title: Bilateral adaptive deep brain stimulation is effective in Parkinson's disease.
abstract: Adaptive 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.
  
  
  
  We 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.
  
  
  
  UPDRS 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.
  
  
  
  Bilateral aDBS can improve both axial and limb symptoms and can track the need for stimulation across drug states.
authors.affiliation: Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK.
authors.forename: Simon
authors.initials: S
authors.lastname: Little
authors.affiliation: Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK Department of Neurology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Martijn
authors.initials: M
authors.lastname: Beudel
authors.affiliation: Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience & Movement Disorders, UCL Institute of Neurology, London, UK.
authors.forename: Ludvic
authors.initials: L
authors.lastname: Zrinzo
authors.affiliation: Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience & Movement Disorders, UCL Institute of Neurology, London, UK.
authors.forename: Thomas
authors.initials: T
authors.lastname: Foltynie
authors.affiliation: Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience & Movement Disorders, UCL Institute of Neurology, London, UK.
authors.forename: Patricia
authors.initials: P
authors.lastname: Limousin
authors.affiliation: Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience & Movement Disorders, UCL Institute of Neurology, London, UK.
authors.forename: Marwan
authors.initials: M
authors.lastname: Hariz
authors.affiliation: Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience & Movement Disorders, UCL Institute of Neurology, London, UK.
authors.forename: Spencer
authors.initials: S
authors.lastname: Neal
authors.affiliation: Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK.
authors.forename: Binith
authors.initials: B
authors.lastname: Cheeran
authors.affiliation: Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK.
authors.forename: Hayriye
authors.initials: H
authors.lastname: Cagnan
authors.affiliation: Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience & Movement Disorders, UCL Institute of Neurology, London, UK.
authors.forename: James
authors.initials: J
authors.lastname: Gratwicke
authors.affiliation: Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK Nuffield Department of Surgical Sciences, John Radcliffe Hospital, University of Oxford, Oxford, UK.
authors.forename: Tipu Z
authors.initials: TZ
authors.lastname: Aziz
authors.affiliation: Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK The Medical Research Council Brain Networks Dynamics Unit, University of Oxford, Oxford, UK.
authors.forename: Alex
authors.initials: A
authors.lastname: Pogosyan
authors.affiliation: Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK The Medical Research Council Brain Networks Dynamics Unit, University of Oxford, Oxford, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: Brown
mesh_terms: D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D046690:Deep Brain Stimulation / Q000379:methods*; D004292:Dominance, Cerebral / Q000502:physiology; D004311:Double-Blind Method; D006801:Humans; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D010300:Parkinson Disease / Q000503:physiopathology / Q000628:therapy*; D020531:Subthalamic Nucleus / Q000503:physiopathology; D016896:Treatment Outcome; D014743:Videotape Recording