Programming Deep Brain Stimulation for Tremor and Dystonia: The Toronto Western Hospital Algorithms

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

doi:10.1016/j.brs.2016.02.003

Cited by 88 publications

(82 citation statements)

References 112 publications

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“…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%

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

Kern

Picillo

Thompson

et al. 2018

Stereotact Funct Neurosurg

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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.

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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

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“…Bilateral DBS (or DBS contralateral to another ablative treatment previously done) is not risk-free with respect to ataxia symptoms; however, these are usually reversible with further adjustments of stimulating parameters 44. Recently, prolonged bilateral Vim-DBS has been linked to a delayed pseudo-progressive ataxia syndrome that can be reverted by turning stimulation off for several days 45…”

Section: Mrgfus-thalamotomy Compared To Other Surgical Modalitiesmentioning

confidence: 99%

Focused Ultrasound for Essential Tremor: Review of the Evidence and Discussion of Current Hurdles

Rohani

Fasano

2017

Tremor and Other Hyperkinetic Movements

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“…Clinically, optimization of the DBS settings by the neurologist routinely starts with the monopolar mode, due to its higher efficacy and longer battery life. [14][15][16][17][18] In some cases, due to undesired adverse effects (caused by the volume of tissue activated [VTA] extending beyond its intended region), a bipolar stimulation pattern is ultimately chosen. 16 Of all the patients with DBS implants, and depending on the programming practices at each center, the percentage of monopolar and bipolar varies from 94%/6% 19 to 55%/45%.…”

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confidence: 99%

On the (Non‐)equivalency of monopolar and bipolar settings for deep brain stimulation fMRI studies of Parkinson's disease patients

Hancu

Boutet

Fiveland

et al. 2018

Magnetic Resonance Imaging

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Background The majority of Parkinson's disease patients with deep brain stimulation (DBS) use a monopolar configuration, which presents challenges for EEG and MRI studies. The literature reports algorithms to convert monopolar to bipolar settings. Purpose/Hypothesis To assess brain responses of Parkinson's disease patients implanted with DBS during fMRI studies using their clinical and presumed equivalent settings using a published conversion recipe. Study Type Prospective. Subjects Thirteen DBS patients. Field Strength/Sequence 1.5T and 3T, fMRI using gradient echo‐planar imaging. Assessment Patients underwent 30/30sec ON/OFF DBS fMRI scans using monopolar and bipolar settings. To convert to a bipolar setting, the negative contact used for the monopolar configuration remained constant and the adjacent dorsal contact was rendered positive, while increasing the voltage by 30%. fMRI activation/deactivation maps and motor Unified Parkinson's Disease Rating Scale (UPDRS‐III) scores were compared for patients in both configurations. Statistical Tests T‐tests were used to compare UPDRS scores and volumes of tissue activated (VTA) diameters in monopolar and bipolar configurations. Results The patterns of fMRI activation in the monopolar and bipolar configurations were generally different. The thalamus, pallidum, and visual cortices exhibited higher activation using the patient's clinical settings than the presumed equivalent settings. VTA diameters were lower (7 mm vs. 6.3 mm, P = 0.047) and UPDRS scores were generally higher in the bipolar (33.2 ± 16) than in the monopolar configuration (28.3 ± 17.4), without reaching statistical significance (P > 0.05). Data Conclusion Monopolar and bipolar configurations result in different patterns of brain activation while using a previously published monopolar–bipolar conversion algorithm. Clinical benefits may be achieved with varying patterns of brain responses. Blind conversion from one to the other should be avoided for purposes of understanding the mechanisms of DBS. Level of Evidence: 1 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2018.

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Programming Deep Brain Stimulation for Tremor and Dystonia: The Toronto Western Hospital Algorithms

Cited by 88 publications

References 112 publications

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

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

Focused Ultrasound for Essential Tremor: Review of the Evidence and Discussion of Current Hurdles

On the (Non‐)equivalency of monopolar and bipolar settings for deep brain stimulation fMRI studies of Parkinson's disease patients

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