Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital, UHN, Toronto, Ontario, Canada.
Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
Neuromodulation. 2019 Jun;22(4):451-455. doi: 10.1111/ner.12957. Epub 2019 Apr 5.
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.
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.
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).
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.
比较十位帕金森病患者接受丘脑底核深部脑刺激时，阴极单极、双极、阳极单极和一种新型“半双极”刺激的治疗窗口（TW）。
患者在“关闭”左旋多巴状态下进行评估。分别测试每个上肢的治疗阈值、TW 和副作用阈值（SET）。还记录了电池消耗指数（BCI）。
与阴极刺激相比，阳极、双极和半双极刺激的治疗阈值显著升高（3.8±1.6 与 4.9±2.1、5.0±1.9 和 5.2±1.9 mA，p=0.0006、0.0002 和 0.008）。双极刺激的 SET（10.9±2.5 mA）显著高于阴极刺激（6.8±2.2 mA，p<0.0001）和阳极刺激（9.2±2.6 mA，p=0.005）。阳极和半双极刺激的 SET 明显高于阴极刺激（p<0.0001）。阴极刺激的 TW（2.5±1.5 mA）明显窄于双极刺激（5.4±2.0 mA，p<0.0001）、半双极刺激（4.6±2.6 mA，p=0.001）和阳极刺激（4.3±2.3 mA，p<0.0001）。双极（p=0.005）和半双极（p=0.0005）刺激的 TW 明显宽于阳极刺激。阴极刺激的 BCI（5.9±1.3）明显低于双极（13.7±6.8，p<0.0001）、半双极（11.0±4.3，p=0.0005）和阳极刺激（8.1±3.0，p<0.0001）。阳极 BCI 明显低于双极（p=0.005）和半双极（p=0.0002）刺激，而半双极 BCI 明显低于双极刺激（p=0.0005）。
在等待进一步研究的同时，我们的发现表明，鉴于其较低的电池消耗，阴极刺激应优先考虑，而在刺激诱导的副作用的情况下，可能随后是半双极刺激。
