Programming Deep Brain Stimulation for Tremor and Dystonia: the Toronto Western Hospital Algorithms

Publication date: Available online 12 February 2016
Source:Brain Stimulation
Author(s): Marina Picillo, Andres M. Lozano, Nancy Kou, Renato Puppi Munhoz, Alfonso Fasano
BackgroundDeep brain stimulation (DBS) is an effective treatment for Essential Tremor (ET) and dystonia. After surgery, a number of extensive programming sessions are performed mainly relying on neurologist's personal experience as no programming guidelines have been provided so far, with the exception of recommendations provided by groups of experts. Finally, fewer information is available for the management of DBS in ET and dystonia compared with Parkinson's disease.Objective/HypothesisOur aim is to review the literature on initial and follow-up DBS programming procedures for ET and dystonia and integrate the results with our current practice at Toronto Western Hospital (TWH) to develop standardized DBS programming protocols.MethodsWe conducted a literature search of Pubmed from inception to July 2014 with the keywords "balance", "bradykinesia", "deep brain stimulation", "dysarthria", "dystonia", "gait disturbances", "initial programming", "loss of benefit", "micrographia", "speech", "speech difficulties" and "tremor". Seventy-six papers were considered for this review.ResultsBased on the literature review and our experience at TWH, we refined three algorithms for management of ET including (1)initial programming, (2)management of balance and speech issues and (3)loss of stimulation benefit. We also depicted algorithms for the management of dystonia including (1)initial programming and (2)management of stimulation-induced hypokinesia (shuffling gait, micrographia and speech impairment).ConclusionsWe propose five algorithms tailored to an individualized approach to managing ET and dystonia patients with DBS. We encourage the application of these algorithms to supplement current standards of care in established as well as new DBS centres to test the clinical usefulness of these algorithms in supplementing the current standards of care.



from Neurology via xlomafota13 on Inoreader http://ift.tt/1PIgYKH
via IFTTT

from #Med Blogs by Alexandros G.Sfakianakis via Alexandros G.Sfakianakis on Inoreader http://ift.tt/1TXHG79
via IFTTT