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Patient-adjusted deep-brain stimulation programming is time saving in dystonia patients

  • Julien F. Bally
  • Mohamad Rohani
  • Marta Ruiz-Lopez
  • Vijayashankar Paramanandam
  • Renato P. Munhoz
  • Mojgan Hodaie
  • Suneil K. Kalia
  • Andres M. Lozano
  • Pierre R. Burkhard
  • Antoine Poncet
  • Alfonso FasanoEmail author
Original Communication

Abstract

Background

Deep-brain stimulation (DBS) programming for dystonia patients is a complex and time-consuming task.

Objective

To analyze whether programming a programming paradigm based on patient’s self-adjustment is practical, effective and time saving in dystonia.

Methods

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.

Results

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].

Conclusions

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.

Keywords

Dystonia Deep-brain stimulation Shared decision making Time saving Advanced stimulation modes 

Notes

Acknowledgements

We thank Dr. Sean Udow for the review of the English language.

Author contribution

(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.

Ethical approval

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.

Supplementary material

415_2019_9423_MOESM1_ESM.docx (42 kb)
Supplementary file1 (DOCX 42 kb)

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Julien F. Bally
    • 1
    • 2
  • Mohamad Rohani
    • 3
  • Marta Ruiz-Lopez
    • 1
    • 4
  • Vijayashankar Paramanandam
    • 1
  • Renato P. Munhoz
    • 1
    • 6
  • Mojgan Hodaie
    • 5
    • 6
  • Suneil K. Kalia
    • 5
    • 6
  • Andres M. Lozano
    • 5
    • 6
  • Pierre R. Burkhard
    • 2
  • Antoine Poncet
    • 7
  • Alfonso Fasano
    • 1
    • 6
    • 8
    Email author
  1. 1.Division of Neurology, Edmond J. Safra Program in Parkinson’s Disease and Morton and Gloria Shulman Movement Disorders Centre, Toronto Western HospitalUHN, University of TorontoTorontoCanada
  2. 2.Department of NeurologyUniversity of Geneva and University Hospitals of GenevaGenevaSwitzerland
  3. 3.Department of Neurology, Hazrat Rasool HospitalIran University of Medical SciencesTehranIran
  4. 4.University Hospital Fundación Jimenez DiazMadridSpain
  5. 5.Division of Neurosurgery, Department of Surgery, Toronto Western HospitalUniversity of TorontoTorontoCanada
  6. 6.Krembil Brain InstituteTorontoCanada
  7. 7.CRC & Division of Clinical-Epidemiology, Department of Health and Community MedicineUniversity of Geneva and University Hospitals of GenevaGenevaSwitzerland
  8. 8.CenteR for Advancing Neurotechnological Innovation to Application (CRANIA)TorontoCanada

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