Pulse Duration Settings in Subthalamic Stimulation for Parkinson's Disease

Background: Stimulation parameters in deep brain stimulation (DBS) of the subthalamic nucleus for Parkinson's disease (PD) are rarely tested in double-blind conditions. Evidence-based recommendations on optimal stimulator settings are needed. Results from the CUSTOM-DBS study are reported, comparing 2 pulse durations. Methods: A total of 15 patients were programmed using a pulse width of 30 mu s (test) or 60 mu s (control). Efficacy and side-effect thresholds and unified PD rating scale (UPDRS) III were measured in meds-off (primary outcome). The therapeutic window was the difference between patients' efficacy and side effect thresholds. Results: The therapeutic window was significantly larger at 30 mu s than 60 mu s (P=.0009) and the efficacy (UPDRS III score) was noninferior (P=.00008). Interpretation: Subthalamic neurostimulation at 30 mu s versus 60 mu s pulse width is equally effective on PD motor signs, is more energy efficient, and has less likelihood of stimulation-related side effects. (c) 2017 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.