• Simon Little, Martijn Beudel, Ludvic Zrinzo, Thomas Foltynie, Patricia Limousin, Marwan Hariz, Spencer Neal, Binith Cheeran, Hayriye Cagnan, James Gratwicke, Tipu Z Aziz, Alex Pogosyan, and Peter Brown.
• Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK.
• J. Neurol. Neurosurg. Psychiatr. 2016 Jul 1; 87 (7): 717-21.

Introduction & ObjectivesAdaptive deep brain stimulation (aDBS) uses feedback from brain signals to guide stimulation. A recent acute trial of unilateral aDBS showed that aDBS can lead to substantial improvements in contralateral hemibody Unified Parkinson's Disease Rating Scale (UPDRS) motor scores and may be superior to conventional continuous DBS in Parkinson's disease (PD). We test whether potential benefits are retained with bilateral aDBS and in the face of concurrent medication.MethodsWe applied bilateral aDBS in 4 patients with PD undergoing DBS of the subthalamic nucleus. aDBS was delivered bilaterally with independent triggering of stimulation according to the amplitude of β activity at the corresponding electrode. Mean stimulation voltage was 3.0±0.1 volts. Motor assessments consisted of double-blinded video-taped motor UPDRS scores that included both limb and axial features.ResultsUPDRS scores were 43% (p=0.04; Cohen's d=1.62) better with aDBS than without stimulation. Motor improvement with aDBS occurred despite an average time on stimulation (ToS) of only 45%. Levodopa was well tolerated during aDBS and led to further reductions in ToS.ConclusionBilateral aDBS can improve both axial and limb symptoms and can track the need for stimulation across drug states.Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

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