A review of neurophysiological effects and efficiency of waveform parameters in deep brain stimulation

Zachary Gilbert, Xenos Mason, Rinu Sebastian, Austin M. Tang, Roberto Martin Del Campo-Vera, Kuang Hsuan Chen, Andrea Leonor, Arthur Shao, Emiliano Tabarsi, Ryan Chung, Shivani Sundaram, Alexandra Kammen, Jonathan Cavaleri, Angad S. Gogia, Christi Heck, George Nune, Charles Y. Liu, Spencer S. Kellis, Brian Lee

Research output: Contribution to journalReview articlepeer-review

10 Scopus citations

Abstract

Neurostimulation has diverse clinical applications and potential as a treatment for medically refractory movement disorders, epilepsy, and other neurological disorders. However, the parameters used to program electrodes—polarity, pulse width, amplitude, and frequency—and how they are adjusted have remained largely untouched since the 1970 s. This review summarizes the state-of-the-art in Deep Brain Stimulation (DBS) and highlights the need for further research to uncover the physiological mechanisms of neurostimulation. We focus on studies that reveal the potential for clinicians to use waveform parameters to selectively stimulate neural tissue for therapeutic benefit, while avoiding activating tissue associated with adverse effects. DBS uses cathodic monophasic rectangular pulses with passive recharging in clinical practice to treat neurological conditions such as Parkinson's Disease. However, research has shown that stimulation efficiency can be improved, and side effects reduced, through modulating parameters and adding novel waveform properties. These developments can prolong implantable pulse generator lifespan, reducing costs and surgery-associated risks. Waveform parameters can stimulate neurons based on axon orientation and intrinsic structural properties, providing clinicians with more precise targeting of neural pathways. These findings could expand the spectrum of diseases treatable with neuromodulation and improve patient outcomes.

Original languageEnglish (US)
Pages (from-to)93-111
Number of pages19
JournalClinical Neurophysiology
Volume152
DOIs
StatePublished - Aug 2023

Keywords

  • Deep Brain Stimulation
  • Frequency
  • Phase
  • Polarity
  • Pulse Width
  • Waveform Parameter

ASJC Scopus subject areas

  • Sensory Systems
  • Neurology
  • Clinical Neurology
  • Physiology (medical)

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