title: Reversing the polarity of bipolar stimulation in deep brain stimulation for essential tremor: a theoretical explanation for a useful clinical intervention.
abstract: The quadripolar electrodes used for deep brain stimulation are designed to give flexibility in contact configuration, optimize therapeutic effect, and minimize side-effects. A patient with essential tremor did not tolerate a bipolar setting due to the emergence of a pulling sensation in her face. However, when the polarity of the contacts was reversed, a 70% higher voltage was tolerated. Using an electric field model, we predicted that this effect was due to the proximity of the topmost contact to the internal capsule. Post-operative imaging supported this prediction. These results demonstrate how a multi-disciplinary approach allows us to optimize parameter settings.
authors.affiliation: a Department of Medicine , Centre for Neuroscience, Imperial College London , London , UK.
authors.forename: Nada
authors.initials: N
authors.lastname: Yousif
authors.forename: Nicola
authors.initials: N
authors.lastname: Pavese
authors.forename: Mohammad J
authors.initials: MJ
authors.lastname: Naushahi
authors.forename: Dipankar
authors.initials: D
authors.lastname: Nandi
authors.forename: Peter G
authors.initials: PG
authors.lastname: Bain
mesh_terms: D046690:Deep Brain Stimulation / Q000009:adverse effects / Q000379:methods*; D020329:Essential Tremor / Q000628:therapy*; D005260:Female; D006801:Humans; D058542:Implantable Neurostimulators; D008875:Middle Aged; D008959:Models, Neurological