-current-steering/