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Practical questions about programming of stimulator

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Hello Doctors Foote and Okune,

I was wondering-when do you use monopolar stimulering and when bipolar?Why do neurologists seem reluctant to use bipolar settings?

How do you know at what setting to put the Frequency of impulses to the brain?

There were many interesting questions and answers in the old forum.I feel I learned a lot just reading them. Any chance of having at least some of the old postings in an "archive" on this forum.Many thanks again for sharing your time and knowledge with the members of the forum.

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The entire old forum is archived and available anytime. You can email webmaster@parkinson.org and he will direct you.

 

We usually start in monopolar DBS settings but this is not an absolute. In this setting one of the four DBS contacts is set as a cathode and the pacemaker in the chest is the anode. It makes a big sphere of current.

 

When we switch to bipolar one contact is cathodal and another contact anodal and that makes an ellipse of the current. Many people use bipolar to limit side effects.

 

Mono and bi- are both ok and both can work. Most start mono- and switch if side effects.

 

Hope that helps.

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I have DBS, with tripolar settings on one side. Having read about them, and with, at the time, a bipolar setting of 5.2v on my bad side and slow speech (slower again when tired), I asked for tripolar to be tried. For me it worked, the setting on my bad side is now 4.3v tripolar and the speech has speeded up (slightly slurred when tired). However, the frog in my throat is still with me, only disappearing when I switch off.

 

My questions: Is there any way to ensure you get the best settings for you possible? Has there been anything written on what the various settings will produce in general terms? Is there any literature out there on the shape the various settings produce?

 

Thank you

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A tripolar setting is when you have one contact of the four set as the negative cathode, and the contacts adjacent both set as the anode (positive pole). Usually we set the device in monopolar (one cathode and the case in the chest as the anode), or bipolar where one contact is the anode and the other the cathode.

 

A tripolar occassionally works to spread current around a contact that has a hot spot surrounding the entire contact.

 

Erwin Montgomery at Wisconsin has a lot of information about specifics of programming on his website (you can google him). Also check the Medtronic website.

 

Dr. Tagliati has a chapter coming out in a new book edited By Dan Tarsy at Harvard that describes in detail programming. Finally if you go to www.pubmed.org and type in deep brain stimulation programming you can order articles. Jens Volkmann at Kiel, Germany has written a few nice reviews on the topic.

 

Good luck.

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