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Effects of pulse width variations in pallidal stimulation for primary generalized dystonia

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Abstract

Background

Various pulse widths (from 60–450 μs) have been used for bilateral pallidal stimulation in generalized dystonia but, to date, no comparison of this parameter’s effects is available.

Objective

To provide an analysis of the differential effects of bilateral short, medium and long stimulus pulse width (PW) on clinical improvement in primary generalized dystonia.

Methods

The most effective therapeutic stimulation parameters were recorded in 22 patients using bilateral pallidal stimulation. Six months after surgery, the effects of bilateral pallidal short (60–90 μs), medium (120–150 μs) and long (450 μs) PWs were studied in 20 of those patients. The effect of the stimulation was assessed by reviewing videotaped sessions by an observer blinded to treatment status (Burke-Fahn-Marsden movement score). Patients were tested on separate days, in random order, for the stimulation conditions (acute effect with the stimulation condition lasting 10 hours). The same contact was used for each stimulation condition. All the electrodes were set at 130 Hz (monopolar stimulation) and the intensity was set individually 10% below the side effect threshold.

Results

Median PWs of 60 (short), 120 (medium) and 450 μs (long) were compared,with a mean intensity of 4.46, 3.45 and 2.47 V, respectively. This study failed to demonstrate any significant difference in the movementscale dystonia mean scores depending on PW.

Conclusion

According to our findings, shortduration stimulus PWs are as effective as longer ones during a 10 hour period of observation. Confirmation of this finding for chronic use could be of importance in saving stimulator energy. Moreover, the use of smaller stimulus pulse widths are said to reduce charge injection and increase the therapeutic window between therapeutic effects and side effects.

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Authors and Affiliations

  1. Neurology and Neurosurgery, CHU Grenoble, 38043, Grenoble, France

    L. Vercueil MD, C. Lagrange, A. Benazzouz, A. L. Benabid & P. Pollak

  2. Neurology and Neurosurgery, CHU Pitié-La Salpêtrière, 75000, Paris, France

    J. L. Houeto, B. Pidoux, Y. Agid & P. Cornu

  3. Neurology and Neurosurgery, CHU Lille, 59000, Lille, France

    P. Krystkowiak, F. Cassim, A. Destée & S. Blond

  4. Dept. of Neurology, CHU Saint Antoine, 75000, Paris, France

    M. Vidailhet

  5. INSERM U679 (former U289), Salpêtrière Hospital Paris, France

    M. Vidailhet

  6. Dept. of Neurology, CHU Grenoble, 38043, Grenoble cedex 9, France

    L. Vercueil MD

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  1. L. Vercueil MD
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  2. J. L. Houeto
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  3. P. Krystkowiak
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  4. C. Lagrange
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  8. A. Destée
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  9. Y. Agid
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  10. P. Cornu
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  12. A. L. Benabid
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  14. M. Vidailhet
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and the Spidy GROUP (French Pallidal stimulation Group for dystonia)

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Correspondence to L. Vercueil MD.

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Vercueil, L., Houeto, J.L., Krystkowiak, P. et al. Effects of pulse width variations in pallidal stimulation for primary generalized dystonia. J Neurol 254, 1533–1537 (2007). https://doi.org/10.1007/s00415-007-0578-8

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  • DOI: https://doi.org/10.1007/s00415-007-0578-8

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