A randomized crossover trial of short versus conventional pulse width DBS in Parkinsons Disease

Abstract

Background: Subthalamic nucleus deep brain stimulation is a well-established treatment for patients with Parkinson`s disease. Previous acute challenge studies suggested that short pulse widths might increase the therapeutic window while maintaining motor symptom control. Objectives: To investigate in patients with Parkinson`s disease and nucleus subthalamicus deep brain stimulation (STN-DBS) whether short pulse width stimulation with 30s maintains equal motor control as conventional 60s stimulation over a period of 4 weeks. Methods: In this monocentric, double-blinded, randomized crossover trial, 30 patients with Parkinson`s disease and STN-DBS were enrolled and assigned to 4 weeks of stimulation with 30s and 4 weeks of stimulation with 60s in randomized order (German Clinical Trials Register No. DRKS00017528). The primary outcome was the difference in motor symptom control as assessed by a motor diary. Secondary outcomes included energy consumption measures, non-motor effects, side-effects, and quality of life. Results: A total of 24 patients were included in the final analysis. There was no difference in motor symptom control between the two treatment conditions. Concerning secondary outcomes there was no difference in energy consumption, non-motor symptoms, side-effects, or quality of life. On the individual level, patients preferring 30s tended to be more dyskinetic in the 60s setting, whereas patients preferring 60s experienced more off-time in the 30s setting. Conclusions: Short pulse width settings (30s) provide equal motor symptom control as conventional (60s) stimulation without significant differences in energy consumption. Future studies are warranted to evaluate a potential benefit of short pulse width settings in patients with pronounced dyskinesia.