Short Versus Conventional Pulse-Width Deep Brain Stimulation in Parkinson's Disease: A Randomized Crossover Comparison.

Subthalamic nucleus deep brain stimulation (STN-DBS) is an effective therapy for selected Parkinson's disease patients with motor fluctuations, but can adversely affect speech and axial symptoms. The use of short pulse width (PW) has been shown to expand the therapeutic window acutely, but its utility in reducing side effects in chronic STN-DBS patients has not been evaluated. To compare the effect of short PW settings using 30-μs with conventional 60-μs settings on stimulation-induced dysarthria in Parkinson's disease patients with previously implanted STN-DBS systems. In this single-center, double-blind, randomized crossover trial, we assigned 16 Parkinson's disease patients who had been on STN-DBS for a mean of 6.5 years and exhibited moderate dysarthria to 30-μs or 60-μs settings for 4 weeks followed by the alternative PW setting for a further 4 weeks. The primary outcome was difference in dysarthric speech measured by the Sentence Intelligibility Test between study baseline and the 2 PW conditions. Secondary outcomes included motor, nonmotor, and quality of life measures. There was no difference in the Sentence Intelligibility Test scores between baseline and the 2 treatment conditions (P = 0.25). There were also no differences noted in motor, nonmotor, or quality of life scores. The 30-μs settings were well tolerated, and adverse event rates were similar to those at conventional PW settings. Post hoc analysis indicated that patients with dysarthria and a shorter duration of DBS may be improved by short PW stimulation. Short PW settings using 30 μs did not alter dysarthric speech in chronic STN-DBS patients. A future study should evaluate whether patients with shorter duration of DBS may be helped by short PW settings. © 2019 International Parkinson and Movement Disorder Society.

Dayal V ，Grover T ，Tripoliti E ，Milabo C ，Salazar M ，Candelario-McKeown J ，Athauda D ，Zrinzo L ，Akram H ，Hariz M ，Limousin P ，Foltynie T ... -  《-》

A Randomized, Double-Blinded Crossover Trial of Short Versus Conventional Pulse Width Subthalamic Deep Brain Stimulation in Parkinson's Disease.

Petry-Schmelzer JN ，Gerus L ，Jergas H ，Reker P ，Steffen JK ，Dafsari HS ，Baldermann JC ，Fink GR ，Visser-Vandewalle V ，Dembek TA ，Barbe MT ... -  《-》

The Effect of Short Pulse Width Settings on the Therapeutic Window in Subthalamic Nucleus Deep Brain Stimulation for Parkinson's disease.

Dayal V ，Grover T ，Limousin P ，Akram H ，Cappon D ，Candelario J ，Salazar M ，Tripoliti E ，Zrinzo L ，Hyam J ，Jahanshahi M ，Hariz M ，Foltynie T ... -  《-》

Deep brain stimulation fine-tuning in Parkinson's disease: Short pulse width effect on speech.

subthalamic nucleus deep brain stimulation (STN-DBS) may have a detrimental effect on speech in Parkinson's disease (PD) patients and new stimulation technologies may help in addressing this issue. to evaluate the STN-DBS acute effect of 30 μs pulse width (30PW) versus conventional 60 μs PW (60PW) on speech and identify the core features of voice modified by 30PW. seven STN-DBS treated PD patients participated into a pilot cross-sectional study. Motor and speech performances were tested by means of both automatic analysis and blinded clinical evaluations in four stimulation conditions: 30PW and 60PW both at the usual amplitude and at an amplitude just below the threshold for stimulation-related side effects. at the threshold amplitude, 30PW stimulation improved speech intelligibility for both words (p = 0.02) and sentences (p = 0.04), without worsening motor performance. A lower but not statistically significant voice variability and instability and percentage of stuttering disfluencies was also observed. The beneficial effect of 30PW detected by automatic analysis, was confirmed by patients' perception. STN-DBS treated patients experiencing low speech intelligibility may benefit from a 30PW stimulation trial at a higher amplitude. Deep characterization of PD speech profiles may help in a better application of recent DBS hardware advances.

Fabbri M ，Natale F ，Artusi CA ，Romagnolo A ，Bozzali M ，Giulietti G ，Guimaraes I ，Rizzone MG ，Accornero A ，Lopiano L ，Zibetti M ... -  《-》

Bilateral subthalamic deep brain stimulation initial impact on nonmotor and motor symptoms in Parkinson's disease: An open prospective single institution study.

Kurcova S ，Bardon J ，Vastik M ，Vecerkova M ，Frolova M ，Hvizdosova L ，Nevrly M ，Mensikova K ，Otruba P ，Krahulik D ，Kurca E ，Sivak S ，Zapletalova J ，Kanovsky P ... -  《-》