Patient-adjusted deep-brain stimulation programming is time saving in dystonia patients
Deep-brain stimulation (DBS) programming for dystonia patients is a complex and time-consuming task.
To analyze whether programming a programming paradigm based on patient’s self-adjustment is practical, effective and time saving in dystonia.
We retrospectively compared dystonia rating scales as well as the time necessary to optimize programming and the number of in-hospital visits in all patients (n = 102) operated at our center who used simple mode (SM) or advanced mode (AM) programming; the latter uses groups of different stimulation parameters and allows the patient and their caregiver to change stimulation groups at home, using the patient remote control.
Both AM- and SM-allocated patients improved clinically to the same extent after DBS, as assessed by the Burke–Fahn–Marsden (BFM) and the Toronto Western Spasmodic Torticollis (TWSTRS) dystonia rating scales. All subscores improved after DBS without statistically significant differences in improvement between AM and SM (BFM: − 43% vs. − 53%, p = 0.569; TWSTRS: − 63% vs. − 72%, p = 0.781). AM and SM patients reached optimization within a similar median time [5.5 months (95% CI 4.6–6.3) for AM vs. 6.2 months (4.2–7.6) for SM, p = 0.674) but patients on advanced programming needed fewer in-hospital visits to achieve the same improvement [median of 5 visits (95% CI 4–7) for AM vs. 8 visits (7–9) for SM, p = 0.008].
Advanced DBS programming based on patient’s self-adjustment under the supervision of the treating physician is feasible, practical and significantly reduces consultation time in dystonia patients.
KeywordsDystonia Deep-brain stimulation Shared decision making Time saving Advanced stimulation modes
We thank Dr. Sean Udow for the review of the English language.
(1) Research project: A. conception, B. organization, C. execution; (2) statistical analysis: A. design, B. execution, C. review and critique; (3) manuscript: A. writing of the first draft, B. review and critique. JFB: 1B, 1C, 2A, 2B, 3A. MR: 1B, 1C, 3B. MRL: 1C, 3B. VP: 1C. RPM: 3B. MH: 1C, 3B. SKK: 1C, 3B. AML: 1C, 3B. PRB: 3B. AP: 2A, 2B, 3B. AF: 1A, 1B, 2C, 3B.
Compliance with ethical standards
Conflicts of interest
The manuscript has not been previously published and is not under review at any other journal. No other related work is under submission elsewhere. All the authors of the paper have participated to the study, revised the manuscript and approved the final version of the manuscript. There is no ghost writer. AF and AML received research funding and honoraria from Medtronic. The other authors (JFB, MR, MRL, VP, RPM, MH, SKK, PRB, and AP) have no disclosure of conflict of interest related to this work.
The manuscript is a retrospective review from our Movement Disorders Center database and as such there was neither ethics committee nor patients’ consent specific to this study.