title: A pilot trial of square biphasic pulse deep brain stimulation for dystonia: The BIP dystonia study.
abstract: Dystonia often has inconsistent benefits and requires more energy-demanding DBS settings. Studies suggest that squared biphasic pulses could provide significant clinical benefit; however, dystonia patients have not been explored.
  
  
  
  To assess safety and tolerability of square biphasic DBS in dystonia patients.
  
  
  
  This study included primary generalized or cervical dystonia patients with bilateral GPi DBS. Square biphasic pulses were implemented and patients were assessed at baseline, immediately postwashout, post-30-minute washout, 1 hour post- and 2 hours postinitiation of investigational settings.
  
  
  
  Ten participants completed the study. There were no patient-reported or clinician-observed side effects. There was improvement across time on the Toronto Western Spasmodic Torticollis Rating Scale (χ2= 10.7; P = 0.031). Similar improvement was detected in objective gait measurements.
  
  
  
  Square biphasic stimulation appears safe and feasible in dystonia patients with GPi DBS. Further studies are needed to evaluate possible effectiveness particularly in cervical and gait features. © 2016 International Parkinson and Movement Disorder Society.
authors.affiliation: Department of Neurology, Center for Movement Disorders and Neurorestoration, University of Florida, Department of Neurology, Gainesville, Florida, USA.
authors.forename: Leonardo
authors.identifier: 0000-0002-0921-887X
authors.initials: L
authors.lastname: Almeida
authors.affiliation: Department of Neurology, Center for Movement Disorders and Neurorestoration, University of Florida, Department of Neurology, Gainesville, Florida, USA.
authors.forename: Daniel
authors.identifier: 0000-0001-8003-0610
authors.initials: D
authors.lastname: Martinez-Ramirez
authors.affiliation: Department of Neurology, Center for Movement Disorders and Neurorestoration, University of Florida, Department of Neurology, Gainesville, Florida, USA.
authors.forename: Bilal
authors.initials: B
authors.lastname: Ahmed
authors.affiliation: Department of Neurology, Center for Movement Disorders and Neurorestoration, University of Florida, Department of Neurology, Gainesville, Florida, USA.
authors.forename: Wissam
authors.initials: W
authors.lastname: Deeb
authors.affiliation: Department of Neurology, Center for Movement Disorders and Neurorestoration, University of Florida, Department of Neurology, Gainesville, Florida, USA.
authors.forename: Sol De
authors.initials: S
authors.lastname: Jesus
authors.affiliation: Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, Florida, USA.
authors.forename: Jared
authors.initials: J
authors.lastname: Skinner
authors.affiliation: Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, Florida, USA.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Terza
authors.affiliation: Department of Neurology, Brown University, Providence, Rhode Island, USA.
authors.forename: Umer
authors.initials: U
authors.lastname: Akbar
authors.affiliation: Neuromodulation Global Research, Medtronic Inc, Minneapolis, Minnesota, USA.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Raike
authors.affiliation: Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, Florida, USA.
authors.forename: Chris J
authors.initials: CJ
authors.lastname: Hass
authors.affiliation: Department of Neurology, Center for Movement Disorders and Neurorestoration, University of Florida, Department of Neurology, Gainesville, Florida, USA.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Okun
mesh_terms: D000328:Adult; D000368:Aged; D001703:Biophysics; D046690:Deep Brain Stimulation / Q000379:methods*; D004421:Dystonia / Q000628:therapy*; D005260:Female; D005917:Globus Pallidus / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010865:Pilot Projects; D012720:Severity of Illness Index; D055815:Young Adult
keywords: deep brain stimulation; dystonia; square biphasic stimulation