Therapeutic Window of Deep Brain Stimulation Using Cathodic Monopolar, Bipolar, Semi-Bipolar, and Anodic Stimulation

Derrick Soh; Timo R Ten Brinke; Andres M Lozano; Alfonso Fasano

doi:10.1111/ner.12957

Therapeutic Window of Deep Brain Stimulation Using Cathodic Monopolar, Bipolar, Semi-Bipolar, and Anodic Stimulation

Neuromodulation. 2019 Jun;22(4):451-455. doi: 10.1111/ner.12957. Epub 2019 Apr 5.

Authors

Derrick Soh¹, Timo R Ten Brinke², Andres M Lozano^{3

4}, Alfonso Fasano^{1

4}

Affiliations

¹ Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital, UHN, Toronto, Ontario, Canada.
² Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
³ Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada.
⁴ Krembil Brain Institute, Toronto, Ontario, Canada.

PMID: 30951239
DOI: 10.1111/ner.12957

Abstract

Objectives: To compare the therapeutic window (TW) of cathodic monopolar, bipolar, anodic monopolar, and a novel "semi-bipolar" stimulation in ten Parkinson's disease patients who underwent deep brain stimulation of the subthalamic nucleus.

Materials and methods: Patients were assessed in the "OFF" L-dopa condition. Each upper limb was tested separately for therapeutic threshold, TW and side-effect threshold (SET). Battery consumption index (BCI) also was documented.

Results: Compared to cathodic stimulation, therapeutic threshold was significantly higher for anodic, bipolar, and semi-bipolar stimulation (3.8 ± 1.6 vs. 4.9 ± 2.1, 5.0 ± 1.9, and 5.2 ± 1.9 mA, p = 0.0006, 0.0002, and 0.008, respectively). SET was significantly higher for bipolar stimulation (10.9 ± 2.5 mA) vs. cathodic (6.8 ± 2.2 mA, p < 0.0001) and anodic stimulation (9.2 ± 2.6 mA, p = 0.005). The SET of anodic and semi-bipolar stimulation was significantly higher vs. cathodic stimulation (p < 0.0001). TW of cathodic stimulation (2.5 ± 1.5 mA) was significantly narrower vs. bipolar (5.4 ± 2.0 mA, p < 0.0001), semi-bipolar (4.6 ± 2.6 mA, p = 0.001) and anodic stimulation (4.3 ± 2.3 mA, p < 0.0001). Bipolar (p = 0.005) and semi-bipolar (p = 0.0005) stimulation had a significantly wider TW vs. anodic stimulation. BCI of cathodic stimulation (5.9 ± 1.3) was significantly lower compared to bipolar (13.7 ± 6.8, p < 0.0001), semi-bipolar (11.0 ± 4.3, p = 0.0005), and anodic stimulation (8.1 ± 3.0, p < 0.0001). Anodic BCI was significantly lower than bipolar (p = 0.005) and semi-bipolar (p = 0.0002) stimulation while semi-bipolar BCI was lower than bipolar stimulation (p = 0.0005).

Conclusions: While awaiting further studies, our findings suggest that cathodic stimulation should be preferred in light of its reduced battery consumption, possibly followed by semi-bipolar in case of stimulation-induced side-effects.

Keywords: Anodic stimulation; Boston scientific; Parkinson's disease; bipolar stimulation; therapeutic window.

MeSH terms

Aged
Deep Brain Stimulation / instrumentation
Deep Brain Stimulation / standards
Deep Brain Stimulation / trends*
Electrodes / standards
Electrodes / trends
Electrodes, Implanted / standards
Electrodes, Implanted / trends*
Female
Humans
Male
Middle Aged
Parkinson Disease / diagnosis
Parkinson Disease / therapy*