Programming Deep Brain Stimulation for Parkinson's Disease: The Toronto Western Hospital Algorithms

Picillo, Marina; Lozano, Andrés M.; Kou, Nancy; Munhoz, Renato P.; Fasano, Alfonso

doi:10.1016/j.brs.2016.02.004

Cited by 171 publications

(171 citation statements)

References 104 publications

Supporting

Mentioning

166

Contrasting

Unclassified

Order By: Relevance

“…As is the standard at our center, all of the patients were initially treated with monopolar stimulation [3, 4]. Unwanted adverse effects or unsatisfying clinical benefits of DBS were then managed by adjusting stimulation parameters as well as changing contacts and attempting bipolar stimulation.…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Interleaving Stimulation in Parkinson’s Disease, Tremor, and Dystonia

Kern

Picillo

Thompson

et al. 2018

Stereotact Funct Neurosurg

Self Cite

View full text Add to dashboard Cite

Background/Aims: Interleaving stimulation (ILS) in deep brain stimulation (DBS) provides individualized stimulation of 2 contacts delivered in alternating order. Currently, limited information on the utility of ILS exists. The aims of this study were to determine the practical applications and outcomes of ILS DBS in Parkinson’s disease (PD), tremor, and dystonia. Methods: We performed a single-center, unblinded, retrospective chart review of all patients with DBS attempted on ILS at our referral center assessing for rationale and outcomes. Results: Fifty patients (PD, n = 27; tremor, n = 7; dystonia, n = 16 patients) tried ILS for 2 rationales: management of adverse effects (n = 29) and to improve clinical efficacy (n = 21). A total of 19 patients demonstrated improvement with ILS for adverse effect management predominately for the treatment of dyskinesias (n = 12). In the vast majority of dyskinetic patients, a contact added into the rostral zona incerta with ILS was performed. Nine out of 21 patients demonstrated improved clinical efficacy with ILS with all 6 PD patients who tried ILS for this rationale demonstrating benefit. Conclusions: In PD, ILS provided benefits for dyskinesias and parkinsonism, with minimal improvement of other adverse effects. In tremor and dystonia, marginal effects in terms of mitigation of adverse effects and improvement of clinical outcomes were evident.

show abstract

Section: Methodsmentioning

confidence: 99%

“…An advantage of DBS is that the volume of activated tissue (VAT) can be adjusted through several parameters including contact configuration, frequency, pulse width, and voltage/current. Despite optimal DBS programming, suboptimal benefits and stimulation-induced adverse effects may occur [3, 4]. …”

Section: Introductionmentioning

confidence: 99%

Interleaving Stimulation in Parkinson’s Disease, Tremor, and Dystonia

Kern

Picillo

Thompson

et al. 2018

Stereotact Funct Neurosurg

Self Cite

View full text Add to dashboard Cite

show abstract

“…DBS is effective for control of tremors that are refractory to dopaminergic medications, motor fluctuations, and levodopa induced dyskinesia that are bothersome to patients. The success of DBS is dependent on many factors including selection of appropriate patients, accurate placement of DBS lead, and a thorough programming process to identify the optimal stimulation parameters [3]. Selection of appropriate patients is based on many factors including the age of the patient, disease stage, disease duration, comorbidities, and responsiveness to levodopa medication.…”

Section: Introductionmentioning

confidence: 99%

DBS Programming: An Evolving Approach for Patients with Parkinson’s Disease

Shukla

Zeilman

Fernández

et al. 2017

Parkinson's Disease

View full text Add to dashboard Cite

Deep brain stimulation (DBS) surgery is a well-established therapy for control of motor symptoms in Parkinson's disease. Despite an appropriate targeting and an accurate placement of DBS lead, a thorough and efficient programming is critical for a successful clinical outcome. DBS programming is a time consuming and laborious manual process. The current approach involves use of general guidelines involving determination of the lead type, electrode configuration, impedance check, and battery check. However there are no validated and well-established programming protocols. In this review, we will discuss the current practice and the recent advances in DBS programming including the use of interleaving, fractionated current, directional steering of current, and the use of novel DBS pulses. These technological improvements are focused on achieving a more efficient control of clinical symptoms with the least possible side effects. Other promising advances include the introduction of computer guided programming which will likely impact the efficiency of programming for the clinicians and the possibility of remote Internet based programming which will improve access to DBS care for the patients.

show abstract

“…Their roles vary from center to center and are not formally established in guidelines, but should cover essential aspects including the adequate selection of candidates for surgery, arrangement and performance of all preoperative assessments and the surgery per se, immediate postoperative (including initial programming) and long-term care and device management 53,54 . We argue that the special dedication to these functions minimizes treatment failures and optimizes care for long-term troubleshooting 55 . Also, the existence of this group of professionals and their interaction is only possible in a center with a special interest, commitment and expertise in these surgical techniques.…”

Section: What Are the Purposes And Benefits Of The Multidisciplinarymentioning

confidence: 99%

“…It is generally accepted that GPi DBS has a direct effect on dyskinesia reduction, while STN DBS may have a similar but indirect effect, dependent on the reduction of the total dopaminergic medication daily dosing (Figure). Also, in general, GPi DBS is not rewarded by significant medication reduction but allows flexibility in the medication regimen 55 . Most of the motor improvement is expected for non-axial signs and symptoms, with attenuation of motor fluctuations.…”

Section: Selection Of the Surgical Targetmentioning

confidence: 99%

Decisions about deep brain stimulation therapy in Parkinson’s disease

Brandão

Grippe²,

Modesto³

et al. 2018

Arq. Neuro-Psiquiatr.

View full text Add to dashboard Cite

Parkinson' s disease (PD), a hypokinetic movement disorder characterized by the classic tetrad of bradykinesia, rest tremor, plastic rigidity, and postural disturbances 1,2 , is a neurodegenerative disorder with an increasing impact on the Brazilian social and healthcare system, mirroring known demographic-epidemiological changes such as aging of the population and widening of the apex of the age pyramid 3,4 . Considering a prevalence of 3.3% in those aged 65 or older in the Brazilian population 5 , the country has at least 200,000 patients living with the disorder, a definitive challenge to the public health system. ABSTRACTParkinson's disease can be treated surgically in patients who present with motor complications such as fluctuations and dyskinesias, or medically-refractory disabling tremor. In this review, a group of specialists formulated suggestions for a preoperative evaluation protocol after reviewing the literature published up to October 2017. In this protocol, eligibility and ineligibility criteria for surgical treatment were suggested, as well as procedures that should be carried out before the multidisciplinary therapeutic decisions. The review emphasizes the need to establish "DBS teams", with professionals dedicated specifically to this area. Finally, surgical target selection (subthalamic nucleus or globus pallidus internus) is discussed briefly, weighing the pros and cons of each target.Keywords: Parkinson disease; deep brain stimulation; reference standards; basal ganglia; neurosurgical procedures. RESUMOA doença de Parkinson pode ser tratada cirurgicamente em pacientes que desenvolveram complicações motoras, como flutuações e discinesias, ou tremores refratários ao uso de medicação. Nesta revisão, um grupo de especialistas formulou sugestões para um protocolo de avaliação pré-operatória, depois de revisar a literatura publicada até outubro de 2017. Neste protocolo, são sugeridos critérios de elegibilidade e inadmissibilidade para tratamento cirúrgico, bem como procedimentos que devem ser realizados antes das decisões terapêuticas multidisciplinares. A revisão enfatiza a necessidade de estabelecer "equipes de DBS", com profissionais dedicados especialmente a esta área. Ao final, a seleção do alvo cirúrgico (núcleo subtalâmico ou globo pálido interno) é discutida brevemente, ponderando prós e contras de cada escolha.Palavras-chave: doença de Parkinson; estimulação cerebral profunda; padrões de referência; gânglios da base; procedimentos neurocirúrgicos.

show abstract

Programming Deep Brain Stimulation for Parkinson's Disease: The Toronto Western Hospital Algorithms

Cited by 171 publications

References 104 publications

Interleaving Stimulation in Parkinson’s Disease, Tremor, and Dystonia

Interleaving Stimulation in Parkinson’s Disease, Tremor, and Dystonia

DBS Programming: An Evolving Approach for Patients with Parkinson’s Disease

Decisions about deep brain stimulation therapy in Parkinson’s disease

Contact Info

Product

Resources

About