Objective: Show how directional steering stimulation can avoid non motor adverse effects in Parkinson disease patient underwent DBS.

Background: Deep brain stimulation (DBS) has become a widely performed procedure for treatment of advanced medication-refractory Parkinson’s disease, however up to 50% patients may suffer adverse effects because the volume of tissue activation with cylindrical shape, produced by conventional electrodes, can extend to boundary areas of subthalamic nucleus. A novel neurostimulation system through directional leads allows steering current in horizontal directions and avoid this symptoms.

Methods: We report a 44-year-old woman with Parkinson’s disease for 6 years, suffering motor fluctuations, dyskinesia and freezing of gait episodes. Neuropsychological evaluation doesn´t reveal any abnormality. Patient underwent bilateral STN. She was implanted with directional electrodes. Vercise Cartesia leads (Boston SC). After surgery, 3D-XRay Skull was performed and fused with previous MRI and the DTI tactography traced from cortical areas to each STN.

Results: Conventional monopolar revision was performed. During left STN stimulation in ring fashion, (2-3-4) as cathode, (C+) with a spherical volume activation, rigidity improved significantly but patient presented an uncontrollable mirthful laughter. Stimulation was then switched to directional fashion where laughter remained with more posterior contact (3-C+) at 2,8mA 60mcs 130Hz but not with 2- or 4- at the same parameters. Possible anatomic structures are discussed. With chronic DBS stimulation (4 months follow-up) initial UPDRS-III score passed from 38 to 8, and medication could be reduced in 90% (LED).

Conclusions: This case represents a clear example that STN stimulation affect not only the motor, but also the limbic and associative loops. Directional electrodes can be a good option to avoid not only undesirable capsular or lemniscal effects but also the limbic/associative ones.

References: P. Krack, R. Kumar, C. Ardouin et al., “Mirthful laughter induced by subthalamic nucleus stimulation,” Movement Disorders, vol. 16, no. 5, pp. 867–875, 2001.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/mirthful-laughter-avoided-by-directional-stimulation-in-a-parkinsons-disease-patient-treated-with-deep-brain-stimulation/