Dosing gastric electrical stimulation
Gastric Electrical Stimulation (GES) is gaining renewed attention as a treatment for refractory gastroparesis. While the therapy has been well studied and shown in clinical trials to significantly improve nausea and vomiting symptoms associated with gastroparesis, recent insights suggest that how the therapy is delivered—specifically, through refined dosage of stimulation output—may be driving new clinical enthusiasm.
The role of dosage/titration
Advances in dosage methodology (also referred to as titration), including structured stimulation parameter algorithm approaches used by physicians, such as the table below created by Dr. Michael Awad, enable clinicians to systematically adjust stimulation settings to optimize symptom relief. Rather than treating GES as a fixed dose therapy, adjusting the stimulation parameters allows the physician to fine-tune the stimulation output resulting in a patient-specific intervention. This patient-centric approach to dosing may help patients find the Nausea and Vomiting relief they are looking for.
| Voltage (V) | On time (sec) | Off time (sec) | Frequency (Hz) | |
|---|---|---|---|---|
| Day of implant | 2.0-2.5 | 0.1 | 5 | 14 |
| 1 month (POV) | 3.5 | 0.1 | 5 | 14 |
| Patient visit 1 | 5.0 | 0.1 | 5 | 14 |
| Step 2 (if necessary) | 5.0 | 0.5 | 5 | 14 |
| Step 3 (if necessary) | 5.0 | 1 | 4 | 14 |
| Step 4 (if necessary) | 5.0 | 2 | 3 | 14 |
| Step 5 (if necessary) | 5.0 | 3 | 2 | 14 |
| Step 6 (if necessary) | 5.0 | 4 | 1 | 14 |
| Step 7 (if necessary) | 5.0 | 4 | 1 | 28 |
Stimulation Parameter Algorithm used by Dr. Michael Awad to achieve results in “Clinical Outcomes of a Large, Prospective Series of Gastric Electrical Stimulation Patients Using a Multidisciplinary Protocol” study.