Interleaving Stimulation in Parkinson’s Disease, Tremor, and Dystonia

Abstract

Background/Aims: Interleaving stimulation (ILS) in deep brain stimulation (DBS) provides individualized stimulation of 2 contacts delivered in alternating order. Currently, limited information on the utility of ILS exists. The aims of this study were to determine the practical applications and outcomes of ILS DBS in Parkinson’s disease (PD), tremor, and dystonia. Methods: We performed a single-center, unblinded, retrospective chart review of all patients with DBS attempted on ILS at our referral center assessing for rationale and outcomes. Results: Fifty patients (PD, n = 27; tremor, n = 7; dystonia, n = 16 patients) tried ILS for 2 rationales: management of adverse effects (n = 29) and to improve clinical efficacy (n = 21). A total of 19 patients demonstrated improvement with ILS for adverse effect management predominately for the treatment of dyskinesias (n = 12). In the vast majority of dyskinetic patients, a contact added into the rostral zona incerta with ILS was performed. Nine out of 21 patients demonstrated improved clinical efficacy with ILS with all 6 PD patients who tried ILS for this rationale demonstrating benefit. Conclusions: In PD, ILS provided benefits for dyskinesias and parkinsonism, with minimal improvement of other adverse effects. In tremor and dystonia, marginal effects in terms of mitigation of adverse effects and improvement of clinical outcomes were evident.

Update on Current Technologies for Deep Brain Stimulation in Parkinson’s Disease

“…In addition to avoiding stimulation-related side effects, interleaving stimulation has been shown to improve dyskinesias in a subset of PD patients. Interestingly, this effect was achieved with activation of a dorsal contact residing in the zona incerta, just outside the STN [ 30 ]. These reports exemplify how interleaving provides greater flexibility in programming, enabling the clinician to better balance Parkinsonian symptoms and stimulation-related side effects.…”

Neuronal Activity and Synaptic Plasticity in a Reimplanted STN-DBS Patient with Parkinson’s Disease: Recordings from Two Surgeries

“…These new clinically beneficial stimulation settings were empirically optimized rather than trying to replicate the same parameters as from the previous surgery. In particular the double monopolar configuration on one side was chosen to further improve the patient's dyskinesia through stimulation of the pallido-fugal fibers of the subthalamic areas, in keeping with our published algorithms [16,17].…”

Invasive and Noninvasive Brain Stimulation in Parkinson's Disease: Clinical Effects and Future Perspectives

“…Interleaving stimulation paradigms were designed to shape the current field to prevent electrical overflow to vicinity of target areas. It can provide further benefits for dyskinesia and parkinsonism management . Besides, double bipolar interleaving stimulation can stimulate the area between the two middle contacts with double stimulation frequency.…”

“…It can provide further benefits for dyskinesia and parkinsonism management. 63 Besides, double bipolar interleaving stimulation can stimulate the area between the two middle contacts with double stimulation frequency. For example, double bipolar 125-Hz stimulation with montage of 0+, 1−, 2−, and 3+ can create 250-Hz stimulation between the cathodes, which may be more effective for tremor suppression.…”