Objective: To describe our long-term clinical experience with directional deep brain stimulation (d-DBS) in patients with advanced Parkinson’s disease (PD) who have been implanted with directional leads (d-leads) in the two subthalamic nuclei between 2016 and 2020.

Background: While conventional DBS leads stimulate the surrounding tissue omnidirectionally, d-leads incorporate three functionally independent segments that allow directing the current toward the intended target. Several recent investigations have demonstrated the superiority of d-DBS in the therapeutic window and the incidence of adverse effects. However, there is still a paucity of scientific literature on the real-life experiences of the long-term use of d-DBS.

Method: 31 PD patients implanted with d-DBS systems between 2016 and 2020 in our centre were identified in order to assess retrospectively the frequency of directional programming settings in the short and long term. After the exclusion of 5 patients (1 unrelated death and 4 patients with participation in another study), 26 patients (11 women,15 men) remained. Apart from demographical information, the DBS parameter settings of the 52 leads at the baseline programming visit as well as in March 2023 were collected from the medical records. Furthermore, the reasons for changing from d-DBS to omnidirectional stimulation were also analysed.

Results: At the baseline visit, d-DBS was chosen as the initial programming setting in at least one lead in 20 from 26 patients (77%). Of the total 52 leads, directional stimulation was used in 37 leads (71%), while omnidirectional stimulation was preferred only in 15 (28%). In this visit, the most frequent setting was single-segment monopole (33), followed by ring monopole (15), two-segment dipole (2), two-segment monopole (1) and compound monopole (1). The 1st of March 2023 (established as the clinical data cut-off date) was separated by a mean time of 4.81 years (2.5-6.8) from the baseline programming visits. After these years, the majority of leads (65%) were still programmed with directional stimulation. The main reasons for switching to omnidirectional stimulation included insufficient motor control, the need for advanced programming techniques and the prevention of dyskinesia.

Conclusion: Our clinical practice shows a more frequent implementation of d-DBS over omnidirectional in the short and long term, thus supporting the idea that its advantages persist despite the disease’s progression.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/directional-deep-brain-stimulation-therapy-in-the-long-term/