Analysis of the time course of the effect of subthalamic nucleus stimulation upon hand function in Parkinson's patients.
BACKGROUND
Deep brain stimulation (DBS) of the subthalamic nucleus (STN) as treatment for Parkinson's disease has been in use for more than a decade, yet the immediate effect of stimulation upon movement parameters is not well characterized.


OBJECTIVE
The goal of the current study is the identification of the best time point to test hand function after programming DBS devices.


METHODS
Reaction time, movement time and velocity were measured at multiple time points with a movement-sensitive glove after the deep brain stimulator had been turned on or off, during 'off medication' conditions.


RESULTS
Velocity, movement time and reaction time worsened significantly in the first 20 min after the deep brain stimulator had been turned off. A 'plateau effect' after 20 min was not observed. Initiation of stimulation led to immediate significant increases in movement time and velocity and to a lesser degree a decrease in reaction time. Patients performed more inconsistently over time after onset of stimulation compared to stimulation withdrawal. Intraoperative testing showed an immediate improvement in velocity after placement of the STN deep brain stimulator.


CONCLUSIONS
Movement time and velocity already reach their peak changes within 20 min after the deep brain stimulator has been reprogrammed, and therefore, this time point may be used to test the maximal clinical effect of stimulation.
Department of Surgery, Division of Neurosurgery, Duke University Medical Center, Durham, NC 27710, USA. ben.waldau@duke.edu
Ben
B
Waldau
Daniel A
DA
Clayton
Lynne B
LB
Gasperson
Dennis A
DA
Turner
D046690:Deep Brain Stimulation / Q000379:methods*; D005260:Female; D006225:Hand / Q000503:physiopathology; D006801:Humans; D018476:Hypokinesia; D058542:Implantable Neurostimulators; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000503:physiopathology / Q000628:therapy*; D016634:Radiosurgery / Q000295:instrumentation; D011930:Reaction Time / Q000502:physiology; D020531:Subthalamic Nucleus / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors
Mov Disord. 2002;17 Suppl 3:S181-7
11948775
Eur Neurol. 2003;50(2):94-9
12944714
Mov Disord. 2007 Apr 15;22(5):619-26
17230483
Neuroscience. 1992;48(3):607-19
1351272
J Neurophysiol. 2004 Sep;92(3):1937-43
15152016
Lancet Neurol. 2009 Jan;8(1):67-81
19081516
Mov Disord. 2005 Oct;20(10):1286-98
16001401
Neurophysiol Clin. 2007 Dec;37(6):457-66
18083502
Neurol Sci. 2002 Sep;23 Suppl 2:S103-4
12548364
Exp Brain Res. 2002 Dec;147(3):322-31
12428140
Mov Disord. 2009 Jan 15;24(1):57-63
18855925
Mov Disord. 2006 Jan;21(1):50-8
16124011
Neurology. 2003 Jan 14;60(1):78-81
12525722
J Cogn Neurosci. 2006 Apr;18(4):626-36
16768365
Neurosurgery. 2004 Jul;55(1):27-35; discussion 35-8
15214971
Mov Disord. 2003 Oct;18(10):1162-9
14534921
Brain. 2010 Mar;133(Pt 3):746-61
20061324
Mov Disord. 2004 Jan;19(1):94-100
14743367