Anodic versus cathodic neurostimulation of the subthalamic nucleus: A randomized-controlled study of acute clinical effects
Please always quote using this URN: urn:nbn:de:bvb:20-opus-325820
- Introduction Stimulation settings of deep brain stimulation (DBS) have evolved empirically within a limited parameter space dictated by first generation devices. There is a need for controlled clinical studies, which evaluate efficacy and safety of established programming practice against novel programming options provided by modern neurostimulation devices. Methods Here, we tested a polarity reversal from conventional monopolar cathodic to anodic stimulation in an acute double-blind, randomized, cross-over study in patients with PDIntroduction Stimulation settings of deep brain stimulation (DBS) have evolved empirically within a limited parameter space dictated by first generation devices. There is a need for controlled clinical studies, which evaluate efficacy and safety of established programming practice against novel programming options provided by modern neurostimulation devices. Methods Here, we tested a polarity reversal from conventional monopolar cathodic to anodic stimulation in an acute double-blind, randomized, cross-over study in patients with PD implanted with bilateral STN DBS. The primary outcome measure was the difference between efficacy and side-effect thresholds (current amplitude, mA) in a monopolar review and the severity of motor symptoms (as assessed by MDS-UPDRS III ratings) after 30 min of continuous stimulation in the medication off-state. Results Effect and side effect thresholds were significantly higher with anodic compared to cathodic stimulation (3.36 ± 1.58 mA vs. 1.99 ± 1.37 mA; 6.05 ± 1.52 mA vs. 4.15 ± 1.13 mA; both p < 0.0001). However, using a predefined amplitude of 0.5 mA below the respective adverse effect threshold, blinded MDS-UPDRS-III-ratings were significantly lower with anodic stimulation (anodic: median 17 [min: 12, max: 25]; cathodic: 23 [12, 37]; p < 0.005). Conclusion Effective anodic stimulation requires a higher charge injection into the tissue, but may provide a better reduction of off-period motor symptoms within the individual therapeutic window. Therefore, a programming change to anodic stimulation may be considered in patients suffering from residual off-period motor symptoms of PD despite reaching the adverse effect threshold of cathodic stimulation in the subthalamic nucleus.…
Author: | Anna Dalal Kirsch, Sharon Hassin-Baer, Cordula Matthies, Jens Volkmann, Frank Steigerwald |
---|---|
URN: | urn:nbn:de:bvb:20-opus-325820 |
Document Type: | Journal article |
Faculties: | Medizinische Fakultät / Neurochirurgische Klinik und Poliklinik |
Medizinische Fakultät / Neurologische Klinik und Poliklinik | |
Language: | English |
Parent Title (English): | Parkinsonism and Related Disorders |
Year of Completion: | 2018 |
Volume: | 55 |
Pagenumber: | 61-67 |
Source: | Parkinsonism and Related Disorders (2018) 55:61-67. https://doi.org/10.1016/j.parkreldis.2018.05.015 |
DOI: | https://doi.org/10.1016/j.parkreldis.2018.05.015 |
Dewey Decimal Classification: | 6 Technik, Medizin, angewandte Wissenschaften / 61 Medizin und Gesundheit / 610 Medizin und Gesundheit |
Tag: | Parkinson's disease; anodic stimulation; deep brain stimulation; subthalamic nucleus |
Release Date: | 2024/08/21 |
Licence (German): | CC BY: Creative-Commons-Lizenz: Namensnennung 4.0 International |