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Movement disorders
Short report
Shorter pulse width reduces gait disturbances following deep brain stimulation for essential tremor
  1. Daniel Kroneberg1,
  2. Siobhan Ewert1,
  3. Anne-Christiane Meyer1,
  4. Andrea A Kühn1,2
  1. 1 Charité - Universitätsmedizin Berlin, Department of Neurology, Movement Disorder and Neuromodulation Unit, Berlin, Germany
  2. 2 Charité - Universitätsmedizin Berlin, NeuroCure Cluster of Excellence, Berlin, Germany
  1. Correspondence to Professor Andrea A Kühn, Department of Neurology, Movement Disorder and Neuromodulation Unit, Charité Universitätsmedizin Berlin, Berlin 10117, Germany; andrea.kuehn{at}charite.de

Abstract

Objective Gait disturbances are frequent side effects occurring during chronic thalamic deep brain stimulation (DBS) in patients with essential tremor (ET). Adapting stimulation settings to shorter pulse widths has been shown to reduce side effects of subthalamic DBS. Here, we assess how a reduction of pulse width changes gait performance of affected patients.

Methods Sensor-based gait assessment was performed to record spatiotemporal gait parameters in 10 healthy subjects (HS) and 7 patients with ET with gait disturbances following thalamic DBS. Patients were tested during standard DBS, after 72 hours of stimulation withdrawal and at least 30 days after adjusting DBS settings to a shorter pulse width of 40 µs (DBS40PW).

Results Patients with ET on standard DBS showed significantly higher variability of several spatiotemporal gait parameters compared with HS. Variability of stride length and range of motion of the shanks significantly decreased OFF DBS as compared with standard DBS. This improvement was maintained over 30 days with DBS40PW while providing effective tremor suppression in six out of seven patients.

Conclusion Shorter pulse widths may reduce gait disturbances in patients with ET that are induced by DBS while preserving a level of tremor suppression equal to standard stimulation settings.

  • movement disorders
  • tremor
  • gait
  • deep brain stimulation
  • essential tremor
  • gait ataxia
  • gait assessment

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0

https://doi.org/10.1136/jnnp-2018-319427

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    Footnotes

    • Contributors DK and AK: study concept and design, project execution, data acquisition and processing, statistical analysis, manuscript preparation. SE: project execution, data processing, manuscript critique. A-CM: project execution, data acquisition, statistical analysis, manuscript critique.

    • Funding Grant from the German Research Council (DFG) Klinische Forschergruppe KFO247 and grant from NeuroCure, Centre of Excellence, Charité, Berlin to AK.

    • Competing interests DK, SE and A-CM declare no competing interests or financial dependencies. AK received honoraria from Medtronic, Boston Scientific and St Jude Medical, is member of an advisory board for Boston Scientific, received a travel grant from Boston Scientific, and received a research grant from Medtronic.

    • Patient consent for publication Not required.

    • Ethics approval The study was approved by the institutional review board of the Charité.

    • Provenance and peer review Not commissioned; externally peer reviewed.