Objective: To examine the use of Deep Brain Stimulation (DBS) directional programming in Parkinson Disease (PD) and Essential Tremor (ET) patients

Background: DBS and its utility in treating symptoms in PD and ET has been known for the greater part of the last two decades. With newer and refined technology, the positioning of the electrodes in the brain along with current steering enables optimal utilization of the implanted system.

Method: In this retrospective analysis, we included patients implanted with directional leads who had undergone at least 2 months of programming. This included 13 ET patients (12 target bilateral Vim and 1 Left Vim) and 12 PD patients (target bilateral STN) that were implanted with directional  leads (4 contacts on each lead with the middle two contacts containing 3 segments each). We evaluated their clinical ratings (Fahn Tolosa Marsden Tremor Rating Scale or Unified Parkinson Disease Rating scale) before and after the procedure, and analyzed their programming settings for uptake in directional stimulation as well as reasons that lead to directional activation.

Results: In 12/13 ET  and all PD patients had at least one side that was on active directional stimulation. 5 ET patients and 8 PD patients ended up with directional configuration bilaterally. Factors that lead to directional programming in ET patients included capsular side effects avoidance in 6 patients, capsular side effects avoidance and better symptom control in 1 patient, capsular side effects and sensory side effects avoidance in 1 patient, and improved tremor control in 4 patients. Factors that lead to directional programming in PD patients included  capsular side effects avoidance in 6 patients, avoidance of autonomic dysfunction including feeling flushed in 1 patient, improved motor symptom control including toe curling and dyskinesia in 1 patient, and better symptom control in 4 patients

Conclusion: In our limited experience, we see very substantially high uptake in direction stimulation in PD (STN-DBS) and ET (Vim-DBS) . We note that our approach was limited to evaluating directional stimulation only when conventional stimulation was limited by side effects or symptom relief was suboptimal rather than proactively and systematically evaluating directionality. We anticipate higher uptake with a change in approach to that end. 
Will be presented at AAN 2021, April. #2638

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MDS Abstracts - https://www.mdsabstracts.org/abstract/dbs-directional-programming-institution-based-study-of-programming-in-pd-and-et-patients/