Double blind, nonrandomized crossover study of active recharge biphasic deep brain stimulation for primary dystonia

Joshua K. Wong, Janine Melo Lobo Jofili Lopes, Wei Hu, Anson Wang, Ka Loong Kelvin Au, Tamara Stiep, Jessica Frey, Jon B. Toledo, Robert S. Raike, Michael S. Okun, Leonardo Almeida

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Background: Deep brain stimulation (DBS) of the globus pallidus interna (GPi) is an effective therapy for select patients with primary dystonia. DBS programming for dystonia is often challenging due to variable time to symptomatic improvement or stimulation induced side effects (SISE) such as capsular or optic tract activation which can prolong device optimization. Objective: To characterize the safety and tolerability of active recharge biphasic DBS (bDBS) in primary dystonia and to compare it to conventional clinical DBS (clinDBS). Methods: Ten subjects with primary dystonia and GPi DBS underwent a single center, double blind, nonrandomized crossover study comparing clinDBS versus bDBS. The testing occurred over two-days. bDBS and clinDBS were administered on separate days and each was activated for 6 h. Rating scales were collected by video recording and scored by four blinded movement disorders trained neurologists. Results: The bDBS paradigm was safe and well-tolerated in all ten subjects. There were no persistent SISE reported. The mean change in the Unified Dystonia Rating Scale after 4 h of stimulation was greater in bDBS when compared to clinDBS (−6.5 vs 0.3, p < 0.04). Conclusion: In this pilot study, we demonstrated that biphasic DBS is a novel stimulation paradigm which can be administered safely. The biphasic waveform revealed a greater immediate improvement. Further studies are needed to determine whether this immediate improvement persists with chronic stimulation or if clinDBS will eventually achieve similar levels of improvement to bDBS over time.

Original languageEnglish (US)
Article number105328
JournalParkinsonism and Related Disorders
Early online dateFeb 18 2023
StatePublished - Apr 2023


  • Active recharge
  • Deep brain stimulation
  • Dystonia
  • Globus pallidus
  • Cross-Over Studies
  • Pilot Projects
  • Dystonia/therapy
  • Globus Pallidus
  • Humans
  • Treatment Outcome
  • Deep Brain Stimulation/adverse effects
  • Dystonic Disorders/therapy

ASJC Scopus subject areas

  • Geriatrics and Gerontology
  • Clinical Neurology
  • Neurology


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