Therapeutic Window of Deep Brain Stimulation Using Cathodic Monopolar, Bipolar, Semi-Bipolar, and Anodic Stimulation

Soh, Derrick; Brinke, Timo R. ten; Lozano, Andrés M.; Fasano, Alfonso

doi:10.1111/ner.12957

Cited by 24 publications

(21 citation statements)

References 20 publications

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“…Cathodic and anodic stimulation are believed to differentially affect neural tissue depending on the orientation of the fibers, such that passing fibers are activated by cathodal stimulation and orthogonally oriented fibers are activated by anodic stimulation [ 37 ]. With the recent development of second-generation DBS systems that allow for increased flexibility in stimulation parameters, the effects of anodic stimulation in comparison to cathodal stimulation have been studied [ 38 , 39 ]. Kirsch et al [ 38 ] studied anodic stimulation in 10 PD patients and reported higher side effect thresholds and lower UPDRS III motor scores with anodic stimulation than with cathodic stimulation.…”

Section: Update On Stimulationmentioning

confidence: 99%

“…Kirsch et al [ 38 ] studied anodic stimulation in 10 PD patients and reported higher side effect thresholds and lower UPDRS III motor scores with anodic stimulation than with cathodic stimulation. Another study involving 10 PD patients found an increased therapeutic window and higher side effect threshold with anodic stimulation [ 39 ]. However, anodic stimulation was not able to control tremors in two patients, and anodic stimulation is also known to result in higher battery consumption [ 39 ].…”

Section: Update On Stimulationmentioning

confidence: 99%

“…Another study involving 10 PD patients found an increased therapeutic window and higher side effect threshold with anodic stimulation [ 39 ]. However, anodic stimulation was not able to control tremors in two patients, and anodic stimulation is also known to result in higher battery consumption [ 39 ].…”

Section: Update On Stimulationmentioning

confidence: 99%

“…Based on clinical experience, this configuration is believed to be useful for avoiding stimulation-related side effects. Soh et al [ 39 ] compared the effects of semibipolar stimulation to bipolar, monopolar cathodal and monopolar anodic stimulation in a study group of 10 PD patients. Semibipolar stimulation was found to have a significantly higher side effect threshold than cathodal stimulation; furthermore, semibipolar stimulation was found to have a lower battery consumption than bipolar stimulation [ 39 ].…”

Section: Update On Stimulationmentioning

confidence: 99%

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Update on Current Technologies for Deep Brain Stimulation in Parkinson’s Disease

Paff

Loh

Sarica

et al. 2020

JMD

Self Cite

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Deep brain stimulation (DBS) is becoming increasingly central in the treatment of patients with Parkinson’s disease and other movement disorders. Recent developments in DBS lead and implantable pulse generator design provide increased flexibility for programming, potentially improving the therapeutic benefit of stimulation. Directional DBS leads may increase the therapeutic window of stimulation by providing a means of avoiding current spread to structures that might give rise to stimulation-related side effects. Similarly, control of current to individual contacts on a DBS lead allows for shaping of the electric field produced between multiple active contacts. The following review aims to describe the recent developments in DBS system technology and the features of each commercially available DBS system. The advantages of each system are reviewed, and general considerations for choosing the most appropriate system are discussed.

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Section: Update On Stimulationmentioning

confidence: 99%

Section: Update On Stimulationmentioning

confidence: 99%

Section: Update On Stimulationmentioning

confidence: 99%

Section: Update On Stimulationmentioning

confidence: 99%

See 2 more Smart Citations

Update on Current Technologies for Deep Brain Stimulation in Parkinson’s Disease

Paff

Loh

Sarica

et al. 2020

JMD

Self Cite

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show abstract

“…Importantly, the higher amplitudes necessary for tremor suppression with bipolar (directional) stimulation reduce the energy efficiency of these settings. This has recently been confirmed in a study featuring devices of the same manufacturer . Prolonged or permanent use of (directional) bipolar settings would therefore probably require more frequent recharging (in rechargeable IPGs) or even earlier IPG replacement (in nonrechargeable) IPGs.…”

Section: Discussionmentioning

confidence: 84%

Bipolar Directional Deep Brain Stimulation in Essential and Parkinsonian Tremor

Steffen

Reker

Mennicken

et al. 2020

Neuromodulation: Technology at the Neural Interface

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Objective To compare directional monopolar, bipolar, and directional bipolar thalamic deep brain stimulation (DBS) in tremor patients. Methods Fourteen tremor patients (7 Essential Tremor and 7 Parkinson's Disease) implanted with directional DBS electrodes in the ventral intermediate nucleus (VIM) were enrolled. Side‐effect thresholds of monopolar directional stimulation (DIRECT) were compared to circular DBS as well as, in a randomized design, to those of two different bipolar stimulation settings (BIPOLAR = circular anode; BI‐DIRECT = directional anode). Tremor suppression (Tremor Rating Scale, TRS) right below the side‐effect threshold was also assessed. Results Directional DBS in the individually best direction showed higher side‐effect thresholds than circular DBS (p = 0.0063). The thresholds were raised further using either one of the bipolar stimulation paradigms (BIPOLAR p = 0.0029, BI‐DIRECT p = 0.0022). The side‐effect thresholds did not differ between both bipolar settings, but side‐effects were less frequent with BI‐DIRECT. No difference in TRS scores with stimulation just below the side‐effect threshold was found between all stimulation conditions. Conclusions Side‐effect thresholds of monopolar directional and bipolar stimulation with both circular and directional anodes were higher compared to traditional monopolar circular stimulation in the VIM. Bipolar DBS with directional anodes evoked side‐effect less frequently than bipolar and monopolar directional stimulation. All stimulation settings had comparable effects on tremor suppression just below their side‐effect thresholds. Thus, directional and different bipolar settings should be explored in patients with bothersome side‐effects of thalamic stimulation when monopolar stimulation settings are not satisfying. Further studies are needed to explore the efficiency of the different bipolar stimulation paradigms.

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Deep Brain Stimulation for Tremor

Avantaggiato,

Isaias

2023

Contemporary Clinical Neuroscience

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Therapeutic Window of Deep Brain Stimulation Using Cathodic Monopolar, Bipolar, Semi-Bipolar, and Anodic Stimulation

Cited by 24 publications

References 20 publications

Update on Current Technologies for Deep Brain Stimulation in Parkinson’s Disease

Update on Current Technologies for Deep Brain Stimulation in Parkinson’s Disease

Bipolar Directional Deep Brain Stimulation in Essential and Parkinsonian Tremor

Deep Brain Stimulation for Tremor

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