Directional Deep Brain Stimulation Programming: Is the Segment Clearly Identifiable and Stable Over Time?

Area of Science:

• Neurology
• Biomedical Engineering

Background:

• Directional deep brain stimulation (d-DBS) programming in Parkinson's disease (PD) may require adjustments over time.
• Investigating the consistency of optimal electrode selection is crucial for reliable d-DBS therapy.

Purpose of the Study:

• To assess the reliability and stability of optimal electrode selection in d-DBS programming for PD.
• To evaluate inter-rater and intra-rater agreement on optimal electrode selection over time.

Main Methods:

• Prospective, double-blind study involving 21 PD patients undergoing d-DBS.
• Mono-polar surveys were conducted four times by two separate assessors at 1 and 6 months.
• Primary aim: inter-rater agreement; Secondary aim: intra-rater agreement.

Main Results:

• Fair inter-rater agreement at 1 month, improving to moderate at 6 months.
• Minimal intra-rater agreement was observed between 1 and 6 months.
• The study's hypothesis of high agreement was refuted.

Conclusions:

• Low agreement suggests the subjective nature of identifying optimal electrodes or acute stimulation changes.
• Programmers should consider exploring different electrode montages periodically.
• Reviewing directional electrode montages may be best guided by clinical symptoms or disease progression.