The Effect of Short Pulse Width Settings on the Therapeutic Window in Subthalamic Nucleus Deep Brain Stimulation for Parkinson’s disease

Dayal, Viswas; Grover, Timothy; Limousin, Patricia; Akram, Harith; Cappon, Davide; Candelario, Joseph; Salazar, Maricel; Tripoliti, Elina; Zrinzo, Ludvic; Hyam, Jonathan A.; Jahanshahi, Marjan; Hariz, Marwan; Foltynie, Thomas

doi:10.3233/jpd-171272

Cited by 32 publications

(42 citation statements)

References 21 publications

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“…We also did not note any differences in motor assessments, nonmotor symptoms, or quality‐of‐life measures after 4 weeks of treatment using short PW stimulation. The therapeutic window during the monopolar review was significantly greater at 30‐μs compared with 60‐μs, consistent with the findings of previous studies …”

Section: Discussionmentioning

confidence: 99%

“…The therapeutic window during the monopolar review was significantly greater at 30-μs compared with 60-μs, consistent with the findings of previous studies. [16][17][18][19] Although the acute effect of short PW on the therapeutic window has been well documented, our trial is the first to examine short PW stimulation in STN-DBS beyond the setting of an acute challenge. The study was not designed to assess efficacy; however, our data suggest that using a PW of 30-μs has a sustained therapeutic effect similar to 60-μs PW at 4 weeks' duration.…”

Section: Discussionmentioning

confidence: 99%

“…Although 60‐μs has been the recommended PW for STN stimulation based on the finding of having the widest therapeutic window in the conventional parameter range, some newer devices have expanded the available range by enabling the use of shorter PWs. Multiple recent studies have confirmed the expected increase in therapeutic window (measured in terms of current amplitude) by the use of shorter than conventional PW in the acute setting . A proposed mechanism by which altering PW may reduce side effects is the notion of fiber selectivity and avoiding the stimulation of neural elements that mediate unwanted effects.…”

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confidence: 99%

“…Multiple recent studies have confirmed the expected increase in therapeutic window (measured in terms of current amplitude) by the use of shorter than conventional PW in the acute setting. [16][17][18][19] A proposed mechanism by which altering PW may reduce side effects is the notion of fiber selectivity and avoiding the stimulation of neural elements that mediate unwanted effects. There is growing evidence for the utility of short PW stimulation of thalamic targets in patients with tremor who experience stimulation induced ataxia.…”

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Short Versus Conventional Pulse‐Width Deep Brain Stimulation in Parkinson's Disease: A Randomized Crossover Comparison

et al. 2019

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Background Subthalamic nucleus deep brain stimulation (STN‐DBS) is an effective therapy for selected Parkinson's disease patients with motor fluctuations, but can adversely affect speech and axial symptoms. The use of short pulse width (PW) has been shown to expand the therapeutic window acutely, but its utility in reducing side effects in chronic STN‐DBS patients has not been evaluated. Objective To compare the effect of short PW settings using 30‐μs with conventional 60‐μs settings on stimulation‐induced dysarthria in Parkinson's disease patients with previously implanted STN‐DBS systems. Methods In this single‐center, double‐blind, randomized crossover trial, we assigned 16 Parkinson's disease patients who had been on STN‐DBS for a mean of 6.5 years and exhibited moderate dysarthria to 30‐μs or 60‐μs settings for 4 weeks followed by the alternative PW setting for a further 4 weeks. The primary outcome was difference in dysarthric speech measured by the Sentence Intelligibility Test between study baseline and the 2 PW conditions. Secondary outcomes included motor, nonmotor, and quality of life measures. Results There was no difference in the Sentence Intelligibility Test scores between baseline and the 2 treatment conditions (P = 0.25). There were also no differences noted in motor, nonmotor, or quality of life scores. The 30‐μs settings were well tolerated, and adverse event rates were similar to those at conventional PW settings. Post hoc analysis indicated that patients with dysarthria and a shorter duration of DBS may be improved by short PW stimulation. Conclusions Short PW settings using 30 μs did not alter dysarthric speech in chronic STN‐DBS patients. A future study should evaluate whether patients with shorter duration of DBS may be helped by short PW settings. © 2019 International Parkinson and Movement Disorder Society

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Short Versus Conventional Pulse‐Width Deep Brain Stimulation in Parkinson's Disease: A Randomized Crossover Comparison

et al. 2019

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“…Despite the unconventionally high amplitudes eventually used with 30µs settings, the charge per pulse of stimulation is not greater than that of the original settings, and the high amplitudes in terms of current are reflective of relatively low impedances (although still within the normal range), and the short pulse duration [7]. The published data on short pulse stimulation suggest when converting from 60µs settings, multiplying the amplitude by a factor of 1.5 can be used to estimate the amplitude required for the same therapeutic effect at 30µs [8][9][10]. However, as illustrated in this case, some patients may require higher amplitudes at 30µs, and double the amplitude at 60µs results in an equivalent charge when using 30µs settings.…”

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Subthalamic Nucleus Deep Brain Stimulation in Parkinson’s Disease: Valuable Programming Insights from Anecdotal Observations

Dayal

Akram

Zrinzo

et al. 2020

Stereotact Funct Neurosurg

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Spatial and amplitude dynamics of neurostimulation: Insights from the acute intrahippocampal kainate seizure mouse model

Foutz,

Rensing,

Han

et al. 2023

Epilepsia Open

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ObjectiveNeurostimulation is an emerging treatment for patients with drug‐resistant epilepsy, which is used to suppress, prevent, and terminate seizure activity. Unfortunately, after implantation and despite best clinical practice, most patients continue to have persistent seizures even after years of empirical optimization. The objective of this study is to determine optimal spatial and amplitude properties of neurostimulation in inhibiting epileptiform activity in an acute hippocampal seizure model.MethodsWe performed high‐throughput testing of high‐frequency focal brain stimulation in the acute intrahippocampal kainic acid mouse model of status epilepticus. We evaluated combinations of six anatomic targets and three stimulus amplitudes.ResultsWe found that the spike‐suppressive effects of high‐frequency neurostimulation are highly dependent on the stimulation amplitude and location, with higher amplitude stimulation being significantly more effective. Epileptiform spiking activity was significantly reduced with ipsilateral 250 μA stimulation of the CA1 and CA3 hippocampal regions with 21.5% and 22.2% reductions, respectively. In contrast, we found that spiking frequency and amplitude significantly increased with stimulation of the ventral hippocampal commissure. We further found spatial differences with broader effects from CA1 versus CA3 stimulation.SignificanceThese findings demonstrate that the effects of therapeutic neurostimulation in an acute hippocampal seizure model are highly dependent on the location of stimulation and stimulus amplitude. We provide a platform to optimize the anti‐seizure effects of neurostimulation, and demonstrate that an exploration of the large electrical parameter and location space can improve current modalities for treating epilepsy.Plain Language SummaryIn this study, we tested how electrical pulses in the brain can help control seizures in mice. We found that the electrode's placement and the stimulation amplitude had a large effect on outcomes. Some brain regions, notably nearby CA1 and CA3, responded positively with reduced seizure‐like activities, while others showed increased activity. These findings emphasize that choosing the right spot for the electrode and adjusting the strength of electrical pulses are both crucial when considering neurostimulation treatments for epilepsy.

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The Effect of Short Pulse Width Settings on the Therapeutic Window in Subthalamic Nucleus Deep Brain Stimulation for Parkinson’s disease

Cited by 32 publications

References 21 publications

Short Versus Conventional Pulse‐Width Deep Brain Stimulation in Parkinson's Disease: A Randomized Crossover Comparison

Short Versus Conventional Pulse‐Width Deep Brain Stimulation in Parkinson's Disease: A Randomized Crossover Comparison

Subthalamic Nucleus Deep Brain Stimulation in Parkinson’s Disease: Valuable Programming Insights from Anecdotal Observations

Spatial and amplitude dynamics of neurostimulation: Insights from the acute intrahippocampal kainate seizure mouse model

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