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Interleaving Stimulation in Parkinson Disease: Interesting to Whom?

Abstract

BACKGROUND

Interleaving stimulation (ILS) is a stimulation strategy that can help the physician manage more challenging cases of patients with deep brain stimulation (DBS) for Parkinson disease (PD). It consists of altering 2 different programs on the electrode with the same frequency.

OBJECTIVES

Our objective was to overview our patients' experience with ILS and explore clinical scenarios in which ILS should be considered when programming DBS in patients with PD.

METHODS

We retrospectively reviewed medical charts from 120 patients with PD treated with DBS between 2011 and 2018.

RESULTS

Eighteen patients received ILS. One was excluded because of the medical chart was incomplete. The remaining 17 patients had subthalamic nucleus DBS (n = 14) and globus pallidus internus DBS (n = 3). Eight patients (47%) received ILS to improve rigidity and bradykinesia, 4 to improve dyskinesias, 4 because of refractory tremor, and 1 for gait management. Until the end of data collection, 13 of 17 patients (70%) were still on ILS, with a mean duration time of 28.8 months (range, 2-44 months). Four patients reported no benefit from ILS and had their program changed.

CONCLUSIONS

Overall, ILS is useful 1) to use 2 contacts that optimally improve 2 specific symptoms but have different therapeutic windows; 2) to avoid side effects related to current spreading to nearby areas; 3) to increase frequency in a small region; or 4) to stimulate a larger target area.

Authors+Show Affiliations

Movement Disorders Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil.Movement Disorders Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil.Division of Functional Neurosurgery, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil.Division of Functional Neurosurgery, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil.Movement Disorders Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil. Electronic address: rubens_cury@usp.br.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31295615

Citation

França, Carina, et al. "Interleaving Stimulation in Parkinson Disease: Interesting to Whom?" World Neurosurgery, 2019.
França C, Barbosa ER, Iglesio R, et al. Interleaving Stimulation in Parkinson Disease: Interesting to Whom? World Neurosurg. 2019.
França, C., Barbosa, E. R., Iglesio, R., Teixeira, M. J., & Cury, R. G. (2019). Interleaving Stimulation in Parkinson Disease: Interesting to Whom? World Neurosurgery, doi:10.1016/j.wneu.2019.06.223.
França C, et al. Interleaving Stimulation in Parkinson Disease: Interesting to Whom. World Neurosurg. 2019 Jul 8; PubMed PMID: 31295615.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Interleaving Stimulation in Parkinson Disease: Interesting to Whom? AU - França,Carina, AU - Barbosa,Egberto Reis, AU - Iglesio,Ricardo, AU - Teixeira,Manoel Jacobsen, AU - Cury,Rubens Gisbert, Y1 - 2019/07/08/ PY - 2019/03/12/received PY - 2019/06/27/revised PY - 2019/06/28/accepted PY - 2019/7/12/pubmed PY - 2019/7/12/medline PY - 2019/7/12/entrez KW - Deep brain stimulation KW - Interleaving KW - Parkinson disease JF - World neurosurgery JO - World Neurosurg N2 - BACKGROUND: Interleaving stimulation (ILS) is a stimulation strategy that can help the physician manage more challenging cases of patients with deep brain stimulation (DBS) for Parkinson disease (PD). It consists of altering 2 different programs on the electrode with the same frequency. OBJECTIVES: Our objective was to overview our patients' experience with ILS and explore clinical scenarios in which ILS should be considered when programming DBS in patients with PD. METHODS: We retrospectively reviewed medical charts from 120 patients with PD treated with DBS between 2011 and 2018. RESULTS: Eighteen patients received ILS. One was excluded because of the medical chart was incomplete. The remaining 17 patients had subthalamic nucleus DBS (n = 14) and globus pallidus internus DBS (n = 3). Eight patients (47%) received ILS to improve rigidity and bradykinesia, 4 to improve dyskinesias, 4 because of refractory tremor, and 1 for gait management. Until the end of data collection, 13 of 17 patients (70%) were still on ILS, with a mean duration time of 28.8 months (range, 2-44 months). Four patients reported no benefit from ILS and had their program changed. CONCLUSIONS: Overall, ILS is useful 1) to use 2 contacts that optimally improve 2 specific symptoms but have different therapeutic windows; 2) to avoid side effects related to current spreading to nearby areas; 3) to increase frequency in a small region; or 4) to stimulate a larger target area. SN - 1878-8769 UR - https://www.unboundmedicine.com/medline/citation/31295615/Interleaving_stimulation_in_Parkinson's_disease:_interesting_to_whom L2 - https://linkinghub.elsevier.com/retrieve/pii/S1878-8750(19)31880-7 DB - PRIME DP - Unbound Medicine ER -