scholarly journals Ultrahigh Frequency Deep Brain Stimulation at 10 000 Hz Improves Motor Function

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Irene E Harmsen ◽  
Darrin J Lee ◽  
Robert F Dallapiazza ◽  
Philippe De Vloo ◽  
Robert Chen ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Deep Brain Stimulation ◽  
Adverse Effects ◽  
Brain Stimulation ◽  
Spinal Cord Stimulation ◽  
Ultrahigh Frequency ◽  
Clinical Effects ◽  
Stimulation Parameters ◽  
Clinical Benefits ◽  
Deep Brain

Abstract INTRODUCTION Stimulation frequency has been considered a crucial determinant of efficacy in deep brain stimulation (DBS). DBS at frequencies over 250 Hz is not currently employed and consensus in the field suggests that higher frequencies are not clinically effective. With the recent demonstration of clinically effective ultrahigh frequency (UHF) spinal cord stimulation at 10 kHz we tested whether UHF stimulation could also be clinically useful in movement disorder patients with DBS. We evaluated the clinical effects and safety of UHF DBS in patients with subthalamic nucleus (STN) or ventral intermediate thalamic nucleus (VIM) DBS. METHODS We studied the effects of conventional (130 Hz) and UHF stimulation in 5 patients with Parkinson's disease (PD) with STN DBS and in one patient with essential tremor (ET) with VIM DBS. We compared the clinical benefit and adverse effects of stimulation at various amplitudes either intraoperatively or postoperatively with the electrodes externalized. RESULTS Motor performance improved in all 6 patients with UHF DBS. About 10 kHz stimulation at amplitudes = 3.0 mA appeared to be as effective as 130 Hz in improving motor symptoms (46.2% vs 53.5% motor score reduction, P = .110, N = 90 trials). Interestingly, 10 kHz stimulation resulted in fewer stimulation-induced paresthesiae and speech adverse effects than 130 Hz stimulation. CONCLUSION Our results indicate that DBS at 10 kHz produces clinical benefits in patients with movement disorders. Like 10 kHz spinal cord stimulation, 10 kHz DBS has the potential to produce clinical benefits while possibly reducing stimulation-induced adverse effects. Further studies will be required to optimize UHF DBS stimulation parameters and to determine its clinical utility.

scholarly journals Introduction to Deep Brain Stimulation

2017 ◽  
Vol 42 (videosuppl2) ◽  
pp. Intro ◽  
Author(s):  
Andres M. Lozano ◽  
Robert E. Gross
Keyword(s):  
Deep Brain Stimulation ◽  
Adverse Effects ◽  
Brain Stimulation ◽  
Movement Disorders ◽  
Surgical Techniques ◽  
Single Target ◽  
Holmes Tremor ◽  
Clinical Benefits ◽  
Technical Details ◽  
Deep Brain

It is estimated that over 160,000 patients worldwide have received deep brain stimulation (DBS) to date predominantly for Parkinson's disease and other movement disorders. With the success of this therapy, a greater appreciation of the clinical benefits and adverse effects is being realized. Neurosurgeons are increasingly paying attention to the technical details of these procedures and optimizing targeting, surgical techniques, and programming to improve outcomes.In this issue, the nuances of surgical techniques for DBS are covered by Dr. House. Dr. Toda et al. and Mr. Chartrain et al. tackle the approach to treating tremors, either essential tremor or Holmes tremor, using either a single target or, in cases of difficult-to-treat tremors, using more than one target and interleaving the stimulation. These abstracts and videos will be appreciated by both those who are being initiated to DBS and the more seasoned practitioners who are looking for helpful hints to tackle challenging cases.

Spinal cord stimulation improves gait in patients with Parkinson's disease previously treated with deep brain stimulation

2016 ◽  
Vol 32 (2) ◽  
pp. 278-282 ◽  
Author(s):  
Carolina Pinto de Souza ◽  
Clement Hamani ◽  
Carolina Oliveira Souza ◽  
William Omar Lopez Contreras ◽  
Maria Gabriela dos Santos Ghilardi ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Spinal Cord ◽  
Parkinson's Disease ◽  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Spinal Cord Stimulation ◽  
Previously Treated ◽  
Deep Brain

scholarly journals Safety assessment of spine MRI in deep brain stimulation patients

2020 ◽  
Vol 32 (6) ◽  
pp. 973-983
Author(s):  
Alexandre Boutet ◽  
Gavin J. B. Elias ◽  
Robert Gramer ◽  
Clemens Neudorfer ◽  
Jürgen Germann ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Adverse Effects ◽  
Brain Stimulation ◽  
Brain Mri ◽  
Safety Data ◽  
Clinical Effects ◽  
Clinical Trial Registration ◽  
Spine Mri ◽  
Deep Brain

OBJECTIVEMany centers are hesitant to perform clinically indicated MRI in patients who have undergone deep brain stimulation (DBS). Highly restrictive guidelines prohibit the use of most routine clinical MRI protocols in these patients. The authors’ goals were to assess the safety of spine MRI in patients with implanted DBS devices, first through phantom model testing and subsequently through validation in a DBS patient cohort.METHODSA phantom was used to assess DBS device heating during 1.5-T spine MRI. To establish a safe spine protocol, routinely used clinical sequences deemed unsafe (a rise in temperature > 2°C) were modified to decrease the rise in temperature. This safe phantom-based protocol was then used to prospectively run 67 spine MRI sequences in 9 DBS participants requiring clinical imaging. The primary outcome was acute adverse effects; secondary outcomes included long-term adverse clinical effects, acute findings on brain MRI, and device impedance stability.RESULTSThe increases in temperature were highest when scanning the cervical spine and lowest when scanning the lumbar spine. A temperature rise < 2°C was achieved when 3D sequences were modified to 2D and when the number of slices was decreased by the minimum amount compared to routine spine MRI protocols (but there were still more slices than allowed by vendor guidelines). Following spine MRI, no acute or long-term adverse effects or acute findings on brain MR images were detected. Device impedances remained stable.CONCLUSIONSPatients with DBS devices may safely undergo spine MRI with a fewer number of slices compared to those used in routine clinical protocols. Safety data acquisition may allow protocols outside vendor guidelines with a maximized number of slices, reducing the need for radiologist supervision.Clinical trial registration no.: NCT03753945 (ClinicalTrials.gov).

Deep Brain Stimulation and Spinal Cord Stimulation for Vegetative State and Minimally Conscious State

2013 ◽  
Vol 80 (3-4) ◽  
pp. S30.e1-S30.e9 ◽  
Author(s):  
Takamitsu Yamamoto ◽  
Yoichi Katayama ◽  
Toshiki Obuchi ◽  
Kazutaka Kobayashi ◽  
Hideki Oshima ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Spinal Cord Stimulation ◽  
Vegetative State ◽  
Minimally Conscious State ◽  
Conscious State ◽  
Minimally Conscious ◽  
Deep Brain

Neuromodulation for Medically Refractory Neuropathic Pain: Spinal Cord Stimulation, Deep Brain Stimulation, Motor Cortex Stimulation, and Posterior Insula Stimulation

2021 ◽  
Vol 146 ◽  
pp. 246-260
Author(s):  
Giovanna Zambo Galafassi ◽  
Pedro Henrique Simm Pires de Aguiar ◽  
Renata Faria Simm ◽  
Paulo Roberto Franceschini ◽  
Marco Prist Filho ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Neuropathic Pain ◽  
Deep Brain Stimulation ◽  
Motor Cortex ◽  
Brain Stimulation ◽  
Spinal Cord Stimulation ◽  
Motor Cortex Stimulation ◽  
Posterior Insula ◽  
Deep Brain

scholarly journals P.089 Ultra-high frequency deep brain stimulation at 10,000 Hz improves motor function

2019 ◽  
Vol 46 (s1) ◽  
pp. S37 ◽  
Author(s):  
IE Harmsen ◽  
DJ Lee ◽  
RF Dallapiazza ◽  
P De Vloo ◽  
R Chen ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Adverse Effects ◽  
Brain Stimulation ◽  
High Frequency ◽  
Motor Score ◽  
Ultra High Frequency ◽  
Clinical Benefits ◽  
Stn Dbs ◽  
Recent Demonstration ◽  
Deep Brain

Background: Stimulation frequency has been considered a crucial determinant of efficacy in deep brain stimulation (DBS). DBS at frequencies over 250Hz is not currently employed and consensus in the field suggests that higher frequencies are not clinically effective. With the recent demonstration of clinically effective ultra-high frequency (UHF) spinal cord stimulation at 10kHz we tested whether UHF stimulation could also be clinically useful in movement disorder patients with DBS. Methods: We studied the effects of conventional (130Hz) and UHF stimulation in five patients with Parkinson’s disease (PD) with STN DBS and in one patient with essential tremor (ET) with VIM DBS. We compared the clinical benefit and adverse effects of stimulation at various amplitudes either intraoperatively or postoperatively with the electrodes externalized. Results: Motor performance improved in all six patients with UHF DBS. 10kHz stimulation at amplitudes ≥3.0mA appeared to be as effective as 130Hz in improving motor symptoms (46.2% vs 53.5% motor score reduction, p=0.110, N=90 trials). Interestingly, 10kHz stimulation resulted in fewer stimulation-induced paresthesiae and speech adverse effects than 130Hz stimulation. Conclusions: Our results indicate that DBS at 10kHz produces clinical benefits while possibly reducing stimulation-induced adverse effects in patients with movement disorders.

Primary orthostatic tremor: is deep brain stimulation better than spinal cord stimulation?

2017 ◽  
Vol 88 (9) ◽  
pp. 804-805 ◽  
Author(s):  
Han-Lin Chiang ◽  
Yi-Cheng Tai ◽  
Jacqueline McMaster ◽  
Victor SC Fung ◽  
Neil Mahant
Keyword(s):  
Spinal Cord ◽  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Spinal Cord Stimulation ◽  
Orthostatic Tremor ◽  
Better Than ◽  
Deep Brain

scholarly journals The continued relevance of Deep Brain Stimulation for chronic pain

2021 ◽  
Vol 6 (1) ◽  
pp. 009-014
Author(s):  
Farrell Sarah Marie ◽  
Aziz Tipu
Keyword(s):  
Spinal Cord ◽  
Chronic Pain ◽  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Spinal Cord Stimulation ◽  
Success Rates ◽  
Off Label ◽  
The Past ◽  
Variable Success ◽  
Deep Brain

For the millions of patients experiencing chronic pain despite pharmacotherapy, deep brain stimulation (DBS) provides a beacon of hope. Over the past decade the field has shifted away from DBS towards other forms of neuromodulation, particularly spinal cord stimulation (SCS). DBS for pain is still performed, albeit off-label in US and UK, and experiences variable success rates. SCS is an extremely useful tool for the modulation of pain but is limited in its application to specific pain aetiologies. We advocate use of DBS for pain, for patients for whom pharmacology has failed and for whom spinal cord stimulation is inadequate. DBS for chronic pain is at risk of premature neglect. Here we outline how this has come to pass, and in the process argue for the untapped potential for this procedure.

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