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J Neurol Neurosurg Psychiatry. 2019 Feb 14. pii: jnnp-2018-319427. doi: 10.1136/jnnp-2018-319427. [Epub ahead of print]

Shorter pulse width reduces gait disturbances following deep brain stimulation for essential tremor.

Author information

1
Charité - Universitätsmedizin Berlin, Department of Neurology, Movement Disorder and Neuromodulation Unit, Berlin, Germany.
2
Charité - Universitätsmedizin Berlin, Department of Neurology, Movement Disorder and Neuromodulation Unit, Berlin, Germany andrea.kuehn@charite.de.
3
Charité - Universitätsmedizin Berlin, NeuroCure Cluster of Excellence, Berlin, Germany.

Abstract

OBJECTIVE:

Gait disturbances are frequent side effects occurring during chronic thalamic deep brain stimulation (DBS) in patients with essential tremor (ET). Adapting stimulation settings to shorter pulse widths has been shown to reduce side effects of subthalamic DBS. Here, we assess how a reduction of pulse width changes gait performance of affected patients.

METHODS:

Sensor-based gait assessment was performed to record spatiotemporal gait parameters in 10 healthy subjects (HS) and 7 patients with ET with gait disturbances following thalamic DBS. Patients were tested during standard DBS, after 72 hours of stimulation withdrawal and at least 30 days after adjusting DBS settings to a shorter pulse width of 40 µs (DBS40PW).

RESULTS:

Patients with ET on standard DBS showed significantly higher variability of several spatiotemporal gait parameters compared with HS. Variability of stride length and range of motion of the shanks significantly decreased OFF DBS as compared with standard DBS. This improvement was maintained over 30 days with DBS40PW while providing effective tremor suppression in six out of seven patients.

CONCLUSION:

Shorter pulse widths may reduce gait disturbances in patients with ET that are induced by DBS while preserving a level of tremor suppression equal to standard stimulation settings.

KEYWORDS:

deep brain stimulation; essential tremor; gait; gait assessment; gait ataxia; movement disorders; tremor

PMID:
30765417
DOI:
10.1136/jnnp-2018-319427
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Conflict of interest statement

Competing interests: DK, SE and A-CM declare no competing interests or financial dependencies. AK received honoraria from Medtronic, Boston Scientific and St Jude Medical, is member of an advisory board for Boston Scientific, received a travel grant from Boston Scientific, and received a research grant from Medtronic.

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