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 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.

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.

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 Neural selectivity, efficiency, and dose equivalence in deep brain stimulation through pulse width tuning and segmented electrodes

2020 ◽  
Vol 13 (4) ◽  
pp. 1040-1050 ◽  
Author(s):  
Collin J. Anderson ◽  
Daria Nesterovich Anderson ◽  
Stefan M. Pulst ◽  
Christopher R. Butson ◽  
Alan D. Dorval
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Pulse Width ◽  
Neural Selectivity ◽  
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

P41 Psychiatric side effects of bilateral deep brain stimulation for movement disorders

Basal Ganglia ◽  
2011 ◽  
Vol 1 (2) ◽  
pp. 120-121
Author(s):  
M.O. Pinsker ◽  
F. Amtage ◽  
M. Berger ◽  
G. Nikkhah ◽  
L. Tebartz van Elst
Keyword(s):  
Deep Brain Stimulation ◽  
Side Effects ◽  
Brain Stimulation ◽  
Movement Disorders ◽  
Psychiatric Side Effects ◽  
Deep Brain
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