scholarly journals Endurance of Short Pulse Width Thalamic Stimulation Efficacy in Intention Tremor

2020 ◽  
pp. 1-6
Author(s):  
Thomas Wirth ◽  
Viswas Dayal ◽  
Alexis de Roquemaurel ◽  
Francisca Ferreira ◽  
Nirosen Vijiaratnam ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Side Effects ◽  
Pulse Width ◽  
Short Pulse ◽  
Therapeutic Window ◽  
Intention Tremor ◽  
Thalamic Stimulation ◽  
Short Pulse Width ◽  
Deep Brain

The benefit of short pulse width stimulation in patients suffering from essential tremor (ET) refractory to thalamic deep brain stimulation remains controversial. Here, we add to the minimal body of evidence available by reporting the effect of this type of stimulation in 3 patients with a persistent and severe intention tremor component despite iterative DBS setting adjustments. While a reduction in pulse width to 30 μs initially showed promise in these patients by improving tremor control and mitigating cerebellar side effects arguably by widening the therapeutic window, these benefits seemed to dissipate during early follow-up. Our experience supports the need for measuring longer-term outcomes when reporting the usefulness of this mode of stimulation in ET.

Short Pulse and Conventional Deep Brain Stimulation Equally Improve the Parkinsonian Gait Disorder

2021 ◽  
pp. 1-10
Author(s):  
Aline Seger ◽  
Alessandro Gulberti ◽  
Eik Vettorazzi ◽  
Hanna Braa ◽  
Carsten Buhmann ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Gait Analysis ◽  
Brain Stimulation ◽  
Pulse Width ◽  
Short Pulse ◽  
Therapeutic Window ◽  
Gait Velocity ◽  
Secondary Endpoints ◽  
Quantitative Gait Analysis ◽  
Deep Brain

Background: Gait disturbances and balance remain challenging issues in Parkinsonian patients (PD) with deep brain stimulation (DBS). Short pulse deep brain stimulation (spDBS) increases the therapeutic window in PD patients, yet the effect on gait and postural symptoms remains unknown. Objective: We assessed the efficacy of spDBS compared to conventional DBS (cDBS) within the subthalamic nucleus (STN) on Parkinsonian gait. Methods: The study was a single-centre, randomized, double-blind, clinical short-term trial. 20 PD patients were studied postoperatively in three different conditions (DBS stimulation switched off (off DBS), spDBS with 40μs pulse width, cDBS with 60μs pulse width) on regular medication. The primary endpoint was the relative difference of gait velocity at self-paced speed during quantitative gait analysis between stimulation conditions. Secondary endpoints were changes of further measures of quantitative gait analysis, Ziegler course, Berg balance scale, FOG questionnaire, MDS-UPDRS, PDQ-39, and HADS. Mixed-model analysis and post-hoc t-tests were performed. Results: Both spDBS and cDBS improved gait velocity at self-paced speed compared to off DBS, however, there was no significant difference between both stimulation modes. Still, nearly half of the patients preferred spDBS over cDBS subjectively. Both stimulation modes were equally effective in improving secondary endpoints of gait, balance, motor and non-motor performances. Conclusion: The use of spDBS and cDBS is equally effective in improving gait and balance in PD and might be beneficial in specified cohorts of PD patients.

Deep brain stimulation fine-tuning in Parkinson’s disease: short pulse width effect on speech

2021 ◽  
Author(s):  
Margherita Fabbri ◽  
Federico Natale ◽  
Carlo Alberto Artusi ◽  
Alberto Romagnolo ◽  
Marco Bozzali ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Pulse Width ◽  
Short Pulse ◽  
Fine Tuning ◽  
Width Effect ◽  
Short Pulse Width ◽  
Deep Brain

scholarly journals Neural Selectivity, Efficiency, and Dose Equivalence in Deep Brain Stimulation through Pulse Width Tuning and Segmented Electrodes

2019 ◽  
Author(s):  
Collin J. Anderson ◽  
Daria Nesterovich Anderson ◽  
Stefan M. Pulst ◽  
Christopher R. Butson ◽  
Alan D. Dorval
Keyword(s):  
Deep Brain Stimulation ◽  
Side Effects ◽  
Brain Stimulation ◽  
Pulse Width ◽  
Short Pulse ◽  
White Matter Tract ◽  
Neuron Models ◽  
Long Pulse ◽  
Neural Selectivity ◽  
Deep Brain

AbstractBackgroundAchieving deep brain stimulation (DBS) dose equivalence is challenging, especially with pulse width tuning and directional contacts. Further, the precise effects of pulse width tuning are unknown.MethodsWe created multicompartment neuron models for two axon diameters and used finite element modeling to determine extracellular influence from standard and segmented electrodes. We analyzed axon activation profiles and calculated volumes of tissue activated.ResultsLong pulse widths focus the stimulation effect on small, nearby fibers, suppressing white matter tract activation (responsible for some DBS side effects) and improving battery utilization. Directional leads enable similar benefits to a greater degree. We derive equations for equivalent activation with pulse width tuning and segmented contacts.InterpretationsWe find agreement with classic studies and reinterpret recent articles concluding that short pulse widths focus the stimulation effect on small, nearby fibers, decrease side effects, and improve power consumption. Our field should reconsider shortened pulse widths.

scholarly journals Combined Unilateral Subthalamic Nucleus and Contralateral Globus Pallidus Interna Deep Brain Stimulation for Treatment of Parkinson Disease: A Pilot Study of Symptom-Tailored Stimulation

Neurosurgery ◽  
2020 ◽  
Author(s):  
Chencheng Zhang ◽  
Linbin Wang ◽  
Wei Hu ◽  
Tao Wang ◽  
Yijie Zhao ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Side Effects ◽  
Parkinson Disease ◽  
Globus Pallidus ◽  
Subthalamic Nucleus ◽  
Brain Stimulation ◽  
Bilateral Stimulation ◽  
Adverse Side Effects ◽  
Deep Brain

Abstract BACKGROUND Subthalamic nucleus (STN) and globus pallidus interna (GPi) are the most effective targets in deep brain stimulation (DBS) treatment for Parkinson disease (PD). However, the individualized selection of targets remains a clinical challenge. OBJECTIVE To combine unilateral STN and contralateral GPi stimulation (STN DBS in one brain hemisphere and GPi DBS in the other) to maximize the clinical advantages of each target while inducing fewer adverse side effects in selected patients with PD because each target has its own clinical effects and risk profiles. METHODS We reviewed the clinical outcomes of 8 patients with idiopathic PD treated with combined unilateral STN and contralateral GPi DBS. Clinical outcome assessments, focusing on motor and nonmotor symptoms, were performed at baseline and 6-mo and 12-mo follow-up. We performed the assessments under the following conditions: medication on and off (bilateral stimulation on and off and unilateral STN stimulation on). RESULTS Patients showed a significant improvement in motor symptoms, as assessed by the Unified Parkinson Disease Rating Scale III (UPDRS-III) and Timed Up-and-Go Test (TUG), in the off-medication/on-stimulation state at 6-mo and 12-mo follow-up. Also, patients reported a better quality of life, and their intake of levodopa was reduced at 12-mo follow-up. In the on-medication condition, bilateral stimulation was associated with an improvement in axial symptoms, with a 64% improvement in measures of gait and falls at 12-mo follow-up. No irreversible adverse side effects were observed. CONCLUSION Our findings suggest that combined unilateral STN and contralateral GPi DBS could offer an effective and well-tolerated DBS treatment for certain PD patients.

Less is more – Pulse width dependent therapeutic window in deep brain stimulation for essential tremor

2018 ◽  
Vol 11 (5) ◽  
pp. 1132-1139 ◽  
Author(s):  
Alexia-Sabine Moldovan ◽  
Christian Johannes Hartmann ◽  
Carlos Trenado ◽  
Nicola Meumertzheim ◽  
Philipp Jörg Slotty ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Essential Tremor ◽  
Brain Stimulation ◽  
Pulse Width ◽  
Therapeutic Window ◽  
Less Is More ◽  
Deep Brain

scholarly journals Shorter pulse width reduces gait disturbances following deep brain stimulation for essential tremor

2019 ◽  
Vol 90 (9) ◽  
pp. 1046-1050 ◽  
Author(s):  
Daniel Kroneberg ◽  
Siobhan Ewert ◽  
Anne-Christiane Meyer ◽  
Andrea A Kühn
Keyword(s):  
Deep Brain Stimulation ◽  
Side Effects ◽  
Essential Tremor ◽  
Brain Stimulation ◽  
Pulse Width ◽  
Stride Length ◽  
Gait Parameters ◽  
Tremor Suppression ◽  
Gait Disturbances ◽  
Deep Brain

ObjectiveGait disturbances are frequent side effects occurring during chronic thalamic deep brain stimulation (DBS) in patients with essential tremor (ET). Adapting stimulation settings to shorter pulse widths has been shown to reduce side effects of subthalamic DBS. Here, we assess how a reduction of pulse width changes gait performance of affected patients.MethodsSensor-based gait assessment was performed to record spatiotemporal gait parameters in 10 healthy subjects (HS) and 7 patients with ET with gait disturbances following thalamic DBS. Patients were tested during standard DBS, after 72 hours of stimulation withdrawal and at least 30 days after adjusting DBS settings to a shorter pulse width of 40 µs (DBS40PW).ResultsPatients with ET on standard DBS showed significantly higher variability of several spatiotemporal gait parameters compared with HS. Variability of stride length and range of motion of the shanks significantly decreased OFF DBS as compared with standard DBS. This improvement was maintained over 30 days with DBS40PW while providing effective tremor suppression in six out of seven patients.ConclusionShorter pulse widths may reduce gait disturbances in patients with ET that are induced by DBS while preserving a level of tremor suppression equal to standard stimulation settings.

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