Document Detail


Tremor response to polarity, voltage, pulsewidth and frequency of thalamic stimulation.
MedLine Citation:
PMID:  12629234     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Thalamic deep brain stimulation ameliorates essential and parkinsonian tremors refractory to medications. Stimulus voltage, polarity configuration, frequency, and pulsewidth can each be adjusted in order to optimize tremor control and maximize battery life. The relative impacts of these programmable variables have not previously been quantified. METHODS: The thalamus of 11 patients (bilaterally in 2) was studied 4 to 59 months postoperatively. The stimulator was inactivated and medications withheld for 12 hours, and optimal electrode contacts were selected. Stimulation followed at a range of voltages (0, 1, 2, 3, or 4 V), pulsewidths (60, 90, or 120 micros), and frequencies (130, 160, or 185 Hz) for both monopolar and bipolar configurations. Seventy-eight combinations of variables were programmed in random sequence. Postural and action tremors were measured with an electromagnetic tracker, tremor was subjectively graded, and side effects were noted. RESULTS: Voltage was consistently predictive of tremor response. Mean postural tremor amplitude in PD fell from 6.4 cm at 0 V to 2.6, 1.0, 0.3, and 0 cm at 1 through 4 V (bipolar configuration). The voltage response curve for essential tremor was flatter. The monopolar configuration was 10 to 25% more effective than bipolar. The longest pulsewidth tested was up to 30% more effective than the shortest, but frequency changes had little effect on tremor amplitude. Side effects occurred only with monopolar stimulation, and the only setting that was intolerable for the majority was 4 V, 120 micros, and 185 Hz. CONCLUSION: Bipolar deep brain stimulation at 90 micros, 130 Hz, adjusting the voltage up to 3 V, tends to be effective and well tolerated. Monopolar provides similar benefits for lower voltage, but side effects become common at 3 or 4 V.
Authors:
Padraig E O'Suilleabhain; William Frawley; Cole Giller; Richard B Dewey
Related Documents :
2807314 - Assessment of autonomic response by broad-band respiration.
17343704 - Comparison of time and frequency domain measures of rsa in ambulatory recordings.
24422244 - Following the masters: portrait viewing and appreciation is guided by selective detail.
19776654 - Cardiac autonomic regulation under hypnosis assessed by heart rate variability: spectra...
3808884 - Effect of stimulus pulse duration and interstimulus interval on cross-modal matching of...
24448004 - Free-weight augmentation with elastic bands improves bench-press kinematics in professi...
Publication Detail:
Type:  Clinical Trial; Journal Article; Randomized Controlled Trial; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Neurology     Volume:  60     ISSN:  1526-632X     ISO Abbreviation:  Neurology     Publication Date:  2003 Mar 
Date Detail:
Created Date:  2003-03-11     Completed Date:  2004-02-09     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  0401060     Medline TA:  Neurology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  786-90     Citation Subset:  AIM; IM    
Affiliation:
Department of Neurology, UT Southwestern Medical School, Dallas, TX, USA. Padraig.osuilleabhain@UTSouthwestern.edu
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Electric Stimulation Therapy / adverse effects,  instrumentation,  methods*
Electricity
Humans
Middle Aged
Thalamus / physiopathology*
Tremor / physiopathology*,  therapy*
Grant Support
ID/Acronym/Agency:
M01-RR00633/RR/NCRR NIH HHS

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


Previous Document:  Temporal discrimination of cross-modal and unimodal stimuli in generalized dystonia.
Next Document:  Caffeine, postmenopausal estrogen, and risk of Parkinson's disease.