Objective: to determine the practicabillity of using an image guide programming setting in our clinical practice.

Background: The applicability of DBS leads and systems that allow a more precise and accurate deliver of current to therapeutic targets is still unkown.Directional DBS promises several advantages: reduced adverse effects and elimination of manual programming. However, none of these has been achieved yet. And nowadays the challenge is to effectively and rapidly program these devices.

Methods: 5 patients (4 Parkinson and 1 essential tremor) were bilaterally implanted with directional leads (Vercise cartesia ™ Directional Lead); PC (1 IPG) and Vercise Gevia™ (4 IPG), Boston Scientific, Marlborough, USA) in the subthalamic nucleus (STN) (4PD patients) and Vim (ET patient) between May/2017 and February/2018 in the Unit of Functional Neurosurgery, Ramon y Cajal University Hospital, Madrid, Spain. They underwent an extended programming session of their DBS system in the practically defined medication off state (PD patients)(> 12 hours of medication withdrawal) 3 to 5 days (mean,3.2) postsurgery. The programming session was scheduled when the stun effect of electrode placement was decreasing. The programming session followed the procedure of a standard monopolar review, in which for each electrode configuration current thresholds are determined for complete rigidity and bradykinesia control and the first adverse event limiting further current increase. Different stimulation directions at each level were tested by restricting cathodal current to each of the three segments, on both segmented contacts. Brainlab Elements will be used considering the synergy with GUIDE XT, as Guide XT CE clearance is expected in the next few weeks. This will allow us to compare our manual programming with a patient-image guide programming.

Results: Will be pressented at the congress.

Conclusions: More studies are needed to analyze the applicability of directional DBS. Focusing on the fact that longer programming session might be needed initially, does not give justice to the opportunities that we may be able to offer to our patients with directional steering of the therapeutic current. Nowadays the challenge is to effectively and rapidly program these devices.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/directional-dbs-clinical-experience-at-unit-of-functional-neurosurgery-ramon-y-cajal-university-hospitalmadrid-spain/