Deep Brain Stimulation Impedance Decreases Over Time Even When Stimulation Settings Are Held Constant

Satzer, David; Yu, Huiyan; Wells, Meredith; Padmanaban, Mahesh; Burns, Matthew R.; Warnke, Peter C.; Xie, Tao

doi:10.3389/fnhum.2020.584005

Cited by 15 publications

(9 citation statements)

References 15 publications

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“…Results from the SANTÉ epilepsy cohort are consistent with retrospective studies evaluating DBS in basal ganglia targets for movement disorders (Parkinson disease, essential tremor, dystonia), which report downward trends in impedance over many years of long-term follow up, with similar rates of change (range = 27-73 Ω/year). [29][30][31][32][33] In contrast, long-term measurement of impedance in the RNS pivotal trial demonstrated no significant changes in impedances, for both depth and subdural electrodes, from 1 year onward, 34 suggesting cortical (focal) and thalamic targets for stimulation may have unique electrode-tissue interface properties. Changes in impedance affect the volume of tissue activated (VTA) with DBS, and if large enough, may potentially impact clinical outcomes.…”

Section: Discussionmentioning

confidence: 96%

The SANTÉ study at 10 years of follow‐up: Effectiveness, safety, and sudden unexpected death in epilepsy

et al. 2021

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We evaluated the efficacy and safety of deep brain anterior thalamus stimulation after 7 and 10 years, and report the incidence of sudden unexpected death in epilepsy (SUDEP) and overall mortality in adults in the Stimulation of the Anterior Nucleus of the Thalamus for Epilepsy (SANTÉ) study. Methods: After the 3-month blinded and 9-month unblinded phases, subjects continued to be assessed during long-term follow-up (LTFU) and later a continued therapy access phase (CAP), to further characterize adverse events and the incidence of SUDEP. Stimulus parameter and medication changes were allowed. Results: One hundred ten implanted subjects accumulated a total of 938 device-years of experience (69 subjects during the LTFU phase and 61 subjects in the CAP phase).Prior to study closure, 57 active subjects continued therapy at 14 study centers, with follow-up of at least 10 (maximum 14) years. At 7 years, median seizure frequency percent reduction from baseline was 75% (p < .001), with no outcome differences related to prior vagus nerve stimulation or resective surgery. The most severe seizure type, focal to bilateral tonic-clonic, was reduced by 71%. Adding new antiseizure medications did not impact the pattern of seizure reduction over time. There were no unanticipated serious adverse events in the study. The definite-plus-probable SUDEP rate, based on SANTÉ study experience (two deaths in 938 years) and previous pilot studies (0 deaths in 76 years), indicated a rate of 2.0 deaths for 1000 person-years.Overall mortality was 6.9 deaths per 1000 person-years. Significance: The long-term efficacy and safety profiles of the deep brain stimulation (DBS) system for epilepsy are favorable and demonstrate stable outcomes.Improvement in frequency of the most severe seizure type may reduce SUDEP risk.The SUDEP rate with DBS (2.0) is comparable to other neuromodulation treatments (i.e., vagus nerve stimulation, responsive neurostimulation) for drug-resistant focal epilepsy.

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Section: Discussionmentioning

confidence: 96%

The SANTÉ study at 10 years of follow‐up: Effectiveness, safety, and sudden unexpected death in epilepsy

et al. 2021

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“…Impedance values tend to decrease during chronic DBS in movement disorders, in a manner correlating with stimulation intensity. 16,17,20,21 Impedance also is thought to reflect the foreign-body reaction and capsule formation around the chronically implanted electrodes. 22 The accumulation of perielectrode fluid has been hypothesized to explain this phenomenon.…”

Section: Discussionmentioning

confidence: 99%

Impedance Characteristics of Stimulation Contacts in Deep Brain Stimulation of the Anterior Nucleus of the Thalamus and Its Relationship to Seizure Outcome in Patients With Refractory Epilepsy

Möttönen

Peltola

Järvenpää

et al. 2023

Neuromodulation: Technology at the Neural Interface

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“…Alternative pharmacological approaches that target cholinergic or adenosine receptor systems do not relieve symptoms to the same degree. Deep brain stimulation (DBS) is effective for many patients, but this method is not appropriate for all patients, and there are issues with the long-term effectiveness of the implanted electrodes due to impedance changes (Nassery et al, 2016; Okun, 2012; Satzer et al, 2020; Voon et al, 2013). Other commonly reported side effects include impairment of axial motor performance and cognition, along with mood effects including apathy, anxiety, impulsiveness, and depressive symptoms (Hartmann et al, 2019).…”

Section: Discussionmentioning

confidence: 99%

Persistent Relief of Motor Symptoms in a Parkinsonian Mouse Model After Induction of LTD at Cortical Inputs to Indirect Pathway Striatal Neurons

Abburi

Thome

Rodriguez

et al. 2022

Preprint

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In Parkinson's disease (PD) patients, dopamine replacement therapy requires days to reach maximal effects, and the return of symptoms without treatment is similarly delayed. We previously postulated that these phenomena are mediated by plasticity of coritcostriatal synapses. As dopamine depletion is expected to promote aberrant potentiation of the cortical inputs onto indirect pathway neurons, we reasoned that induction of LTD here could reduce motor deficits in a PD model. Optogenetic cortical stimulation combined with a D2 receptor agonist, quinpirole, induces robust optical LTD (oLTD) in brain slices from 6-OHDA lesioned mice. When lesioned mice were subjected to corticostriatal oLTD treatment over 5 days, motor performance was improved for >3 weeks. Consistent with LTD induction, oLTD-treated mice had reduced VGLUT1 expression in striatum and greater excitability of D2 neurons. These findings suggest that reversing aberrant corticostriatal synaptic plasticity in the indirect pathway may lead to persistent relief of PD motor symptoms.

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Deep Brain Stimulation Impedance Decreases Over Time Even When Stimulation Settings Are Held Constant

Cited by 15 publications

References 15 publications

The SANTÉ study at 10 years of follow‐up: Effectiveness, safety, and sudden unexpected death in epilepsy

The SANTÉ study at 10 years of follow‐up: Effectiveness, safety, and sudden unexpected death in epilepsy

Impedance Characteristics of Stimulation Contacts in Deep Brain Stimulation of the Anterior Nucleus of the Thalamus and Its Relationship to Seizure Outcome in Patients With Refractory Epilepsy

Persistent Relief of Motor Symptoms in a Parkinsonian Mouse Model After Induction of LTD at Cortical Inputs to Indirect Pathway Striatal Neurons

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