Pulse duration settings in subthalamic stimulation for Parkinson's disease

Abstract

BackgroundStimulation parameters in deep brain stimulation (DBS) of the subthalamic nucleus for Parkinson's disease (PD) are rarely tested in double‐blind conditions. Evidence‐based recommendations on optimal stimulator settings are needed. Results from the CUSTOM‐DBS study are reported, comparing 2 pulse durations.MethodsA total of 15 patients were programmed using a pulse width of 30 µs (test) or 60 µs (control). Efficacy and side‐effect thresholds and unified PD rating scale (UPDRS) III were measured in meds‐off (primary outcome). The therapeutic window was the difference between patients’ efficacy and side effect thresholds.ResultsThe therapeutic window was significantly larger at 30 µs than 60 µs (P = ·0009) and the efficacy (UPDRS III score) was noninferior (P = .00008).InterpretationSubthalamic neurostimulation at 30 µs versus 60 µs pulse width is equally effective on PD motor signs, is more energy efficient, and has less likelihood of stimulation‐related side effects. © 2017 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.

Short Versus Conventional Pulse‐Width Deep Brain Stimulation in Parkinson's Disease: A Randomized Crossover Comparison

“…We also did not note any differences in motor assessments, nonmotor symptoms, or quality‐of‐life measures after 4 weeks of treatment using short PW stimulation. The therapeutic window during the monopolar review was significantly greater at 30‐μs compared with 60‐μs, consistent with the findings of previous studies …”

“…A consistent finding across multiple studies and one of the proposed mechanisms by which the therapeutic window is increased by using short PW stimulation is that a lower charge is required to achieve the therapeutic effect when compared with standard PW . Given that stimulation settings tend to be increased over time in chronic patients, it is possible that the reduction in charge at thresholds for therapeutic effect at short PW in these patients is not sufficient to alleviate side effects because of the higher absolute electrical charge delivered.…”

“…Although 60‐μs has been the recommended PW for STN stimulation based on the finding of having the widest therapeutic window in the conventional parameter range, some newer devices have expanded the available range by enabling the use of shorter PWs. Multiple recent studies have confirmed the expected increase in therapeutic window (measured in terms of current amplitude) by the use of shorter than conventional PW in the acute setting . A proposed mechanism by which altering PW may reduce side effects is the notion of fiber selectivity and avoiding the stimulation of neural elements that mediate unwanted effects.…”

An update on adaptive deep brain stimulation in Parkinson's disease

“…Also, pulse‐width modulation might provide clinical benefit in certain situations. By exciting thin axon bundles belonging to the direct cortico‐subthalamic pathway more selectively, therapeutic windows may increase using shorter pulse widths, while using less energy …”

“…By exciting thin axon bundles belonging to the direct cortico-subthalamic pathway more selectively, 92 therapeutic windows may increase using shorter pulse widths, while using less energy. 93,94 Battery Power Balance aDBS may require less battery power for stimulation compared to cDBS. In contrast, more battery power may be needed for data processing and transferal, for example, by Bluetooth.…”