Skip to main content

Advertisement

SpringerLink
Log in

Subthalamic nucleus deep brain stimulation programming settings do not correlate with Parkinson’s disease severity

  • Original Article - Functional Neurosurgery - Movement disorders
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Abstract

Background

Deep brain stimulation (DBS) is a well-established treatment for Parkinson’s disease (PD). While the success of DBS is dependent on careful patient selection and accurate lead placement, programming parameters play a pivotal role in tailoring therapy on the individual level. Various algorithms have been developed to streamline the initial programming process, but the relationship between pre-operative patient characteristics and post-operative device settings is unclear. In this study, we investigated how PD severity correlates with DBS settings.

Methods

We conducted a retrospective review of PD patients who underwent DBS of the subthalamic nucleus at one US tertiary care center between 2014 and 2018. Pre-operative patient characteristics and post-operative programming data at various intervals were collected. Disease severity was measured using the Unified Parkinson’s Disease Rating Scale score (UPDRS) as well as levodopa equivalent dose (LED). Correlation analyses were conducted looking for associations between pre-operative disease severity and post-operative programming parameters.

Results

Fifty-six patients were analyzed. There was no correlation between disease severity and any of the corresponding programming parameters. Pre-operative UPDRS scores on medication were similar to post-operative scores with DBS. Settings of amplitude, frequency, and pulse width increased significantly from 1 to 6 months post-operatively. Stimulation volume, inferred by the distance between contacts used, also increased significantly over time.

Conclusions

Interestingly, we found that patients with more advanced disease responded to electrical stimulation similarly to patients with less advanced disease. These data provide foundational knowledge of DBS programming parameters used in a single cohort of PD patients over time.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

Abbreviations

DBS:

Deep brain stimulation

PD:

Parkinson’s disease

UPDRS:

Unified Parkinson’s Disease Rating Scale

LED:

Levodopa equivalent dose

STN:

Subthalamic nucleus

References

  1. Accolla E, Caputo E, Cogiamanian F, Tamma F, Mrakic-Sposta S, Marceglia S, Egidi M, Rampini P, Locatelli M, Priori A (2007) Gender differences in patients with Parkinson’s disease treated with subthalamic deep brain stimulation. Mov Disord 22(8):1150–1156

    Article  Google Scholar 

  2. Annic A, Moreau C, Salleron J, Devos D, Delval A, Dujardin K, Touzet G, Blond S, Destée A, Defebvre L (2014) Predictive factors for improvement of gait by low-frequency stimulation in Parkinson’s disease. J Parkinsons Dis 4(3):413–420

    Article  CAS  Google Scholar 

  3. Aubignat M, Lefranc M, Tir M, Krystkowiak P (2020) Deep brain stimulation programming in Parkinson’s disease: introduction of current issues and perspectives. Rev Neurol (Paris) 176(10):770–779

    Article  CAS  Google Scholar 

  4. Dayal V, Limousin P, Foltynie T (2017) Subthalamic nucleus deep brain stimulation in Parkinson’s disease: the effect of varying stimulation parameters. J Parkinsons Dis 7(2):235–245

    Article  Google Scholar 

  5. Di GI, Kalliolia E, Georgiev D, Peters AL, Voyce DC, Akram H, Foltynie T, Limousin P, Day BL (2019) Chronic subthalamic nucleus stimulation in Parkinson’s disease: optimal frequency for gait depends on stimulation site and axial symptoms. Front Neurol. https://doi.org/10.3389/FNEUR.2019.00029

    Article  PubMed  PubMed Central  Google Scholar 

  6. Gorodetsky C, Fasano A (2021) Basic tips: how do I start programming deep brain stimulation in Parkinson disease patients? Mov Disord Clin Pract 8(4):639–644

    Article  Google Scholar 

  7. Heldman DA, Pulliam CL, Mendoza EU, Gartner M, Giuffrida JP, Montgomery EB Jr, Espay AJ, Revilla FJ (2016) Computer-guided deep brain stimulation programming for Parkinson’s disease. Neuromodulation 19(2):127

    Article  Google Scholar 

  8. Jiang L, Chen W, Guo Q et al (2021) Eight-year follow-up outcome of subthalamic deep brain stimulation for Parkinson’s disease: maintenance of therapeutic efficacy with a relatively low levodopa dosage and stimulation intensity. CNS Neurosci Ther 27(11):1366–1373

    Article  CAS  Google Scholar 

  9. Khazen O, Dimarzio M, Platanitis K et al (2021) Sex-specific effects of subthalamic nucleus stimulation on pain in Parkinson’s disease. J Neurosurg 135(2):629–636

    Article  Google Scholar 

  10. Koeglsperger T, Palleis C, Hell F, Mehrkens JH, Bötzel K (2019) Deep brain stimulation programming for movement disorders: current concepts and evidence-based strategies. Front Neurol. https://doi.org/10.3389/FNEUR.2019.00410

    Article  PubMed  PubMed Central  Google Scholar 

  11. Montuno MA, Kohner AB, Foote KD, Okun MS (2013) An algorithm for management of deep brain stimulation battery replacements: devising a web-based battery estimator and clinical symptom approach. Neuromodulation Technol Neural Interface 16(2):147–153

    Article  Google Scholar 

  12. Okun MS, Tagliati M, Pourfar M, Fernandez HH, Rodriguez RL, Alterman RL, Foote KD (2005) Management of referred deep brain stimulation failures: a retrospective analysis from 2 movement disorders centers. Arch Neurol 62(8):1250–1255

    Article  Google Scholar 

  13. Ondo WG, Meilak C, Vuong KD (2007) Predictors of battery life for the Activa® Soletra 7426 Neurostimulator. Park Relat Disord 13(4):240–242

    Article  Google Scholar 

  14. Paek SH, Kim HJ, Yoon JY et al (2011) Fusion image-based programming after subthalamic nucleus deep brain stimulation. World Neurosurg 75(3–4):517–524

    Article  Google Scholar 

  15. Palleis C, Gehmeyr M, Mehrkens JH, Bötzel KKT (2020) Establishment of a visual analog scale for DBS programming (VISUAL-STIM Trial). Front Neurol. https://doi.org/10.3389/FNEUR.2020.561323

    Article  PubMed  PubMed Central  Google Scholar 

  16. Park YS, Kim HY, Chang WS, Lee PH, Sohn YH, Chang JW (2010) A comparison of LEDD and motor scores following STN-DBS treatment in patient with young onset vs. late onset Parkinson’s disease. Neuromodulation Technol Neural Interface 13(4):255–260

    Article  Google Scholar 

  17. Peralta M, Haegelen C, Jannin P, Baxter JSH (2021) PassFlow: a multimodal workflow for predicting deep brain stimulation outcomes. Int J Comput Assist Radiol Surg 16(8):1361–1370

    Article  Google Scholar 

  18. Picillo M, Lozano AM, Kou N, Puppi Munhoz R, Fasano A (2016) Programming deep brain stimulation for Parkinson’s disease: the Toronto Western Hospital algorithms. Brain Stimul 9(3):425–437

    Article  Google Scholar 

  19. Pourfar MH, Mogilner AY, Farris S, Giroux M, Gillego M, Zhao Y, Blum D, Bokil H, Pierre MC (2015) Model-based deep brain stimulation programming for Parkinson’s disease: the GUIDE pilot study. Stereotact Funct Neurosurg 93(4):231–239

    Article  Google Scholar 

  20. Santaniello S, Gale JT, Sarma SV (2018) Systems approaches to optimizing deep brain stimulation therapies in Parkinson’s disease. Wiley Interdiscip Rev Syst Biol Med 10(5):e1421

    Article  Google Scholar 

  21. Schor JS, Nelson AB (2019) Multiple stimulation parameters influence efficacy of deep brain stimulation in parkinsonian mice. J Clin Invest 129(9):3833

    Article  Google Scholar 

  22. Shamir RR, Dolber T, Noecker AM, Walter BL, McIntyre CC (2015) Machine learning approach to optimizing combined stimulation and medication therapies for Parkinson’s disease. Brain Stimul 8(6):1025

    Article  Google Scholar 

  23. Shukla AW, Zeilman P, Fernandez H, Bajwa JA, Mehanna R (2017) DBS programming: an evolving approach for patients with Parkinson’s disease. Parkinsons Dis. https://doi.org/10.1155/2017/8492619

    Article  Google Scholar 

  24. Xu C, Zhuang P, Hallett M, Zhang Y, Li J, Li Y (2018) Parkinson’s disease motor subtypes show different responses to long-term subthalamic nucleus stimulation. Front Hum Neurosci. https://doi.org/10.3389/FNHUM.2018.00365

    Article  PubMed  PubMed Central  Google Scholar 

  25. Zhang D, Lin H, Liu J, Liu Z, Yan J, Cai X (2019) Electrode reconstruction assists postoperative contact selection in deep brain stimulation. World Neurosurg 125:e442–e447

    Article  Google Scholar 

  26. Zibetti M, Merola A, Rizzi L et al (2011) Beyond nine years of continuous subthalamic nucleus deep brain stimulation in Parkinson’s disease. Mov Disord 26(13):2327–2334

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Clinical Neurosciences, University of Calgary, 1403 29 Street NW, Calgary, AB, T2N 2T9, Canada

    Rena Far & Fady Girgis

  2. Department of Neurological Surgery, University of California Davis, Sacramento, CA, USA

    Ignacio Saez & Kiarash Shahlaie

  3. School of Medicine, University of California Davis, Sacramento, CA, USA

    Angela Sardo & Eric Ovruchesky

  4. Department of Neurology, University of California Davis, Sacramento, CA, USA

    Laura Sperry & Lin Zhang

Authors
  1. Rena Far
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ignacio Saez
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Angela Sardo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Eric Ovruchesky
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Laura Sperry
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Lin Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Kiarash Shahlaie
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Fady Girgis
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Drs. Girgis and Shahlaie designed and conducted the study. Dr. Zhang, Ms. Sardo, Ms. Sperry, and Mr. Ovruchesky collected data. Drs. Saez and Far performed statistical analyses. Dr. Far prepared the manuscript with important intellectual input from the other authors. All authors approved the final manuscript.

Corresponding author

Correspondence to Rena Far.

Ethics declarations

Ethical approval

Ethics approval was obtained from the Institutional Review Board (IRB #1440605).

Informed consent

Not applicable.

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Comments

The authors of this study analyzed the programming settings in a large single-center cohort of Parkinson’s disease patients treated with subthalamic nucleus (STN) deep brain stimulation (DBS). Despite common stereotype that more severe symptoms require higher stimulation settings, the authors discovered that the correlation between disease severity and stimulation settings is lacking; although the settings were increased during initial 6 months after the implantation, they subsequently plateaued for the duration of follow-up.

Based on review of the presented data, one may wonder if the explanation is more complex than it appears and the real reason for this lack of correlation is the progressive atrophy of the stimulated targets (that may require less electricity to be suppressed), or gradual normalization of stimulated networks that develops over time (and therefore maintains stable stimulation response despite disease progression), or some other mechanism that is yet to be elucidated.

Nevertheless, I applaud the authors for their thorough analysis and want to encourage them and others to maintain critical thinking in processing the wealth of patients’ data in prospective fashion. It is, indeed, conceivable that, similar to recent developments in spinal cord stimulation arena, we will come up to a conclusion that “less is more” and that settings need to be reduced rather than raised when the symptoms change with disease progression.

Konstantin Slavin.

Chicago, USA.

This article is part of the Topical Collection on Functional Neurosurgery—Movement disorders

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Far, R., Saez, I., Sardo, A. et al. Subthalamic nucleus deep brain stimulation programming settings do not correlate with Parkinson’s disease severity. Acta Neurochir 164, 2271–2278 (2022). https://doi.org/10.1007/s00701-022-05279-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00701-022-05279-7

Keywords

Search

Navigation