Estimulación cerebral profunda direccional bipolar en temblor esencial y parkinsoniano.: Publicado originalmente en la Revista Neuromodulation. 2020; 23: 543–549. Traducción: Dra. Laura Contartese

Julia K. Steffen; Paul Reker; Fiona K. Mennicken; Till A. Dembek; Haidar S. Dafsari; Gereon R. Fink; Veerle Visser-Vandewalle; Michael T. Barbe

doi:10.47924/neurotarget202176

Authors

Julia K. Steffen Faculty of Medicine and University Hospital Cologne, Department of Neurology, University of Cologne, Cologne, Germany.
Paul Reker Faculty of Medicine and University Hospital Cologne, Department of Neurology, University of Cologne, Cologne, Germany.
Fiona K. Mennicken Faculty of Medicine and University Hospital Cologne, Department of Neurology, University of Cologne, Cologne, Germany.
Till A. Dembek Faculty of Medicine and University Hospital Cologne, Department of Neurology, University of Cologne, Cologne, Germany.
Haidar S. Dafsari Faculty of Medicine and University Hospital Cologne, Department of Neurology, University of Cologne, Cologne, Germany.
Gereon R. Fink Faculty of Medicine and University Hospital Cologne, Department of Neurology, University of Cologne, Cologne, Germany.
Veerle Visser-Vandewalle Faculty of Medicine and University Hospital Cologne, Department of Stereotactic and Functional Neurosurgery, University of Cologne, Cologne, Germany.
Michael T. Barbe Faculty of Medicine and University Hospital Cologne, Department of Neurology, University of Cologne, Cologne, Germany.

DOI:

https://doi.org/10.47924/neurotarget202176

Keywords:

deep brain stimulation, essential tremor, Parkinson’s disease

Abstract

Objective: To compare directional monopolar, bipolar, and directional bipolar thalamic deep brain stimulation (DBS) in tremor patients.
Methods: Fourteen tremor patients (7 Essential Tremor and 7
Parkinson’s Disease) implanted with directional DBS electrodes in the ventral intermediate nucleus (VIM) were enrolled. Sideeffect thresholds of monopolar directional stimulation (DIRECT) were compared to circular DBS as well as, in a randomized design, to those of two different bipolar stimulation settings (BIPOLAR = circular anode; BI-DIRECT = directional anode). Tremor suppression (Tremor Rating Scale, TRS) right below the side-effect threshold was also assessed.
Results: Directional DBS in the individually best direction showed higher side-effect thresholds than circular DBS (p = 0.0063). The thresholds were raised further using either one of the bipolar stimulation paradigms (BIPOLAR p = 0.0029, BIDIRECT p = 0.0022). The side-effect thresholds did not differ between both bipolar settings, but side-effects were less frequent with BI-DIRECT. No difference in TRS scores with stimulation just below the side-effect threshold was found between all stimulation conditions.
Conclusions: Side-effect thresholds of monopolar directional and bipolar stimulation with both circular and directional anodes were higher compared to traditional monopolar circular stimulation in the VIM. Bipolar DBS with directional anodes evoked side-effect less frequently than bipolar and monopolar directional stimulation. All stimulation settings had comparable effects on tremor suppression just below their side-effect thresholds. Thus, directional and different bipolar settings should be explored in patients with bothersome side-effects of thalamic stimulation when monopolar stimulation settings are not satisfying. Further studies are needed to explore the efficiency of the different bipolar stimulation paradigms.

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References

Flora ED, Perera CL, Cameron AL, Maddern GJ. Deep brain stimulation for essential tremor: A systematic review. Mov Disord Off J Mov Disord Soc 2010;25:1550–1559.

Barbe MT, Reker P, Hamacher S et al. DBS of the PSA and the VIM in essential tremor: A randomized, double-blind, crossover trial. Neurology 2018;91:e543–e550.

Ondo W, Jankovic J, Schwartz K, Almaguer M, Simpson RK. Unilateral thalamic deep brain stimulation for refractory essential tremor and Parkinson’s disease tremor. Neurology 1998;51:1063–1069.

Lozano AM. Vim thalamic stimulation for tremor. Arch Med Res 2000;31:266–269.

Contarino MF, Bour LJ, Verhagen R et al. Directional steering: A novel approach to deep brain stimulation. Neurology 2014;83:1163-1169.

Steigerwald F, Müller L, Johannes S, Matthies C, Volkmann J. Directional deep brain stimulation of the subthalamic nucleus: A pilot study using a novel neurostimulation device. Mov Disord 2016;31:1240–1243.

Dembek TA, Reker P, Visser-Vandewalle V et al. Directional DBS increases side effect thresholds — A prospective, double-blind trial. Mov Disord 2017;32: 1380–1388.

Rebelo P, Green AL, Aziz TZ et al. Thalamic directional deep brain stimulation for tremor: Spend less, get more. Brain Stimulat. 2018;11:600–606.

Reker P, Dembek TA, Becker J, VisserVandewalle V, Timmermann L. Directional deep brain stimulation: A case of avoiding dysarthria with bipolar directional current steering. Parkinsonism Relat Disord 2016;31:156–158.

Deuschl G, Bain P, Brin M. Consensus statement of the movement disorder society on tremor. Ad hoc scientific committee. Mov Disord Off J Mov Disord Soc 1998;13:2–23.

Hughes AJ, Daniel SE, Ben-Shlomo Y, Lees AJ. The accuracy of diagnosis of parkinsonian syndromes in a specialist movement disorder service. Brain J Neurol. 2002;125:861–870.

Hellerbach A, Dembek TA, Hoevels M et al. DiODe: Directional orientation detection of segmented deep brain stimulation leads: A sequential algorithm based on CT imaging. Stereotact Funct Neurosurg 2018;96:335–341.

Sitz A, Hoevels M, Hellerbach A et al. Determining the orientation angle of directional leads for deep brain stimulation using computed tomography and digital x-ray imaging: A phantom study. Med Phys 2017;44:4463–4473.

Horn A, Li N, Dembek TA et al. Lead-DBS v2: Towards a comprehensive pipeline for deep brain stimulation imaging. Neuroimage. 2019;184:293–316.

Avants BB, Epstein CL, Grossman M, Gee JC. Symmetric diffeomorphic image registration with cross-correlation: Evaluating automated labeling of elderly and neurodegenerative brain. Med Image Anal 2008;12:26–41.

Schönecker T, Kupsch A, Kühn AA, Schneider G-H, Hoffmann K-T. Automated optimization of subcortical cerebral MR Imaging−atlas coregistration for improved postoperative electrode localization in deep brain stimulation. Am J Neuroradiol 2009;30:1914–1921.

Husch A V. Petersen M, Gemmar P, Goncalves J, Hertel F. PaCER - a fully automated method for electrode trajectory and contact reconstruction in deep brain stimulation. NeuroImage Clin. 2017;17:80–89.

Fahn S, Tolosa E, Concepcion M. In: Jankovic J, Tolosa E, editors. Clinical rating scale for tremor. 2nd ed. Baltimore, MD: Williams & Wilkins, 1993.

Cheung T, Mamelak A, Tagliati M. Bipolar versus monopolar electrode configuration in thalamic DBS for essential tremor (P05.033). Neurology 2013;80:P05.033–P05.033.

Yousif N, Pavese N, Naushahi MJ, Nandi D, Bain PG. Reversing the polarity of bipolar stimulation in deep brain stimulation for essential tremor: A theoretical explanation for a useful clinical intervention. Neurocase 2014;20:10–17.

O’Suilleabhain PE, Frawley W, Giller C, Dewey RB. Tremor response to polarity, voltage, pulsewidth and frequency of thalamic stimulation. Neurology 2003;60:786–790.

Anderson DN, Duffley G, Vorwerk J, Dorval AD, Butson CR. Anodic stimulation misunderstood: Preferential activation of fiber orientations with anodic waveforms in deep brain stimulation. J Neural Eng 2019;16:016026.

Slopsema JP, Peña E, Patriat R et al. Clinical deep brain stimulation strategies for orientationselective pathway activation. J Neural Eng 2018;15:056029.

Kirsch AD, Hassin-Baer S, Matthies C, Volkmann J, Steigerwald F. Anodic versus cathodic neurostimulation of the subthalamic nucleus: A randomized-controlled study of acute clinical effects. Parkinsonism Relat Disord 2018;55:61–67.

Soh D, ten Brinke TR, Lozano AM, Fasano A. Therapeutic window of deep brain stimulation using cathodic monopolar, bipolar, semibipolar, and anodic stimulation. Neuromodulation Technol Neural Interface 2019 22:451–455.