Objective: To assess DBS practitioners’ perceptions of the therapeutic window at the level of electrode contacts.

Background: Deep brain stimulation (DBS) is an effective treatment for movement disorders, but requires manual adjustment of multiple device parameters that influence therapeutic outcomes. Consequently, the perception of the size of the therapeutic window (TW) is variable among DBS centers.  This study aims to evaluate DBS practitioners’ perceptions of the therapeutic window at the level of individual electrode contacts, accounting for the spatial influence on its delineation.

Method: Clinical DBS programmers at the University of Florida were surveyed via REDCap on their perception of the therapeutic window with respect to amplitude, pulse width and frequency. Scores were aggregated and analyzed using bootstrap resampling with 1000 iterations to estimate the mean and 95% confidence interval (CI) of the therapeutic window based on the survey responses.

Results: The therapeutic window increased as contacts moved dosrally for all targets, with GPi demonstrating the highest thresholds (Figure 1).  The mean (95% CI) amplitude for contacts 0, 1, 2 and 3 in the GPi were 2.79 (2.50–3.04), 3.38 (3.13–3.63), 4.07 (3.79–4.36), and 4.25 (3.97–4.51) respectively. For the STN, the mean (95% CI) amplitude for contacts 0, 1, 2 and 3 were 2.06 (1.85–2.27), 2.42 (2.20–2.65), 2.62 (2.40–2.83), and 2.67 (2.47–2.86) respectively. In the VIM, the mean (95% CI) amplitude for contacts 0, 1, 2 and 3 were 2.36 (2.12–2.57), 2.98 (2.75–3.22), 3.23 (3.00–3.48), and 3.41 (3.19–3.63) respectively.

Conclusion: Practitioner perceptions of the DBS therapeutic window vary by target and contact level, supporting the anatomic considerations on therapeutic window estimation. This survey represents the first step towards establishing a universal standard for monopolar review and therapeutic window interpretation to facilitate improving DBS outcomes.

Figure 1.

« Back to 2025 International Congress

MDS Abstracts - https://www.mdsabstracts.org/abstract/perception-of-the-deep-brain-stimulation-therapeutic-window-an-anatomically-informed-survey/