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Long-Term Clinical Experience with Directional Deep Brain Stimulation Programming: A Retrospective Review
Jessica A Karl1, Jessica Joyce2, Bichun Ouyang2
1Movement Disorder Division of the Department of Neurological Sciences at Rush University Medical Center, 1725 W. Harrison St, Suite 755, Chicago, IL, 60612, USA. Jessica_karl@rush.edu.
Neurology and Therapy
|July 1, 2022
Summary
Directional deep brain stimulation (d-DBS) programming was used in 39-68% of Parkinson
Area of Science:
- Neurosurgery
- Neurology
- Biomedical Engineering
Background:
- Directional deep brain stimulation (d-DBS) offers precise control over the activated tissue volume, potentially enhancing therapeutic benefits and minimizing side effects.
- Clinical trials indicate d-DBS with directional electrodes provides a wider therapeutic window.
- The clinical rationale and implementation patterns for directional programming remain underexplored.
Purpose of the Study:
- To investigate the prevalence and clinical motivations behind using directional programming in deep brain stimulation.
- To evaluate the adoption and reasons for utilizing directional electrodes in patients with Parkinson's disease and essential tremor.
Main Methods:
- A retrospective review of patients with Parkinson's disease (PD) and essential tremor (ET) who received deep brain stimulation (DBS) using the Abbott Infinity system.
- Data collected included stimulation parameters, use of directional electrodes, advanced programming techniques, and reasons for directional programming at multiple follow-up intervals (3, 12, 24, and 36 months).
Main Results:
- Of the patients studied, 39-68% with PD and 50-72% with ET utilized at least one directional electrode lead.
- Primary reasons for directional programming included improved symptom control, reduced side effects, or a combination of both.
- In essential tremor patients, improved battery longevity and therapeutic window were additional cited reasons.
Conclusions:
- Directional programming is frequently employed in both Parkinson's disease and essential tremor patients to optimize therapeutic outcomes and mitigate side effects.
- Initial higher utilization in ET compared to PD evolved over time, suggesting increasing experience and application of directional DBS for complex symptom management.
- Directional electrodes provide a valuable alternative to conventional omnidirectional stimulation for refining DBS therapy.
