Comparison of Monopolar Review to Fixed Parameter Fractionation in Deep Brain Stimulation

Abstract

AbstractBackgroundTechnological advancements in deep brain stimulation (DBS) require methodological changes in programming. Fractionalization poses significant practical challenges for the most common approach for assessing DBS efficacy, monopolar review (MR).ObjectivesTwo DBS programming methods: MR and fixed parameter vertical and horizontal fractionalization (FPF) were compared.MethodsA two‐phase process of vertical and horizontal FPF was performed. MR was conducted thereafter. After a short wash‐out period, both optimal configurations determined by MR and FPF were tested in a double‐blind randomized manner.ResultsSeven PD patients were enrolled, providing 11 hemispheres to compare the two conditions. In all subjects, the blinded examiner selected a directional or fractionalization configuration. There was no significant difference in clinical benefits between MR and FPF. FPF was the preferred method for initial programming as selected by subject and clinician.ConclusionsFPF programming is a viable and efficient methodology that may be incorporated into clinical practice.