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.

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.

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

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 Gait and Balance Changes with Investigational Peripheral Nerve Cell Therapy during Deep Brain Stimulation in People with Parkinson’s Disease

2021 ◽  
Vol 11 (4) ◽  
pp. 500
Author(s):  
Geetanjali Gera ◽  
Zain Guduru ◽  
Tritia Yamasaki ◽  
Julie A. Gurwell ◽  
Monica J. Chau ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Deep Brain Stimulation ◽  
Peripheral Nerve ◽  
Brain Stimulation ◽  
Step Length ◽  
Gait Velocity ◽  
Balance Performance ◽  
Improved Performance ◽  
Deep Brain

Background: The efficacy of deep brain stimulation (DBS) and dopaminergic therapy is known to decrease over time. Hence, a new investigational approach combines implanting autologous injury-activated peripheral nerve grafts (APNG) at the time of bilateral DBS surgery to the globus pallidus interna. Objectives: In a study where APNG was unilaterally implanted into the substantia nigra, we explored the effects on clinical gait and balance assessments over two years in 14 individuals with Parkinson’s disease. Methods: Computerized gait and balance evaluations were performed without medication, and stimulation was in the off state for at least 12 h to best assess the role of APNG implantation alone. We hypothesized that APNG might improve gait and balance deficits associated with PD. Results: While people with a degenerative movement disorder typically worsen with time, none of the gait parameters significantly changed across visits in this 24 month study. The postural stability item in the UPDRS did not worsen from baseline to the 24-month follow-up. However, we measured gait and balance improvements in the two most affected individuals, who had moderate PD. In these two individuals, we observed an increase in gait velocity and step length that persisted over 6 and 24 months. Conclusions: Participants did not show worsening of gait and balance performance in the off therapy state two years after surgery, while the two most severely affected participants showed improved performance. Further studies may better address the long-term maintanenace of these results.

scholarly journals Effects of Deep Brain Stimulation of the Subthalamic Nucleus Settings on Voice Quality, Intensity, and Prosody in Parkinson’s Disease: Preliminary Evidence for Speech Optimization

2019 ◽  
Vol 46 (3) ◽  
pp. 287-294 ◽  
Author(s):  
Anita Abeyesekera ◽  
Scott Adams ◽  
Cynthia Mancinelli ◽  
Thea Knowles ◽  
Greydon Gilmore ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Subthalamic Nucleus ◽  
Brain Stimulation ◽  
Pulse Width ◽  
Voice Quality ◽  
Preliminary Evidence ◽  
Clinical Settings ◽  
Stn Dbs ◽  
Deep Brain ◽  
Stimulation Of

ABSTRACT:Objective: To systematically evaluate how different deep brain stimulation of the subthalamic nucleus (STN-DBS) amplitude, frequency, and pulse-width electrical parameter settings impact speech intensity, voice quality, and prosody of speech in Parkinson’s disease (PD). Methods: Ten individuals with PD receiving bilateral STN-DBS treatments were seen for three baseline and five treatment visits. The five treatment visits involved an examination of the standard clinical settings as well as manipulation of different combinations of frequency (low, mid, and high), pulse width (low, mid, and high), and voltage (low, mid, and high) of stimulation. Measures of speech intensity, jitter, shimmer, harmonics–noise ratio, semitone standard deviation, and listener ratings of voice quality and prosody were obtained for each STN-DBS manipulation. Results: The combinations of lower frequency, lower pulse width, and higher voltage settings were associated with improved speech outcomes compared to the current standard clinical settings. In addition, decreased total electrical energy delivered to the STN appears to be associated with speech improvements. Conclusions: This study provides preliminary evidence that STN-DBS may be optimized for Parkinson-related problems with voice quality, speech intensity, and prosody of speech.

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