Analysis and visualisation of tremor dynamics in deep brain stimulation patients

AbstractDeep brain stimulation (DBS) is an established therapy for movement disorders such as in Parkinson's disease (PD) and essential tremor (ET). Adjusting the stimulation parameters, however, is a labour-intensive process and often requires several patient visits. Physicians prefer objective tools to improve (or maintain) the performance in DBS. Wearable motion sensors (WMS) are able to detect some manifestations of pathological signs, such as tremor in PD. However, the interpretation of sensor data is often highly technical and methods to visualise tremor data of patients undergoing DBS in a clinical setting are lacking. This work aims to visualise the dynamics of tremor responses to DBS parameter changes with WMS while patients performing clinical hand movements. To this end, we attended DBS programming sessions of two patients with the aim to visualise certain aspects of the clinical examination. PD tremor and ET were effectively quantified by acceleration amplitude and frequency. Tremor dynamics were analysed and visualised based on setpoints, movement transitions and stability aspects. These methods have not yet been employed and examples demonstrate how tremor dynamics can be visualised with simple analysis techniques. We therefore provide a base for future research work on visualisation tools in order to assist clinicians who frequently encounter patients for DBS therapy. This could lead to benefits in terms of enhanced evaluation of treatment efficacy in the future.

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Deep brain stimulation in intractable epilepsy: Postulated optimal stimulation parameters

Epilepsy & Behavior ◽

10.1016/j.yebeh.2013.09.017 ◽

2013 ◽

Vol 29 (3) ◽

pp. 597-598 ◽

Cited By ~ 5

Author(s):

Harinder Jaseja

Keyword(s):

Deep Brain Stimulation ◽

Brain Stimulation ◽

Intractable Epilepsy ◽

Stimulation Parameters ◽

Deep Brain

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iHandU: A Novel Quantitative Wrist Rigidity Evaluation Device for Deep Brain Stimulation Surgery

Sensors ◽

10.3390/s20020331 ◽

2020 ◽

Vol 20 (2) ◽

pp. 331 ◽

Cited By ~ 2

Author(s):

Elodie Múrias Lopes ◽

Maria do Carmo Vilas-Boas ◽

Duarte Dias ◽

Maria José Rosas ◽

Rui Vaz ◽

...

Keyword(s):

Deep Brain Stimulation ◽

Brain Stimulation ◽

Lessons Learned ◽

Wrist Flexion ◽

Stimulation Parameters ◽

Average Accuracy ◽

Gyroscope Sensor ◽

Work Done ◽

Deep Brain Stimulation Surgery ◽

Deep Brain

Deep brain stimulation (DBS) surgery is the gold standard therapeutic intervention in Parkinson’s disease (PD) with motor complications, notwithstanding drug therapy. In the intraoperative evaluation of DBS’s efficacy, neurologists impose a passive wrist flexion movement and qualitatively describe the perceived decrease in rigidity under different stimulation parameters and electrode positions. To tackle this subjectivity, we designed a wearable device to quantitatively evaluate the wrist rigidity changes during the neurosurgery procedure, supporting physicians in decision-making when setting the stimulation parameters and reducing surgery time. This system comprises a gyroscope sensor embedded in a textile band for patient’s hand, communicating to a smartphone via Bluetooth and has been evaluated on three datasets, showing an average accuracy of 80%. In this work, we present a system that has seen four iterations since 2015, improving on accuracy, usability and reliability. We aim to review the work done so far, outlining the iHandU system evolution, as well as the main challenges, lessons learned, and future steps to improve it. We also introduce the last version (iHandU 4.0), currently used in DBS surgeries at São João Hospital in Portugal.

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Diplopia associated with loop routing in deep brain stimulation: illustrative case

Journal of Neurosurgery: Case Lessons ◽

10.3171/case2031 ◽

2021 ◽

Vol 1 (1) ◽

Author(s):

Yasushi Miyagi ◽

Eiichirou Urasaki

Keyword(s):

Deep Brain Stimulation ◽

Brain Stimulation ◽

Electromagnetic Interference ◽

Illustrative Case ◽

Pulse Generators ◽

Replacement Surgery ◽

Dual Channel ◽

Stimulation Parameters ◽

External Sources ◽

Deep Brain

BACKGROUNDDeep brain stimulation (DBS) is a powerful surgical option for drug-resistant movement disorders; however, electromagnetic interference (EMI) from external sources poses a potential risk for implanted electronics.OBSERVATIONSA 61-year-old woman with Parkinson’s disease originally had two implantable pulse generators (IPGs) for bilateral subthalamic DBS, which were then replaced with one dual-channel IPG routed in a loop. After the replacement surgery, with the same DBS programming as before the IPG replacement (bipolar setting for right, unipolar setting for left), the patient began to complain of transient paroxysmal diplopia. After multiple attempts to adjust the stimulation parameters, the diplopia was resolved by changing the left unipolar setting to a bipolar setting. At the authors’ institution, before the present case, four other patients had undergone IPG replacement with loop routing. None of these previous patients complained of diplopia; however, two of the four presented with diplopia in an experimental unipolar setting.LESSONSClinicians should be aware that loop-routed circuits may generate distortion of the stimulus field in DBS, even in the absence of external EMI sources.

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Gait worsening and the microlesion effect following deep brain stimulation for essential tremor

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp-2018-319723 ◽

2019 ◽

Vol 90 (8) ◽

pp. 913-919 ◽

Cited By ~ 2

Author(s):

Ryan Roemmich ◽

Jaimie A Roper ◽

Robert S Eisinger ◽

Jackson N Cagle ◽

Lauren Maine ◽

...

Keyword(s):

Deep Brain Stimulation ◽

Essential Tremor ◽

Brain Stimulation ◽

Repeated Measures ◽

Walking Speed ◽

Stimulation Parameters ◽

Gait Parameters ◽

Before And After ◽

Walking Speeds ◽

Deep Brain

ObjectiveTo investigate the effects of unilateral thalamic deep brain stimulation (DBS) on walking in persons with medication-refractory essential tremor (ET).MethodsWe performed laboratory-based gait analyses on 24 persons with medication-refractory ET before and after unilateral thalamic DBS implantation. Normal and tandem walking parameters were analysed across sessions (PRE-DBS/DBS OFF/DBS ON) by repeated measures analyses of variance. Pearson’s correlations assessed whether changes in walking after DBS were global (ie, related across gait parameters). Baseline characteristics, lead locations and stimulation parameters were analysed as possible contributors to gait effects.ResultsDBS minimally affected gait at the cohort level. However, 25% of participants experienced clinically meaningful gait worsening. Walking speed decreased by >30% in two participants and by >10% in four others. Decreased walking speed correlated with increased gait variability, indicating global gait worsening in affected participants. The worsening persisted even after the stimulation was turned off. Participants with worse baseline tandem walking performance may be more likely to experience post-DBS gait worsening; the percentage of tandem missteps at baseline was nearly three times higher and tandem walking speeds were approximately 30% slower in participants who experienced gait worsening. However, these differences in tandem walking in persons with gait worsening as compared with those without worsening were not statistically significant. Lead locations and stimulation parameters were similar in participants with and without gait worsening.ConclusionGlobal gait worsening occurred in 25% of participants with unilateral DBS for medication-refractory ET. The effect was present on and off stimulation, likely indicating a microlesion effect.

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Bilateral Deep Brain Stimulation for Cervical Dystonia: Long-term Outcome in a Series of 10 Patients

Neurosurgery ◽

10.1227/neu.0b013e3181ec49c7 ◽

2010 ◽

Vol 67 (4) ◽

pp. 957-963 ◽

Cited By ~ 39

Author(s):

Francesco Cacciola ◽

Jibril Osman Farah ◽

Paul R Eldridge ◽

Patricia Byrne ◽

Telekath K Varma

Keyword(s):

Deep Brain Stimulation ◽

Brain Stimulation ◽

Cervical Dystonia ◽

Rating Scale ◽

Spasmodic Torticollis ◽

Long Term Outcome ◽

Stimulation Parameters ◽

Deep Brain

Abstract BACKGROUND: Bilateral globus pallidus internus (GPi) deep brain stimulation (DBS) was shown to be effective in cervical dystonia refractory to medical treatment in several small short-term and 1 long-term follow-up series. Optimal stimulation parameters and their repercussions on the cost/benefit ratio still need to be established. OBJECTIVE: To report our long-term outcome with bilateral GPi deep brain stimulation in cervical dystonia. METHODS: The Toronto Western Spasmodic Torticollis Rating Scale was evaluated in 10 consecutive patients preoperatively and at last follow-up. The relationship of improvement in postural severity and pain was analyzed and stimulation parameters noted and compared with those in a similar series in the literature. RESULTS: The mean (standard deviation) follow-up was 37.6 (16.9) months. Improvement in the total Toronto Western Spasmodic Torticollis Rating Scale score as evaluated at latest follow-up was 68.1% (95% confidence interval: 51.5-84.6). In 4 patients, there was dissociation between posture severity and pain improvement. Prevalently bipolar stimulation settings and high pulse widths and amplitudes led to excellent results at the expense of battery life. CONCLUSION: Improvement in all 3 subscale scores of the Toronto Western Spasmodic Torticollis Rating Scale with bilateral GPi deep brain stimulation seems to be the rule. Refinement of stimulation parameters might have a significant impact on the cost/benefit ratio of the treatment. The dissociation of improvement in posture severity and pain provides tangible evidence of the complex nature of cervical dystonia and offers interesting insight into the complex functional organization of the GPi.

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Stability of symptom control after replacement of impulse generators for deep brain stimulation

Journal of Neurosurgery ◽

10.3171/2009.1.jns081352 ◽

2009 ◽

Vol 110 (6) ◽

pp. 1274-1277 ◽

Cited By ~ 21

Author(s):

Niels Allert ◽

Holger Kirsch ◽

Waldemar Weirich ◽

Hans Karbe

Keyword(s):

Deep Brain Stimulation ◽

Brain Stimulation ◽

Single Channel ◽

Short Circuit ◽

Symptom Control ◽

Technical Problems ◽

Dual Channel ◽

Stimulation Parameters ◽

The Stability ◽

Deep Brain

Object Impulse generators (IPGs) for deep brain stimulation (DBS) need to be replaced when their internal batteries fail or when technical problems occur. New IPGs are routinely programmed with the previous stimulation parameters. In this study, the authors evaluate the stability of symptom control after such IPG replacements. Methods The authors retrospectively analyzed the outcome of 56 IPG replacements in 42 patients with various movement disorders treated using DBS. Results Stable symptom control was found in 65% of single-channel IPG replacements and 53% of dual-channel IPG replacements. Worsening of symptoms resulted primarily from changes in stimulation effects requiring reprogramming of stimulation parameters (17% of dual-channel IPG and 25% of single-channel IPG). In 14% of dualchannel IPG replacements, instability resulted from erroneous extension adjustment with change in laterality. A new short circuit of active with previously inactive contacts of the quadripolar stimulation lead resulted in a worsening of symptoms in 4% of replacements. Conclusions Replacement of the IPG requires careful follow-up of patients with DBS to ensure stable symptom control.

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A comparative study of asleep and awake deep brain stimulation robot-assisted surgery for Parkinson’s disease

npj Parkinson s Disease ◽

10.1038/s41531-020-00130-1 ◽

2020 ◽

Vol 6 (1) ◽

Author(s):

Hai Jin ◽

Shun Gong ◽

Yingqun Tao ◽

Hua Huo ◽

Xiao Sun ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Deep Brain Stimulation ◽

Brain Stimulation ◽

Robot Assisted ◽

Electrode Implantation ◽

Stimulation Parameters ◽

Procedure Duration ◽

Electrophysiological Signal ◽

Deep Brain

Abstract To compare the differences between asleep and awake robot-assisted deep brain stimulation (DBS) surgery for Parkinson’s Disease (PD), we conducted this retrospective cohort study included 153 PD patients undergoing bilateral robot-assisted DBS from June 2017 to August 2019, of which 58 cases were performed under general anesthesia (GA) and 95 cases under local anesthesia (LA). Procedure duration, stimulation parameters, electrode implantation accuracy, intracranial air, intraoperative electrophysiological signal length, complications, and Unified PD Rating Scale (UPDRS) measurements were recorded and compared. The clinical evaluation was conducted by two raters who were blinded to the choice of anesthesia. Procedure duration was significantly shorter in the GA group, while on stimulation off medication motor scores (UPDRS-III) were significantly improved in both the GA and LA group. ANCOVA covariated for the baseline UPDRS-III and levodopa challenge exhibited no significant differences. In terms of amplitude, frequency, and pulse width, the stimulation parameters used for DBS power-on were similar. There were no significant differences in electrode implantation accuracy, intraoperative electrophysiological signal length, or intracerebral hemorrhage (no occurrences in either group). The pneumocephalus volume was significantly smaller in the GA group. Six patients exhibited transient throat discomfort associated with tracheal intubation in the GA group. The occurrence of surgical incision infection was similar in both groups. Compared with the awake group, the asleep group exhibited a shorter procedure duration with a similar electrode implantation accuracy and short-term motor improvement. Robot-assisted asleep DBS surgery is a promising surgical method for PD.

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Optimizing Deep Brain Stimulation Parameters in Obsessive–Compulsive Disorder

Neuromodulation Technology at the Neural Interface ◽

10.1111/ner.13243 ◽

2020 ◽

Cited By ~ 1

Author(s):

Maarten van Westen ◽

Erik Rietveld ◽

Isidoor O. Bergfeld ◽

Pelle de Koning ◽

Nienke Vullink ◽

...

Keyword(s):

Deep Brain Stimulation ◽

Obsessive Compulsive Disorder ◽

Brain Stimulation ◽

Obsessive Compulsive ◽

Compulsive Disorder ◽

Stimulation Parameters ◽

Deep Brain

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

Neurosurgery ◽

10.1093/neuros/nyz310_367 ◽

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.

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