Dosing of Electrical Parameters in Deep Brain Stimulation (DBS) for Intractable Depression: A Review of Clinical Studies

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dc.contributor.authorRamasubbu, Rajamannar
dc.contributor.authorLang, Stefan
dc.contributor.authorKiss, Zelma H. T.
dc.date.accessioned2018-11-08T16:58:54Z
dc.date.available2018-11-08T16:58:54Z
dc.date.issued2018-01
dc.descriptionThis work was funded by Alberta Innovates Health Solutions. We thank the Alberta SPOR SUPPORT Unit Knowledge Translation Platform in literature search and Anthony Vu for assisting in tabulation of studies.en_US
dc.description.abstractBackground: The electrical parameters used for deep brain stimulation (DBS) in movement disorders have been relatively well studied, however for the newer indications of DBS for psychiatric indications these are less clear. Based on the movement disorder literature, use of the correct stimulation parameters should be crucial for clinical outcomes. This review examines the stimulation parameters used in DBS studies for treatment resistant depression (TRD) and their relevance to clinical outcome and brain targets. Methods: We examined the published studies on DBS for TRD archived in major databases. Data on stimulus parameters (frequency, pulse width, amplitude), stimulation mode, brain target, efficacy, safety, and duration of follow up were extracted from 29 observational studies including case reports of patients with treatment resistant unipolar, bipolar, and co-morbid depression. Results: The algorithms commonly used to optimize efficacy were increasing amplitude followed by changing the electric contacts or increasing pulse width. High frequency stimulation (>100 Hz) was applied in most cases across brain targets. Keeping the high frequency stimulation constant, three different combinations of parameters were mainly used: (i) short pulse width (60-90 us) and low amplitude (0-4 V), (ii) short pulse width and high amplitude (5-10 V), (iii) long pulse width (120-450 us) and low amplitude. There were individual variations in clinical response to electrical dosing and also in the time of clinical recovery. There was no significant difference in mean stimulation parameters between responders and non-responders suggesting a role for stimulation unrelated factors in response. Conclusions: Although limited by open trials and small sample size, three optimal stimulation parameter combinations emerged from this review. Studies are needed to assess the comparative efficacy and safety of these combinations, such as a registry of data from patients undergoing DBS for TRD with individual data on stimulation parameters.en_US
dc.identifier.citationRamasubbu, R., Lang, S., & Kiss, Z. H. T. (2018). Dosing of Electrical Parameters in Deep Brain Stimulation (DBS) for Intractable Depression: A Review of Clinical Studies. Frontiers in Psychiatry, 9. https://doi.org/10.3389/fpsyt.2018.00302en_US
dc.identifier.doi10.3389/fpsyt.2018.00302en_US
dc.identifier.doihttp://dx.doi.org/10.11575/PRISM/33902
dc.identifier.urihttp://hdl.handle.net/1880/109165
dc.language.isoenen_US
dc.publisherFrontiersen_US
dc.publisher.departmentClinical Neurosciencesen_US
dc.publisher.departmentPsychiatryen_US
dc.publisher.facultyCumming School of Medicineen_US
dc.publisher.hasversionPublisher's versionen_US
dc.publisher.institutionUniversity of Calgaryen_US
dc.publisher.policyhttps://www.frontiersin.org/journals/psychiatry/sections/neuroimaging-and-stimulation#OpenAccessen_US
dc.rightsCopyright © 2018 Ramasubbu, Lang and Kiss. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.en_US
dc.rights.urihttps://creativecommons.org/licenses/by/4.0en_US
dc.subjectdeep brain stimulationen_US
dc.subjectelectrical stimulationen_US
dc.subjectstimulation dosimetryen_US
dc.subjectstimulation parametersen_US
dc.subjecttreatment resistant depressionen_US
dc.titleDosing of Electrical Parameters in Deep Brain Stimulation (DBS) for Intractable Depression: A Review of Clinical Studiesen_US
dc.typejournal articleen_US
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