Effect of stimulation frequency on tremor suppression in essential tremor

Ushe, Mwiza; Mink, Jonathan W.; Revilla, Fredy J.; Wernle, Angie R.; Gibson, P. Schneider; McGee‐Minnich, Lori; Hong, Minna; Rich, Keith M.; Lyons, Kelly E.; Pahwa, Rajesh; Perlmutter, Joel S.

doi:10.1002/mds.20231

Cited by 59 publications

(46 citation statements)

References 17 publications

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“…Reduction of the frequency setting to 130 Hz, as supported by our results and previous work on postural tremor, could extend expected battery life by approximately 30% for these individuals (Ushe et al 2004(Ushe et al , 2006. This would lead to fewer pulse generator replacements, thereby reducing medical costs and patient risk.…”

Section: Discussionsupporting

confidence: 78%

“…In our clinical practice, we typically set stimulator frequency at 185 Hz, while adjusting voltage and pulse width to optimize tremor control. We have previously described that using 185 Hz stimulation frequency may not be necessary since postural tremor improves incrementally with stimulation frequencies up to 100 Hz, and frequencies above 100 Hz appear to confer little additional suppression of postural tremor for most people (Ushe et al 2004(Ushe et al , 2006. However, the effects of stimulation frequency on the intention tremor component of ET have yet to be determined.…”

Section: Introductionmentioning

confidence: 99%

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Effects of thalamic stimulation frequency on intention and postural tremor

Earhart

Hong

Tabbal

et al. 2007

Experimental Neurology

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Deep brain stimulation (DBS) of the ventral intermediate nucleus (VIM) of the thalamus improves essential tremor. Suppression of the amplitude of the postural tremor component with VIM DBS depends on stimulation frequency. The purpose of this study is to determine the effect of DBS frequency on the intention tremor component, i.e. tremor that is enhanced by target-directed movement, and to compare it to the effect of DBS frequency on postural tremor in people with essential tremor. We measured tremor frequency and amplitude during trials of postural holding and voluntary reaching between two targets at 10 different stimulation frequency settings between 0 and 185 Hz. Tremor frequency did not change with changes in stimulation frequency. Amplitude suppression of both intention and postural tremor depended on stimulation frequency. Maximal tremor reduction occurred at approximately 130 Hz for both forms of tremor. However, at optimal frequencies the percent reduction in tremor amplitude relative to the DBS OFF condition was greater for postural than for intention tremor. These results suggest that VIM DBS stimulation frequencies near 130Hz may provide maximal control of intention and postural tremor. Identification of optimal stimulation settings should consider assessment of intention tremor not just postural tremor, as intention tremor may not be as well controlled as postural tremor but may be a better gauge for functional benefit.

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Section: Discussionsupporting

confidence: 78%

Section: Introductionmentioning

confidence: 99%

Effects of thalamic stimulation frequency on intention and postural tremor

Earhart

Hong

Tabbal

et al. 2007

Experimental Neurology

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“…59 High-frequency (Ͼ70 Hz) STN DBS reduced pallidal beta oscillations (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30) in PD subjects in a manner similar to the administration of dopamine precursors, whereas 25 Hz DBS increased the power of pallidal beta oscillations. 60 In addition, high-frequency STN DBS at 130 Hz or 185 Hz attenuated STN beta oscillations in subjects with PD during the period just after DBS was turned off.…”

Section: Changes In Neuronal Firing During Dbsmentioning

confidence: 99%

Mechanisms of Deep Brain Stimulation in Movement Disorders as Revealed by Changes in Stimulus Frequency

2008

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Summary: Deep brain stimulation (DBS) is an established treatment for symptoms in movement disorders and is under investigation for symptom management in persons with psychiatric disorders and epilepsy. Nevertheless, there remains disagreement regarding the physiological mechanisms responsible for the actions of DBS, and this lack of understanding impedes both the design of DBS systems for treating novel diseases and the effective tuning of current DBS systems. Currently available data indicate that effective DBS overrides pathological bursts, low frequency oscillations, synchronization, and disrupted firing patterns present in movement disorders, and replaces them with more regularized firing. Although it is likely that the specific mechanism(s) by which DBS exerts its effects varies between diseases and target nuclei, the overriding of pathological activity appears to be ubiquitous. This review provides an overview of changes in motor symptoms with changes in DBS frequency and highlights parallels between the changes in motor symptoms and the changes in cellular activity that appear to underlie the motor symptoms.

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“…DBS typically uses regular high-frequency stimulation with constant interpulse intervals, but we measured the effects of high-frequency paired-pulse stimulation (nonconstant interpulse intervals) on tremor. We chose to examine subjects with essential tremor and Vim DBS because of the well-established and short latency of therapeutic tremor reduction (Benabid et al 1991;Lyons and Pahwa 2004;Ushe et al 2004).Second, what are the stimulus-dependent changes in neuronal firing that may underlie the observed changes in tremor during Vim DBS? To address this question, we used a computer-based biophysical model of thalamocortical relay neurons to simulate the response of Vim thalamic neurons to paired-pulse stimulation.…”

mentioning

confidence: 99%

Pulse-to-Pulse Changes in the Frequency of Deep Brain Stimulation Affect Tremor and Modeled Neuronal Activity

Birdno

Cooper²,

Rezai

et al. 2007

Journal of Neurophysiology

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Birdno MJ, Cooper SE, Rezai AR, Grill WM. Pulse-to-pulse changes in the frequency of deep brain stimulation affect tremor and modeled neuronal activity. J Neurophysiol 98: [1675][1676][1677][1678][1679][1680][1681][1682][1683][1684] 2007. First published July 18, 2007; doi:10.1152/jn.00547.2007. The effectiveness of deep brain stimulation (DBS) in relieving the symptoms of movement disorders is dependent on the average frequency of stimulation. However, no one has yet examined whether the effectiveness of DBS in relieving tremor is dependent on the pulse-to-pulse (instantaneous) frequency of DBS. We examined the effects of pairedpulse thalamic DBS on tremor in subjects with essential tremor and on the firing of model neurons in a biophysically based computational model of DBS. DBS with an average rate of 130 Hz was more effective at reducing tremor when pulses were evenly spaced than when there were large differences between intrapair and interpair pulse intervals. Similar correlations were observed in the firing patterns of model neurons: increasing the difference between the intrapair and interpair intervals rendered model neurons more likely to fire synchronous bursts, more likely to fire irregularly, and less likely to entrain to the stimulus. The tremor responses provide evidence that the pulse-to-pulse frequency of DBS, not just its average rate, plays an important role in DBS function. Modeling results also suggest that effective DBS overrides oscillatory pathological activity and replaces it with more regularized neuronal firing patterns. I N T R O D U C T I O NChronic high-frequency stimulation of the brain, or deep brain stimulation (DBS), is an effective treatment for motor symptoms in Parkinson's disease, dystonia, and essential tremor (Benabid et al. 1991;Gross and Lozano 2000;Schuurman et al. 2000). DBS is also being investigated for treatment of epilepsy (Goodman 2004;Hodaie et al. 2002) and psychiatric disorders (Gross 2004), including obsessive-compulsive disorder (Nuttin et al. 2003) and depression (Carpenter 2006;Mayberg et al. 2005). Despite the clinical success of DBS, the underlying physiological mechanisms of action are unclear (Breit et al. 2004;Garcia et al. 2005;Grill and McIntyre 2001;McIntyre et al. 2004b). This lack of knowledge may limit the application of DBS for treating novel diseases; it also complicates the identification of optimal anatomical targets and the selection of appropriate stimulation parameters. The purposes of this investigation were to quantify the effects of paired-pulse DBS on tremor in subjects with essential tremor and to provide insight into the mechanisms responsible for these effects by analysis with a computational model.The effects of frequency of DBS within the ventral intermediate nucleus of the thalamus (Vim) on tremor in essential tremor subjects are well documented. Reductions in tremor are typically observed only when the frequency of stimulation is Ͼ90 Hz; conversely, low-frequency DBS (Ͻ50 Hz) often worsens symptoms (Benabid et al. 1991;Kuncel et ...

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Effect of stimulation frequency on tremor suppression in essential tremor

Cited by 59 publications

References 17 publications

Effects of thalamic stimulation frequency on intention and postural tremor

Effects of thalamic stimulation frequency on intention and postural tremor

Mechanisms of Deep Brain Stimulation in Movement Disorders as Revealed by Changes in Stimulus Frequency

Pulse-to-Pulse Changes in the Frequency of Deep Brain Stimulation Affect Tremor and Modeled Neuronal Activity

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