Multiple Independent Current Control DBS Associated With Improved Outcomes in Parkinson Disease

Author(s):

No stimulation adverse effects were reported, and patients on the MICC stimulation alone resulted in greater than 50% improvement in UPDRS motor scores.

Alina Shub, PA

Research presented at the 2021 American Academy of Neurology (AAN) Annual Meeting, April 17-22, demonstrated that multiple independent current control (MICC) deep brain stimulation (DBS) alone had a greater than 50% improvement in Unified Parkinson’s Disease Rating Scale (UPDRS)-III motor scores in patients with Parkinson disease (PD).¹

Lead author Alina Shub, PA, department of neurology, University of South Florida Health, and colleagues assessed the clinical outcomes of 9 patients implanted with the Boston Scientific Vercise System and were evaluated on UPDRS-III motor scores at preoperative visit, 9-, and 18-months post-activation.

Five patients were implanted in the globus pallidus internus (GPi), 3 patients in the subthalamic nucleus (STN), and 1 patient in the STN and ventral intermediate nucleus of the thalamus (VIM). At post-activation visit, the mean OFF stimulation/OFF medication UPDRS-III score was 35.14 (±10.60), while mean ON stimulation/OFF medication UPDRS-III score was 14.58 (±10.45).

Prior to the operation, the mean OFF medication UPDRS-III score was 47.67 (±20). Following the procedure, the data correlated to a 69% improvement from baseline and 59% improvement compared to OFF stimulation/OFF medication scores at the same post activation visit.

Scores of 1 and 2 on Patient Global Impression scale score were defined as very much improved and much improved, respectively. All told, the mean Patient Global Impression scale score was 1.75 (±0.89) for 8 patients who responded.

Fractionalized stimulation was used in all directional and linear leads ranging from 1 to 6 contacts per lead with a mean of 3.06 (±1.34). The authors noted that no stimulation side effects were reported. The mean time to initial device activation was 12.11 months (±2.62) while the mean age at surgery was 57.22 years (±13).

The INTREPID study (NCT01839396) was another research project that assessed the clinical efficacy and safety of the Vercise DBS system, which uses MICC technology, in 160 patients with PD. Results published in May 2020 showed that from post-implantation baseline to 3 months post-randomization, the difference in mean change in increased time without troublesome dyskinesias between the active (n = 121) and control (n = 39) groups was 3.03 hours (standard deviation [SD], 4.52 [95% CI, 1.3-4.7]; P <.0001).²

All told, the improvements equated to a 51% improvement in motor symptoms, as measured by UPDRS-III scores, compared to pre-surgery screening. For the active group, a 6-hour improvement in on time without troublesome dyskinesias was reported, in addition to marked and maintained improvements in quality of life, as measured by Parkinson’s Disease Questionnaire.

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REFERENCES

1. Shub A, Zesiewicz, Smith D, Malapira T, Hancock J, Bezchlibnyk Y. Clinical outcomes with deep brain stimulation with multiple independent current control (MICC) in Parkinson disease. Presented at 2021 American Academy of Neurology Annual Meeting; April 17-22. Abstract P14.097

2. Vitek JL, Jain R, Chen L, et al. Subthalamic nucleus deep brain stimulation with a multiple independent constant current-controlled device in Parkinson's disease (INTREPID): a multicentre, double-blind, randomized, sham-controlled study. Lancet Neurol. 2020;19(6):491-501. doi: 10.1016/S1474-4422(20)30108-3