Interleaving programming of subthalamic deep brain stimulation to reduce side effects with good motor outcome in a patient with Parkinson's disease.

摘要

Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is a very effective treatment for Parkinson's disease (PD). However, the therapeutic window of stimulation is sometimes limited by side effects [1]. Hypokinetic-rigid symptoms can show different responses than tremor due to different functional subregions of the target. Besides the initial programming settings reprogram-ming including changes of the active contacts and changes between monopolar and bipolar settings can be useful to shape the electrical field [2,3].We report a case of interleaving programming with two different stimulation amplitudes of one electrode that provided differential motor effects on tremor and hypokinesia without limiting side effects. A 47 year-old patient with young-onset Parkinson's Disease for ten years suffered from motor fluctuations with cardinal motor symptoms equally pronounced for the last 3 years. Off-time freezing episodes and severe tremor, in particular, restricted quality of life.