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Parameters for subthalamic deep brain stimulation in patients with dystonia: a systematic review

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Abstract

Background and objective

Deep brain stimulation (DBS) is used for treating dystonia, commonly targeting the subthalamic nucleus (STN). Optimal stimulation parameters are required to achieve satisfying results. However, recommended parameters for STN-DBS remain to be identified. In this review, we aimed to assess the optimal stimulation parameters by analyzing previously published STN-DBS data of patients with dystonia.

Methods

We examined the STN-DBS stimulation parameters used in studies on dystonia selected on the PubMed/Medline database.

Results

Of the 86 publications retrieved from the PubMed/Medline database, we included 24, which consisted of data from 94 patients and 160 electrodes. Overall, the following average stimulation parameters were observed: amplitude, 2.59 ± 0.67 V; pulse width, 83.87 ± 34.70 μs; frequency, 142.08 ± 37.81 Hz. The average improvement rate was 64.72 ± 24.74%. The improvement rate and stimulation parameters were linearly dependent. The average improvement rate increased by 3.58% at each 10-Hz increase in frequency. In focal and segmental dystonia, the improvement rate and stimulation parameters were linearly dependent. The improvement rate increased by 6.06% and decreased by 2.14% at each 10-Hz increase in frequency and pulse width, respectively. Seventeen publications (83 patients) mentioned stimulation-related adverse effects, including dyskinesia (17), depression (8), transient dysarthria (5), weight gain (4), transient dysphasia (3), transient paresthesia (2), and sustained hyperkinesia (2).

Conclusions

The optimal stimulation parameter for STN-DBS varies across patients. Our findings may be useful for DBS programming based on the specific dystonia subtypes, especially for patients with focal and segmental dystonia.

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Funding

This study was supported by the National Natural Science Foundation of China (Grant number: 81870887).

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Authors and Affiliations

  1. Department of Neurosurgery, Center for Functional Neurosurgery, RuiJin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China

    Yuhan Wang, Chencheng Zhang, Bomin Sun & Dianyou Li

  2. Department of Neurology, RuiJin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China

    Yiwen Wu

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  1. Yuhan Wang
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  2. Chencheng Zhang
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  3. Bomin Sun
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  4. Dianyou Li
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by YW, CZ and YW. The first draft of the manuscript was written by YW and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Dianyou Li or Yiwen Wu.

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The authors declare no conflicts of interest.

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Wang, Y., Zhang, C., Sun, B. et al. Parameters for subthalamic deep brain stimulation in patients with dystonia: a systematic review. J Neurol 269, 197–204 (2022). https://doi.org/10.1007/s00415-020-10372-x

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  • DOI: https://doi.org/10.1007/s00415-020-10372-x

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