Optimal Parameters of Deep Brain Stimulation in Essential Tremor: A Meta-Analysis and Novel Programming Strategy

Abstract

The programming of deep brain stimulation (DBS) parameters for tremor is laborious and empirical. Despite extensive efforts, the end-result is often suboptimal. One reason for this is the poorly understood relationship between the stimulation parameters’ voltage, pulse width, and frequency. In this study, we aim to improve DBS programming for essential tremor (ET) by exploring a new strategy. At first, the role of the individual DBS parameters in tremor control was characterized using a meta-analysis documenting all the available parameters and tremor outcomes. In our novel programming strategy, we applied 10 random combinations of stimulation parameters in eight ET-DBS patients with suboptimal tremor control. Tremor severity was assessed using accelerometers and immediate and sustained patient-reported outcomes (PRO’s), including the occurrence of side-effects. The meta-analysis showed no substantial relationship between individual DBS parameters and tremor suppression. Nevertheless, with our novel programming strategy, a significantly improved (accelerometer p = 0.02, PRO p = 0.02) and sustained (p = 0.01) tremor suppression compared to baseline was achieved. Less side-effects were encountered compared to baseline. Our pilot data show that with this novel approach, tremor control can be improved in ET patients with suboptimal tremor control on DBS. In addition, this approach proved to have a beneficial effect on stimulation-related complications.

Parkinson’s Disease and Deep Brain Stimulation Have an Impact on My Life: A Multimodal Study on the Experiences of Patients and Family Caregivers

“…However, we have rather observed an improvement in spousal relationships as a result of motor improvement. What was a source of stress for a few couples were some of the side effects of DBS such as impulsivity or depressive episodes, which usually occur in the first few months with DBS and are often resolved by adjusting the stimulation parameters [ 46 , 100 , 101 , 102 ]. Nevertheless, PD symptoms, both motor and non-motor, as well as drug-induced side effects, pose important challenges for the couple’s relationships.…”

Loss of long‐term benefit from VIM‐DBS in essential tremor: A secondary analysis of repeated measurements

“… 22 We divided the follow‐up time points into four groups: 6 months, 7–12 months, 1–3 years, and >4 years. 23 For each period, mean and SD values of the scores were extracted. For studies with no SD reported, we extracted the p value, standard error (SE), and the 95% confidence interval to estimate the SD.…”

“…The TRS scores were collected under two conditions: with stimulation (stim‐on) and without stimulation (stim‐off) 22 . We divided the follow‐up time points into four groups: 6 months, 7–12 months, 1–3 years, and >4 years 23 . For each period, mean and SD values of the scores were extracted.…”

Serendipitous Stimulation of Nucleus Basalis of Meynert—The Effect of Unintentional, Long-Term High-Frequency Stimulation on Cognition in Parkinson’s Disease

“…The use of predefined stimulation parameters might have also played a detrimental role. Although the interaction of stimulation parameters with the stimulation substrate has yet to be elucidated, evidence suggests that DBS-optimization might require broad parameter searches, extending beyond the limits of conventional stimulation parameters (i.e., preset pulse-widths and frequencies) [16]. In line with this, Bergfeld and colleagues underline the importance of first ensuring optimal DBS titration before establishing its effectivity in a randomized clinical trial of DBS for treatment-resistant depression [17].…”