Abstract Details

Title “Dual Frequency” Deep Brain Stimulation Programming Paradigm for Gait and Balance Impairment in Parkinson’s Disease

Topic Movement Disorders

Presentation(s) P1 - Poster Session 1 (5:30 PM-6:30 PM)

Poster/Presentation
Number 10-018

Objective To report the outcome of a DBS programming paradigm (PP) aimed at reducing gait/balance impairment after prolonged STN DBS.

Background High frequency stimulation (HFS) is more effective for appendicular than axial symptoms. Low frequency stimulation (LFS) may reduce gait/balance impairment, but often results in worsening of appendicular symptoms. Medtronic DBS offers interleaving allowing delivery of two programs on each lead. We used this to create a PP with a combination of low and high frequencies.

Design/Methods A novel PP (interlink-interleave, IL-IL) consists of two overlapping LFS programs on each lead, with the overlapping area focused around the optimal contact. This area receives HFS aimed at controlling appendicular symptoms. The non-overlapping areas receives LFS potentially reducing gait/balance impairment. A randomized, cross-over trial comparing optimized conventional-HFS and IL-IL is currently underway. The primary outcome measure is the CGI-S-patient. Secondary outcome measures include patient preferred setting, CGI-S-clinician, MDS-UPDRS-I-IV, PDQ-39, FOG-Q, and FES. If carry-over is not detected between sequences, data from each period will be combined and analyzed. Patients will also be separated into two groups based on preferred setting and appropriate analysis will be applied.

Results Twenty-five patients have been recruited, 12 completed, 2 dropped out, and 11 scheduled. Seven patients preferred IL-IL and 5 conventional-HFS. There was no carry-over detected between sequences. Combined data demonstrated no significant difference in any outcome measure between settings. In those who preferred IL-IL there was improvement in PDQ-39 (p=0.01), FOG-Q (p=0.01), FES (p=0.047), and CGI-S (p=0.03) when on IL-IL. In those who preferred conventional-HFS there was no difference in any outcome measure between settings.

Conclusions Preliminary results (n=14) demonstrate no difference in appendicular symptoms between settings suggesting IL-IL did not provide inferior appendicular symptom control. In those who preferred IL-IL there was improvement in gait and quality-of-life without an impact on appendicular symptoms. Final analysis (n=25) will be presented.

Authors/Disclosures
Jessica A. Karl, PA (Northwestern Memorial) PRESENTER	No disclosure on file
Bichun Ouyang	Bichum Ouyang has nothing to disclose.
Leonard Verhagen Metman, MD, PhD (Northwestern University)	Dr. Verhagen Metman has received personal compensation in the range of $500-$4,999 for serving as a Consultant for AbbVie. Dr. Verhagen Metman has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Abbott. Dr. Verhagen Metman has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Mitsubishi Tanabe. Dr. Verhagen Metman has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Supernus. Dr. Verhagen Metman has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for AbbVie. Dr. Verhagen Metman has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Cerevel. Dr. Verhagen Metman has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Frontiers.

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