Dayal, Viswas Vishnu;
(2020)
Optimising programming to reduce side effects of subthalamic nucleus deep brain stimulation in Parkinson’s Disease.
Doctoral thesis (Ph.D), UCL (University College London).
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Abstract
Subthalamic nucleus deep brain stimulation (STN DBS) is a widely used treatment for Parkinson’s disease patients with motor complications refractory to medical management. However, a significant proportion of treated patients suffer from stimulation induced side effects. Conventional options to address these by modulation of stimulation parameters and programming configurations have been limited. In recent years, technological advances have resulted in the emergence of novel programming features, including the use of short pulse width (PW) and directional steering, that represent further avenues to explore in this regard. In this thesis, I will present data on the utility of these programming techniques in alleviating stimulation induced side effects, and explore mechanisms that may mediate any observed effects. The data presented here is derived from four studies. Study 1 quantified the therapeutic window using short PW stimulation at 30μs relative to conventional 60μs settings. Study 2 represents a randomised controlled trial on short PW in chronic STN DBS patients with dysarthria. Study 3 evaluated the utility of directional steering, short PW, and the combination of these features in reversing stimulation induced dysarthria, dyskinesia, and pyramidal side effects. The findings of these studies suggest that short PW significantly increases the therapeutic window in terms of amplitude and charge, and that while it may not benefit chronic dysarthric patients collectively, directional steering and short PW can each significantly improve reversible stimulation induced side effects early in the course of STN DBS therapy. These novel techniques represent effective additional tools to conventional methods for optimising stimulation. In study 4, imaging and visualisation software are used to model and explore shifts in volume of tissue activated based on clinical data from study 3, and quantitatively compare charge per pulse, in order to explore potential mechanisms underlying the changes seen with these techniques.
| Type: | Thesis (Doctoral) |
|---|---|
| Qualification: | Ph.D |
| Title: | Optimising programming to reduce side effects of subthalamic nucleus deep brain stimulation in Parkinson’s Disease |
| Event: | UCL (University College London) |
| Open access status: | An open access version is available from UCL Discovery |
| Language: | English |
| Additional information: | Copyright © The Author 2020. Original content in this thesis is licensed under the terms of the Creative Commons Attribution 4.0 International (CC BY 4.0) Licence (https://creativecommons.org/licenses/by/4.0/). Any third-party copyright material present remains the property of its respective owner(s) and is licensed under its existing terms. Access may initially be restricted at the author’s request. |
| Keywords: | Parkinson's, Subthalamic nucleus, Deep Brain Stimulation |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > UCL Queen Square Institute of Neurology UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > UCL Queen Square Institute of Neurology > Clinical and Movement Neurosciences |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10108652 |
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