Deep Brain Stimulation Programming for Movement Disorders: Current Concepts and Evidence-Based Strategies

Frontiers in Neurology

Kai Bötzel¹  Jan H. Mehrkens²  Thomas Koeglsperger³  Carla Palleis³  Franz Hell⁴ 

[1] Department of Neurology, Ludwig Maximilians University, Munich, Germany;Department of Neurosurgery, Ludwig Maximilians University, Munich, Germany;Department of Translational Neurodegeneration, German Center for Neurodegenerative Diseases (DZNE), Munich, Germany;Graduate School of Systemic Neurosciences, Ludwig-Maximilians-Universität München, Martinsried, Germany;

关键词: DBS programming algorithms;    subthalamic nucleus;    DBS side effects;    segmented electrode;    short pulse width;   

DOI  :  10.3389/fneur.2019.00410

来源: DOAJ

【 摘 要 】

Deep brain stimulation (DBS) has become the treatment of choice for advanced stages of Parkinson's disease, medically intractable essential tremor, and complicated segmental and generalized dystonia. In addition to accurate electrode placement in the target area, effective programming of DBS devices is considered the most important factor for the individual outcome after DBS. Programming of the implanted pulse generator (IPG) is the only modifiable factor once DBS leads have been implanted and it becomes even more relevant in cases in which the electrodes are located at the border of the intended target structure and when side effects become challenging. At present, adjusting stimulation parameters depends to a large extent on personal experience. Based on a comprehensive literature search, we here summarize previous studies that examined the significance of distinct stimulation strategies for ameliorating disease signs and symptoms. We assess the effect of adjusting the stimulus amplitude (A), frequency (f), and pulse width (pw) on clinical symptoms and examine more recent techniques for modulating neuronal elements by electrical stimulation, such as interleaving (Medtronic®) or directional current steering (Boston Scientific®, Abbott®). We thus provide an evidence-based strategy for achieving the best clinical effect with different disorders and avoiding adverse effects in DBS of the subthalamic nucleus (STN), the ventro-intermedius nucleus (VIM), and the globus pallidus internus (GPi).

【 授权许可】

Unknown