Objective: To evaluate the application of commonly available advanced programming strategies in deep brain stimulation (DBS) of the subthalamic nucleus (STN) in patients with Parkinson’s Disease (PD) as per clinical routine at our center.

Background: STN-DBS is a well-established treatment for advanced PD. Recent technical developments allow advanced programming strategies, such as vertical and directional current steering, shorter pulse widths, variation of stimulation frequencies, bipolar, and interleaving stimulation. However, their application in clinical routine has not yet been systematically reported.

Method: In this cross-sectional study, we retrospectively analyzed the stimulation settings of PD patients with STN-DBS 12 months after DBS surgery. Only patients implanted with a DBS device capable of advanced programming strategies were included. Advanced programming strategies were defined as 1) directional current steering, 2) vertical current steering, 3) pulse width ≠ 60 µs, 4) frequency ≠ 130 Hz, 5) bipolar stimulation settings, and 6) interleaving stimulation.

Results: Stimulation settings of a total of 121 patients, implanted with bilateral STN-DBS between August 2016 and February 2022 at the University Hospital Cologne, were retrospectively analyzed at the regular 12 months follow-up visit. At least one advanced programming strategy was applied in 70 % (N = 85) of all patients. Directional current steering was applied in 35 % (N = 42) of the patients. Vertical steering was applied in 30 % (N = 36). In 26 % of the patients (N = 31) a frequency ≠ 130 Hz was chosen (N = 12 <130 Hz, N = 19 >130 Hz). A variation of pulse widths was applied in 25 % of the patients (N = 30), preferably by the usage of shorter pulse widths (N = 28). Bipolar stimulation (2 %, N = 2) and interleaving stimulation settings (1 %, N = 1) were only applied sporadically. In 34 % of the patients ≥ 2 advanced programming strategies (N = 41) were combined.

Conclusion: The recent technical innovations in the field of DBS, allowing for advanced programming strategies, are well-established and widely used in clinical routine at a center specialized in the care of patients with PD and DBS. Future studies should focus on when to apply which paradigm in chronic DBS to optimize the individual patient’s outcome.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/advanced-programming-strategies-in-subthalamic-dbs-just-a-gimmick-or-well-established-in-clinical-routine/