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Square biphasic pulse deep brain stimulation for essential tremor: The BiP tremor study.
Sol De Jesus1, Leonardo Almeida2, Leili Shahgholi2
1University of Florida, Department of Neurology, Center for Movement Disorders and Neurorestoration, Gainesville, FL, USA; Department of Neurology, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, PA, USA.
Parkinsonism & Related Disorders
|November 6, 2017
Summary
New biphasic pulses (BiP) offer a safe and effective alternative to conventional deep brain stimulation (DBS) for essential tremor (ET). This novel waveform improved tremor symptoms without adverse effects, demonstrating feasibility for clinical use.
Area of Science:
- Neurology
- Biomedical Engineering
- Neurosurgery
Background:
- Conventional deep brain stimulation (DBS) uses high-frequency pulses for essential tremor (ET).
- Modifying DBS pulse shapes is a promising strategy for enhanced effectiveness.
- Current treatments often involve medication-refractory symptoms.
Purpose of the Study:
- To assess the safety, tolerability, and effectiveness of square biphasic pulse shaping (BiP) as an alternative to conventional ET DBS.
- To compare BiP with conventional DBS (ClinDBS) in ET patients.
- To evaluate objective tremor measures under BiP stimulation.
Main Methods:
- A pilot study comparing biphasic pulses (BiP) against conventional DBS (ClinDBS).
- Eleven ET subjects with optimized ventralis intermedius nucleus DBS were enrolled.
- Objective tremor measures were recorded over 3 hours during BiP stimulation.
Main Results:
- Biphasic pulses (BiP) showed significant improvement in Fahn-Tolosa Tremor Rating Scale (TRS) scores compared to DBS OFF and ClinDBS.
- Accelerometer data confirmed tremor reduction in rest, posture, and action conditions with BiP.
- No adverse effects were reported, and gait remained unaffected.
Conclusions:
- Biphasic pulse (BiP) deep brain stimulation (DBS) is safe, tolerable, and effective for essential tremor (ET) symptoms up to 3 hours.
- This novel DBS waveform demonstrates feasibility for clinical application.
- Larger prospective studies with extended follow-up are warranted.
Keywords:
Biphasic pulse stimulationDeep brain stimulationEssential tremorMovement disordersNeurostimulation
