The Rationale Driving the Evolution of Deep Brain Stimulation to Constant-Current Devices

Bronstein, Jeff M.; Tagliati, Michele; McIntyre, Cameron C.; Chen, Robert; Cheung, Tyler; Hargreaves, Eric L.; Israel, Zvi; Moffitt, Michael; Montgomery, Erwin B.; Stypulkowski, Paul H.; Shils, Jay L.; Denison, Timothy; Vitek, Jerrold L.; Volkman, Jens; Wertheimer, Jeffrey; Okun, Michael S.

doi:10.1111/ner.12227

Cited by 78 publications

(62 citation statements)

References 14 publications

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“…All of these devices deliver constant current (Agnew and McCreery 1987; Bronstein et al 2015). Stimulators differ for specific features, like suitability for other stimulation protocols (e.g., tACS, tRNS), programming capabilities, number of channels, size, weight, portability, suitability for magnetic resonance imaging (MRI), and blinding options.…”

Section: Transcranial Direct Current Stimulationmentioning

confidence: 99%

A technical guide to tDCS, and related non-invasive brain stimulation tools

Woods

Antal

Bikson

et al. 2016

Clinical Neurophysiology

1,117

842

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Transcranial electrical stimulation (tES), including transcranial direct and alternating current stimulation (tDCS, tACS) are non-invasive brain stimulation techniques increasingly used for modulation of central nervous system excitability in humans. Here we address methodological issues required for tES application. This review covers technical aspects of tES, as well as applications like exploration of brain physiology, modelling approaches, tES in cognitive neurosciences, and interventional approaches. It aims to help the reader to appropriately design and conduct studies involving these brain stimulation techniques, understand limitations and avoid shortcomings, which might hamper the scientific rigor and potential applications in the clinical domain.

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Section: Transcranial Direct Current Stimulationmentioning

confidence: 99%

A technical guide to tDCS, and related non-invasive brain stimulation tools

Woods

Antal

Bikson

et al. 2016

Clinical Neurophysiology

1,117

842

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“…Such a study was proposed in 2012 in Princeton at a meeting of the Parkinson Alliance with representatives of the DBS industry. It was concluded that the scope and cost of a large-scale study would not be justified [32]. …”

Section: Discussionmentioning

confidence: 99%

Constant Current versus Constant Voltage Subthalamic Nucleus Deep Brain Stimulation in Parkinson's Disease

Noriega

Eitan²,

Marmor³

et al. 2015

Stereotact Funct Neurosurg

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Background: Subthalamic nucleus (STN) deep brain stimulation (DBS) is an established therapy for advanced Parkinson's disease (PD). Motor efficacy and safety have been established for constant voltage (CV) devices and more recently for constant current (CC) devices. CC devices adjust output voltage to provide CC stimulation irrespective of impedance fluctuation, while the current applied by CV stimulation depends on the impedance that may change over time. No study has directly compared the clinical effects of these two stimulation modalities. Objective: To compare the safety and clinical impact of CC STN DBS to CV STN DBS in patients with advanced PD 2 years after surgery. Methods: Patients were eligible for inclusion if they had undergone STN DBS surgery for idiopathic PD, had been implanted with a Medtronic Activa PC and if their stimulation program and medication had been stable for at least 1 year. This single-center trial was designed as a double-blind, randomized, prospective study with crossover after 2 weeks. Motor equivalence of the 2 modalities was confirmed utilizing part III of the Unified Parkinson's Disease Rating Scale (UPDRS). PD diaries and multiple subjective and objective evaluations of quality of life, depression, cognition and emotional processing were evaluated on both CV and on CC stimulation. Analysis using the paired t test with Bonferroni correction for multiple comparisons was performed to identify any significant difference between the stimulation modalities. Results: 8 patients were recruited (6 men, 2 women); 1 patient did not complete the study. The average age at surgery was 56.7 years (range 47-63). Disease duration at the time of surgery was 7.5 years (range 3-12). Patients were recruited 23.8 months (range 22.5-24) after surgery. At the postoperative study baseline, this patient group showed an average motor improvement of 69% (range 51-97) as measured by the change in UPDRS part III with stimulation alone. Levodopa equivalent medication was reduced on average by 67% (range 15-88). Patients were poorly compliant with PD diaries, and these did not yield useful information. The minor deterioration in quality-of-life scores (Parkinson's Disease Questionnaire-39, Quality of Life Enjoyment and Satisfaction Questionnaire) with CC stimulation were not statistically significant. Two measures of depression (Hamilton Rating Scale D17, Quick Inventory of Depressive Symptomatology - Self-Report) showed a nonsignificant lower score (less depression) with CC stimulation, but a third (Beck Depression Inventory) showed equivalence. Cognitive testing (Mini Mental State Examination) and emotional processing (Montreal Affective Voices) were equivalent for CC and CV. Conclusion: CC STN DBS is safe. For equivalent motor efficacy, no significant difference could be identified between CC and CV stimulation for nonmotor evaluations in PD patients 2 years after surgery.

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“…3 mA corresponds to 3 mm [35,37,38]. In vivo studies [9] and a recent review by Bronstein et al [8] suggest the use of current controlled DBS systems based on their low susceptibility to the conductivity of the brain.…”

Section: Operating Modementioning

confidence: 99%

“…Present literature seems to show that current controlled stimulation induces at least as good clinical effects as voltage controlled stimulation [6,7], and that it should be preferred towards voltage controlled devices due to the automatic voltage adjustment as impedance changes [8,9]. Nevertheless, to switch from one mode to the other remains complicated as clinicians risk to lose their reference for programming.…”

Section: Introductionmentioning

confidence: 99%

Influence on Deep Brain Stimulation from Lead Design, Operating Mode and Tissue Impedance Changes ? A Simulation Study

Alonso¹,

Hemm-Ode²,

Wårdell³

2015

Brain Disord Ther

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Background: Deep brain stimulation (DBS) systems in current mode and new lead designs are recently available. To switch between DBS-systems remains complicated as clinicians may lose their reference for programming. Simulations can help increase the understanding.Objective: To quantitatively investigate the electric field (EF) around two lead designs simulated to operate in voltage and current mode under two time points following implantation. Methods:The finite element method was used to model Lead 3389 (Medtronic) and 6148 (St Jude) with homogenous surrounding grey matter and a peri-electrode space (PES) of 250 µm. The PES-impedance mimicked the acute (extracellular fluid) and chronic (fibrous tissue) time-point. Simulations at different amplitudes of voltage and current (n=236) were performed using two different contacts. Equivalent current amplitudes were extracted by matching the shape and maximum EF of the 0.2 V/mm isolevel. Results:The maximum EF extension at 0.2 V/mm varied between 2-5 mm with a small difference between the leads. In voltage mode EF increased about 1 mm at acute compared to the chronic PES. Current mode presented the opposite relationship. Equivalent EFs for lead 3389 at 3 V were found for 7 mA (acute) and 2.2 mA (chronic). Conclusions:Simulations showed a major impact on the electric field extension between postoperative time points. This may explain the clinical decisions to reprogram the amplitude weeks after implantation. Neither the EF extension nor intensity is considerably influenced by the lead design. However, the EF distribution is affected by the larger contact of Lead 6148 generating an electric field below the tip.

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The Rationale Driving the Evolution of Deep Brain Stimulation to Constant-Current Devices

Cited by 78 publications

References 14 publications

A technical guide to tDCS, and related non-invasive brain stimulation tools

A technical guide to tDCS, and related non-invasive brain stimulation tools

Constant Current versus Constant Voltage Subthalamic Nucleus Deep Brain Stimulation in Parkinson's Disease

Influence on Deep Brain Stimulation from Lead Design, Operating Mode and Tissue Impedance Changes ? A Simulation Study

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