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@ARTICLE{Steffen:874450,
      author       = {Steffen, Julia K. and Reker, Paul and Mennicken, Fiona K.
                      and Dembek, Till A. and Dafsari, Haidar S. and Fink, Gereon
                      R. and Visser‐Vandewalle, Veerle and Barbe, Michael T.},
      title        = {{B}ipolar {D}irectional {D}eep {B}rain {S}timulation in
                      {E}ssential and {P}arkinsonian {T}remor},
      journal      = {Neuromodulation},
      volume       = {23},
      number       = {4},
      issn         = {1525-1403},
      address      = {Oxford [u.a.]},
      publisher    = {Wiley-Blackwell},
      reportid     = {FZJ-2020-01451},
      pages        = {543-549},
      year         = {2020},
      abstract     = {ObjectiveTo compare directional monopolar, bipolar, and
                      directional bipolar thalamic deep brain stimulation (DBS) in
                      tremor patients.MethodsFourteen tremor patients (7 Essential
                      Tremor and 7 Parkinson's Disease) implanted with directional
                      DBS electrodes in the ventral intermediate nucleus (VIM)
                      were enrolled. Side‐effect thresholds of monopolar
                      directional stimulation (DIRECT) were compared to circular
                      DBS as well as, in a randomized design, to those of two
                      different bipolar stimulation settings (BIPOLAR = circular
                      anode; BI‐DIRECT = directional anode). Tremor suppression
                      (Tremor Rating Scale, TRS) right below the side‐effect
                      threshold was also assessed.ResultsDirectional DBS in the
                      individually best direction showed higher side‐effect
                      thresholds than circular DBS (p = 0.0063). The thresholds
                      were raised further using either one of the bipolar
                      stimulation paradigms (BIPOLAR p = 0.0029, BI‐DIRECT p
                      = 0.0022). The side‐effect thresholds did not differ
                      between both bipolar settings, but side‐effects were less
                      frequent with BI‐DIRECT. No difference in TRS scores with
                      stimulation just below the side‐effect threshold was found
                      between all stimulation conditions.ConclusionsSide‐effect
                      thresholds of monopolar directional and bipolar stimulation
                      with both circular and directional anodes were higher
                      compared to traditional monopolar circular stimulation in
                      the VIM. Bipolar DBS with directional anodes evoked
                      side‐effect less frequently than bipolar and monopolar
                      directional stimulation. All stimulation settings had
                      comparable effects on tremor suppression just below their
                      side‐effect thresholds. Thus, directional and different
                      bipolar settings should be explored in patients with
                      bothersome side‐effects of thalamic stimulation when
                      monopolar stimulation settings are not satisfying. Further
                      studies are needed to explore the efficiency of the
                      different bipolar stimulation paradigms.},
      cin          = {INM-3},
      ddc          = {610},
      cid          = {I:(DE-Juel1)INM-3-20090406},
      pnm          = {572 - (Dys-)function and Plasticity (POF3-572)},
      pid          = {G:(DE-HGF)POF3-572},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:32040883},
      UT           = {WOS:000540114400017},
      doi          = {10.1111/ner.13109},
      url          = {https://juser.fz-juelich.de/record/874450},
}