Objective: The objective of the present study was determinate the clinical benefits using directional leads in DBS in two different centers.

Background: Deep brain stimulation (DBS) is an effective therapy in the symptomatic treatment of different movement disorders, but stimulation efficacy may be limited by the diffusion of the current towards adjacent structures, which can cause adverse effects (AEs) and often prevent optimal clinical results. Using recently-developed directional, current steering becomes an option, to increase the therapeutic window.

Method: Prospective multicenter study of 20 patients who were implanted with directional electrodes due to movement disorders, 10 from the Clinical Hospital of Barcelona, Spain and the remaining, from the Latin American Institute of Neurology and Nervous System (ILANS) of Colombia. All of them underwent a monopolar review to choose the best contact, and
if adverse effects appeared, directional stimulation was used. The results in effectiveness, adverse effects and activated tissue volume were then compared.

Results: During the study period, 3 males and 7 females were implanted with a D-DBS system for drug-refractory disabling movement disorders. After monopolar review and follow up, five of the 20 patients had optimal clinical effects without the appearance of AEs. The remaining 15 patients (75%) presented AEs with standard DBS during programming, preventing us from increasing the current intensity; they also had some persisting clinical residual problems that were considered to be bothersome for the patient. The AEs that justified changing to D-DBS were attributed to 22 of the 40 electrodes. In patients in whom D-DBS was necessary (n=15), the AEs disappeared when stimulation was guided in the opposite direction to the anatomical theoretical area causing the AE. An overall increase in the AET of 0.8 mA (30% higher than BCS) was possible with D-DBS, leading to better clinical outcomes.

Conclusion: This prospective study shows that D-DBS is safe and can be a useful tool to minimize side effects and improve clinical results. Most patients presented better clinical outcomes using D-DBS compared with standard circular stimulation.

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