Objective: To assess the impact of Deep Brain Stimulation (DBS) parameters on stimulation-induced dyskinesias (SID) in patients with Parkison’s Disease (PD).

Background: SID resemble levodopa-induced dyskinesias and can be challenging to manage. Adjusting stimulation parameters (contact(s), configuration, amplitude, frequency and pulse width) has shown some benefit, but currently no standard approach exists to reduce SID without sacrificing the efficacy of DBS for PD motor symptoms. This study investigates optimization of amplitude and frequency for improved SID.

Method: Patients with PD implanted with DBS (N=20) completed baseline Unified Parkinson’s Disease Rating Scales (UPDRS) and Unified Dyskinesia Rating Scales (UDysRS) in the ON-medication state. DBS programming parameters were systematically adjusted to eight settings using two amplitudes and four frequencies (155/165, 125, 85, and 55/65 Hz). With each adjustment, patients rested for two minutes then open/closed their fist for one minute. Motor symptoms in each trial were scored using modified UPDRS and UDysRS. Local field potentials (LFPs) were recorded throughout the duration of the study for neurophysiologic data.

Results: Patients included 12/20 male, 18/20 right-handed, with average age 67.9, and average symptom duration of 9.3 years. DBS targets included 5/20 globus pallidus internus (GPi) and 15/20 subthalamic nucleus (STN). Average baseline UPDRS was 18.7, UDysRS-dyskinesia was 8.0, and UDYsRS-dystonia was 2.1. Mixed linear model statistical analysis found that higher frequency and higher amplitude trended toward higher dyskinesia (p=0.425, p=0.614), and the interaction between lower frequency and amplitude trended toward lower dyskinesia (p=0.416). The interaction between amplitude and frequency trended toward decreased tone (p=0.301), bradykinesia (p=0.222), and tremor (p=0.302).

Conclusion: Higher frequencies, regardless of amplitude, were associated with lower tremor, tone, and bradykinesia, but higher dyskinesia. However, lower frequencies with higher amplitudes trended toward improved tremor, tone, and dyskinesia. These results suggest this stimulation paradigm may be beneficial for patients with SID. Exploration of a link between physiologic changes and clinical symptoms is in process via analysis of LFPs.

Preliminary data presented at American Academy of Neurology on April 8, 2025. This abstract adds 10 patients.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/optimizing-deep-brain-stimulation-programming-settings-for-patients-with-stimulation-induced-dyskinesias-in-parkinsons-disease/