Optimal Parameters of Deep Brain Stimulation in Essential Tremor: A Meta-Analysis and Novel Programming Strategy
The programming of deep brain stimulation (DBS) parameters for tremor is laborious and empirical. Despite extensive efforts, the end-result is often suboptimal. One reason for this is the poorly understood relationship between the stimulation parameters’ voltage, pulse width, and frequency. In this...
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doaj-e6e7cce332e54f6b8cd4b989e8564cdb2020-11-25T03:20:17ZengMDPI AGJournal of Clinical Medicine2077-03832020-06-0191855185510.3390/jcm9061855Optimal Parameters of Deep Brain Stimulation in Essential Tremor: A Meta-Analysis and Novel Programming StrategyI. Daria Bogdan0Teus van Laar1D.L. Marinus Oterdoom2Gea Drost3J. Marc C. van Dijk4Martijn Beudel5Department of Neurology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The NetherlandsDepartment of Neurology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The NetherlandsDepartment of Neurosurgery, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The NetherlandsDepartment of Neurology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The NetherlandsDepartment of Neurosurgery, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The NetherlandsDepartment of Neurology, Amsterdam Neuroscience Institute, Amsterdam University Medical Center, 1007 MB Amsterdam, The NetherlandsThe programming of deep brain stimulation (DBS) parameters for tremor is laborious and empirical. Despite extensive efforts, the end-result is often suboptimal. One reason for this is the poorly understood relationship between the stimulation parameters’ voltage, pulse width, and frequency. In this study, we aim to improve DBS programming for essential tremor (ET) by exploring a new strategy. At first, the role of the individual DBS parameters in tremor control was characterized using a meta-analysis documenting all the available parameters and tremor outcomes. In our novel programming strategy, we applied 10 random combinations of stimulation parameters in eight ET-DBS patients with suboptimal tremor control. Tremor severity was assessed using accelerometers and immediate and sustained patient-reported outcomes (PRO’s), including the occurrence of side-effects. The meta-analysis showed no substantial relationship between individual DBS parameters and tremor suppression. Nevertheless, with our novel programming strategy, a significantly improved (accelerometer <i>p</i> = 0.02, PRO <i>p</i> = 0.02) and sustained (<i>p</i> = 0.01) tremor suppression compared to baseline was achieved. Less side-effects were encountered compared to baseline. Our pilot data show that with this novel approach, tremor control can be improved in ET patients with suboptimal tremor control on DBS. In addition, this approach proved to have a beneficial effect on stimulation-related complications.https://www.mdpi.com/2077-0383/9/6/1855DBStremorstimulation parametersDBS programming algorithmDBS side effectsthalamic nucleus |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
I. Daria Bogdan Teus van Laar D.L. Marinus Oterdoom Gea Drost J. Marc C. van Dijk Martijn Beudel |
spellingShingle |
I. Daria Bogdan Teus van Laar D.L. Marinus Oterdoom Gea Drost J. Marc C. van Dijk Martijn Beudel Optimal Parameters of Deep Brain Stimulation in Essential Tremor: A Meta-Analysis and Novel Programming Strategy Journal of Clinical Medicine DBS tremor stimulation parameters DBS programming algorithm DBS side effects thalamic nucleus |
author_facet |
I. Daria Bogdan Teus van Laar D.L. Marinus Oterdoom Gea Drost J. Marc C. van Dijk Martijn Beudel |
author_sort |
I. Daria Bogdan |
title |
Optimal Parameters of Deep Brain Stimulation in Essential Tremor: A Meta-Analysis and Novel Programming Strategy |
title_short |
Optimal Parameters of Deep Brain Stimulation in Essential Tremor: A Meta-Analysis and Novel Programming Strategy |
title_full |
Optimal Parameters of Deep Brain Stimulation in Essential Tremor: A Meta-Analysis and Novel Programming Strategy |
title_fullStr |
Optimal Parameters of Deep Brain Stimulation in Essential Tremor: A Meta-Analysis and Novel Programming Strategy |
title_full_unstemmed |
Optimal Parameters of Deep Brain Stimulation in Essential Tremor: A Meta-Analysis and Novel Programming Strategy |
title_sort |
optimal parameters of deep brain stimulation in essential tremor: a meta-analysis and novel programming strategy |
publisher |
MDPI AG |
series |
Journal of Clinical Medicine |
issn |
2077-0383 |
publishDate |
2020-06-01 |
description |
The programming of deep brain stimulation (DBS) parameters for tremor is laborious and empirical. Despite extensive efforts, the end-result is often suboptimal. One reason for this is the poorly understood relationship between the stimulation parameters’ voltage, pulse width, and frequency. In this study, we aim to improve DBS programming for essential tremor (ET) by exploring a new strategy. At first, the role of the individual DBS parameters in tremor control was characterized using a meta-analysis documenting all the available parameters and tremor outcomes. In our novel programming strategy, we applied 10 random combinations of stimulation parameters in eight ET-DBS patients with suboptimal tremor control. Tremor severity was assessed using accelerometers and immediate and sustained patient-reported outcomes (PRO’s), including the occurrence of side-effects. The meta-analysis showed no substantial relationship between individual DBS parameters and tremor suppression. Nevertheless, with our novel programming strategy, a significantly improved (accelerometer <i>p</i> = 0.02, PRO <i>p</i> = 0.02) and sustained (<i>p</i> = 0.01) tremor suppression compared to baseline was achieved. Less side-effects were encountered compared to baseline. Our pilot data show that with this novel approach, tremor control can be improved in ET patients with suboptimal tremor control on DBS. In addition, this approach proved to have a beneficial effect on stimulation-related complications. |
topic |
DBS tremor stimulation parameters DBS programming algorithm DBS side effects thalamic nucleus |
url |
https://www.mdpi.com/2077-0383/9/6/1855 |
work_keys_str_mv |
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