Anodic and symmetric biphasic pulses enlarge the therapeutic window in deep brain stimulation for essential tremor

Alexandra Boogers; Jana Peeters; Tine Van Bogaert; Boateng Asamoah; Philippe De Vloo; Wim Vandenberghe; Bart Nuttin; Myles Mc Laughlin

Brain Stimulation (Mar 2022)

Anodic and symmetric biphasic pulses enlarge the therapeutic window in deep brain stimulation for essential tremor

Alexandra Boogers,
Jana Peeters,
Tine Van Bogaert,
Boateng Asamoah,
Philippe De Vloo,
Wim Vandenberghe,
Bart Nuttin,
Myles Mc Laughlin

Affiliations

Alexandra Boogers: Experimental ORL, Department of Neurosciences, The Leuven Brain Institute, KU Leuven, Herestraat 49, 3000, Leuven, Belgium; Department of Neurology, UZ Leuven, Herestraat 49, 3000, Leuven, Belgium; Corresponding author. Experimental ORL, Department of Neurosciences, The Leuven Brain Institute, KU Leuven, Herestraat 49, 3000, Leuven, Belgium.
Jana Peeters: Experimental ORL, Department of Neurosciences, The Leuven Brain Institute, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
Tine Van Bogaert: Experimental ORL, Department of Neurosciences, The Leuven Brain Institute, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
Boateng Asamoah: Experimental ORL, Department of Neurosciences, The Leuven Brain Institute, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
Philippe De Vloo: Department of Neurosurgery, UZ Leuven, Herestraat 49, 3000, Leuven, Belgium; Experimental Neurosurgery and Neuroanatomy, Department of Neurosciences, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
Wim Vandenberghe: Department of Neurology, UZ Leuven, Herestraat 49, 3000, Leuven, Belgium; Laboratory for Parkinson Research, Department of Neurosciences, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
Bart Nuttin: Department of Neurosurgery, UZ Leuven, Herestraat 49, 3000, Leuven, Belgium; Experimental Neurosurgery and Neuroanatomy, Department of Neurosciences, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
Myles Mc Laughlin: Experimental ORL, Department of Neurosciences, The Leuven Brain Institute, KU Leuven, Herestraat 49, 3000, Leuven, Belgium

Journal volume & issue: Vol. 15, no. 2
pp. 286 – 290

Abstract

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Background: Since the inception of DBS, cathodic pulses have been used. Objective: To investigate the effect of anodic and symmetric biphasic pulses on the therapeutic window (TW) in essential tremor (ET) patients. Methods: A randomized, doubled-blinded, cross-over design was used to test the effect of cathodic, anodic and symmetric biphasic pulses (cathode-first and anode-first) on the TW in an acute clinical setting. TW was defined as the difference between the minimal stimulation amplitude provoking side effects and minimal stimulation amplitude inducing tremor arrest. Results: 9 ET patients (10 hemispheres) were included. Anodic stimulation induced a significantly larger TW compared to cathodic stimulation (p = 0.008). Symmetric biphasic stimulation also widened the TW compared to cathodic stimulation for both cathode- (p = 0.047) and anode-first (p = 0.008) biphasic pulses. For both anodic and biphasic pulses, the effect on TW was mainly driven by the change in side effect threshold. The order of the phases in the biphasic pulse had a significant effect on the side effect threshold (p = 0.039), with biphasic-anode first having the highest value. All pulse shapes were safe in the acute setting. Conclusion: Anodic and symmetric biphasic pulses increase TW in ET patients.

Published in Brain Stimulation

ISSN: 1935-861X (Print); 1876-4754 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Neurosciences. Biological psychiatry. Neuropsychiatry
Website: https://www.journals.elsevier.com/brain-stimulation

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