Objective: To review the use of directional current steering in a Berlin cohort implanted with segmented leads between 2016-2019.

Background: The dorsolateral area of the subthalamic nucleus (STN) should be targeted for effective deep brain stimulation (DBS) in Parkinson’s disease (PD). Suboptimal electrode placement may lead to higher current volumes and activate adjacent fibres, resulting in adverse effects such as dysarthria. Recently available segmented lead models enable directional current steering using the tripartite middle contacts of the electrode. The actual use of directional stimulation in clinical routine remains unknown even though an increased therapeutic window has been shown with the new technology in small patient cohorts.

Method: Medical records from all PD patients that underwent surgery for STN-DBS with segmented leads (Boston Scientific) between 2016-2019 at the Charité – Berlin were reviewed. Demographic data were assessed as well as the stimulation parameters on the 12-month follow-up visit (12MFU, range 9-16 months after surgery) and at last follow-up (LFU). Directional current steering was defined as the asymmetrical activation (least 5% mismatch) of the segmented contacts in at least 1 of the pairwise implanted electrodes.

Results: Between February 2016 and December 2019, 96 PD patients were implanted with segmented leads targeted at the STN (28f, 62 years±1; average±s.e.m.) in our centre. Last follow-up occurred on average 31 months after surgery (17-60 months). In total, 57.0% (45/79) had active directional current steering settings at the 12MFU (i.e. 34/79 ring mode). For 17 patients no information concerning 12MFU was available. At LFU, 60.0% (36/60) benefited from directional current steering settings (23/60 ring mode; 1/60 unknown). From the 36/96 Patients without LFU data: 22 12MFU=LFU, 14 LFU<17months postoperative.

Conclusion: We present data from a PD cohort implanted with segmented leads at our centre between 2016-2019. More than 50% of patients were set to directional stimulation parameters one year after surgery and this proportion was sustained at last follow-up. Our results show that directional steering is widely used in clinical DBS-programming routine. To what extent using this technology leads to greater clinical benefit from DBS should be explored in prospective studies taking into account main outcome parameters such as quality of life and PD motor scores.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/directional-steering-in-subthalamic-deep-brain-stimulation-for-parkinsons-disease-the-berlin-experience/