Reply to comment on: Short pulse width widens the therapeutic window of subthalamic neurostimulation

Reich, Martin M.; Volkmann, Jens

doi:10.1002/acn3.252

Cited by 4 publications

(3 citation statements)

References 2 publications

(2 reference statements)

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“…However, analysis of data from Reich et al shows that the ratio between the minimum and maximum amplitudes in the therapeutic window did not significantly change over pulse widths from 20 to 120 ms 3 . While amplitude is the simplest way to define therapeutic window [30], we believe that it could be misleading to define therapeutic window on one programming variable whose effects can be countered by accommodations of other programming variables (i.e. amplitude and pulse width).…”

Section: Pulse Width and Therapeutic Windowmentioning

confidence: 99%

Neural selectivity, efficiency, and dose equivalence in deep brain stimulation through pulse width tuning and segmented electrodes

Anderson

Pulst

et al. 2020

Brain Stimulation

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Background: Achieving deep brain stimulation (DBS) dose equivalence is challenging, especially with pulse width tuning and directional contacts. Further, the precise effects of pulse width tuning are unknown, and recent reports of the effects of pulse width tuning on neural selectivity are at odds with classic biophysical studies. Methods: We created multicompartment neuron models for two axon diameters and used finite element modeling to determine extracellular influence from standard and segmented electrodes. We analyzed axon activation profiles and calculated volumes of tissue activated. Results: We find that long pulse widths focus the stimulation effect on small, nearby fibers, suppressing distant white matter tract activation (responsible for some DBS side effects) and improving battery utilization when equivalent activation is maintained for small axons. Directional leads enable similar benefits to a greater degree. Reexamining previous reports of short pulse stimulation reducing side effects, we explore a possible alternate explanation: non-dose equivalent stimulation may have resulted in reduced spread of neural activation. Finally, using internal capsule avoidance as an example in the context of subthalamic stimulation, we present a patient-specific model to show how long pulse widths could help increase the biophysical therapeutic window. Discussion: We find agreement with classic studies and predict that long pulse widths may focus the stimulation effect on small, nearby fibers and improve power consumption. While future pre-clinical and clinical work is necessary regarding pulse width tuning, it is clear that future studies must ensure dose equivalence, noting that energy-and charge-equivalent amplitudes do not result in equivalent spread of neural activation when changing pulse width.

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Section: Pulse Width and Therapeutic Windowmentioning

confidence: 99%

Neural selectivity, efficiency, and dose equivalence in deep brain stimulation through pulse width tuning and segmented electrodes

Anderson

Pulst

et al. 2020

Brain Stimulation

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show abstract

“…Directly comparing DBS paradigms remains difficult and concepts such as TW are somewhat artificial. While it is tempting to only consider TW defined as difference in amplitude between therapeutic and side effect threshold, as amplitude is a tangible stimulation parameter [43], this TW definition comes with important limitations [10,41]. Due to the laws of physics and physiology there is no other possibility than that spDBS leads to an increased TW defined as a difference in stimulation amplitudes.…”

Section: Limitations Of Using Therapeutic Windowmentioning

confidence: 99%

Deep brain stimulation with short versus conventional pulse width in Parkinson's disease and essential tremor: A systematic review and meta-analysis

Smeets,

Boogers,

Van Bogaert

et al. 2024

Brain Stimulation

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“…However, Reich's data shows that the ratio between the minimum and maximum amplitudes in the therapeutic window did not significantly change over pulse widths from 20 to 120 µs 2 , and our results show that longer pulse widths can substantially change this ratio. While amplitude is the simplest way to define therapeutic window 19 , we believe that the field could be misled by continuing to strictly define the therapeutic window on one programming variable whose effects can be countered by accommodations of other programming variables (i.e. amplitude and pulse width).…”

Section: Pulse Width and Therapeutic Windowmentioning

confidence: 99%

Neural Selectivity, Efficiency, and Dose Equivalence in Deep Brain Stimulation through Pulse Width Tuning and Segmented Electrodes

Anderson

Pulst

et al. 2019

Preprint

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AbstractBackgroundAchieving deep brain stimulation (DBS) dose equivalence is challenging, especially with pulse width tuning and directional contacts. Further, the precise effects of pulse width tuning are unknown.MethodsWe created multicompartment neuron models for two axon diameters and used finite element modeling to determine extracellular influence from standard and segmented electrodes. We analyzed axon activation profiles and calculated volumes of tissue activated.ResultsLong pulse widths focus the stimulation effect on small, nearby fibers, suppressing white matter tract activation (responsible for some DBS side effects) and improving battery utilization. Directional leads enable similar benefits to a greater degree. We derive equations for equivalent activation with pulse width tuning and segmented contacts.InterpretationsWe find agreement with classic studies and reinterpret recent articles concluding that short pulse widths focus the stimulation effect on small, nearby fibers, decrease side effects, and improve power consumption. Our field should reconsider shortened pulse widths.

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Reply to comment on: Short pulse width widens the therapeutic window of subthalamic neurostimulation

Cited by 4 publications

References 2 publications

Neural selectivity, efficiency, and dose equivalence in deep brain stimulation through pulse width tuning and segmented electrodes

Neural selectivity, efficiency, and dose equivalence in deep brain stimulation through pulse width tuning and segmented electrodes

Deep brain stimulation with short versus conventional pulse width in Parkinson's disease and essential tremor: A systematic review and meta-analysis

Neural Selectivity, Efficiency, and Dose Equivalence in Deep Brain Stimulation through Pulse Width Tuning and Segmented Electrodes

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