Brandon D Swan1, David T Brocker1, Justin D Hilliard1, Stephen B Tatter2, Robert E Gross3, Dennis A Turner4, Warren M Grill5. 1. Department of Biomedical Engineering, Duke University, Durham, NC, USA. 2. Department of Neurosurgery, Wake Forest University Baptist Medical Center, Winston-Salem, NC, USA. 3. Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA; Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA. 4. Department of Surgery, Duke University Medical Center, Durham, NC, USA; Department of Neurobiology, Duke University Medical Center, Durham, NC, USA. 5. Department of Biomedical Engineering, Duke University, Durham, NC, USA; Department of Surgery, Duke University Medical Center, Durham, NC, USA; Department of Neurobiology, Duke University Medical Center, Durham, NC, USA; Department of Electrical and Computer Engineering, Duke University, Durham, NC, USA. Electronic address: warren.grill@duke.edu.
Abstract
OBJECTIVE: We conducted intraoperative measurements of tremor during DBS containing short pauses (⩽50 ms) to determine if there is a minimum pause duration that preserves tremor suppression. METHODS: Nine subjects with ET and thalamic DBS participated during IPG replacement surgery. Patterns of DBS included regular 130 Hz stimulation interrupted by 0, 15, 25 or 50 ms pauses. The same patterns were applied to a model of the thalamic network to quantify effects of pauses on activity of model neurons. RESULTS: All patterns of DBS decreased tremor relative to 'off'. Patterns with pauses generated less tremor reduction than regular high frequency DBS. The model revealed that rhythmic burst-driver inputs to thalamus were masked during DBS, but pauses in stimulation allowed propagation of bursting activity. The mean firing rate of bursting-type model neurons as well as the firing pattern entropy of model neurons were both strongly correlated with tremor power across stimulation conditions. CONCLUSIONS: The temporal pattern of stimulation influences the efficacy of thalamic DBS. Pauses in stimulation resulted in decreased tremor suppression indicating that masking of pathological bursting is a mechanism of thalamic DBS for tremor. SIGNIFICANCE: Pauses in stimulation decreased the efficacy of open-loop DBS for suppression of tremor.
OBJECTIVE: We conducted intraoperative measurements of tremor during DBS containing short pauses (⩽50 ms) to determine if there is a minimum pause duration that preserves tremor suppression. METHODS: Nine subjects with ET and thalamic DBS participated during IPG replacement surgery. Patterns of DBS included regular 130 Hz stimulation interrupted by 0, 15, 25 or 50 ms pauses. The same patterns were applied to a model of the thalamic network to quantify effects of pauses on activity of model neurons. RESULTS: All patterns of DBS decreased tremor relative to 'off'. Patterns with pauses generated less tremor reduction than regular high frequency DBS. The model revealed that rhythmic burst-driver inputs to thalamus were masked during DBS, but pauses in stimulation allowed propagation of bursting activity. The mean firing rate of bursting-type model neurons as well as the firing pattern entropy of model neurons were both strongly correlated with tremor power across stimulation conditions. CONCLUSIONS: The temporal pattern of stimulation influences the efficacy of thalamic DBS. Pauses in stimulation resulted in decreased tremor suppression indicating that masking of pathological bursting is a mechanism of thalamic DBS for tremor. SIGNIFICANCE: Pauses in stimulation decreased the efficacy of open-loop DBS for suppression of tremor.
Authors: David T Brocker; Brandon D Swan; Rosa Q So; Dennis A Turner; Robert E Gross; Warren M Grill Journal: Sci Transl Med Date: 2017-01-04 Impact factor: 17.956
Authors: Brandon D Swan; David T Brocker; Robert E Gross; Dennis A Turner; Warren M Grill Journal: Clin Neurophysiol Date: 2019-12-26 Impact factor: 3.708