Objective: To investigate efficacy of STN-DBS via segmented directional leads compared to conventional omnidirectional leads in PD-patients.

Background: Recently, novel leads which allow stimulation steering in certain horizontal direction became widely available to use in DBS-surgery. However, potential benefits of their application for clinical outcome are not yet established assuming growing complexity of postoperative programming.

Method: We evaluated a group of PD-patients which underwent STN-DBS surgery in the last 2 years in our center. In 16 patients (32 leads), directional 8-contact electrodes were used (mean age at surgery 52.8±11.6 years, disease duration 13.8±4.3years, H&Y-stage 3.25±0.5). In other 16 patients operated in the same timeframe, conventional 4-contact electrodes were implanted (mean age at surgery 55.9±8.6years, disease duration 11.5±4.0years, H&Y-stage 3.25±0.5). Groups did not differ significantly in baseline clinical characteristics. Patients were operated by the same surgeon and surgical procedure was uniform. Neurological evaluation was performed preoperatively and at the 6-month follow-up (UPDRS, PDQ-39, Schwab&England, LEDD scoring). We analyzed programming settings and strategy in each patient.

Results: Following continuous STN-DBS, all patients experienced amelioration of parkinsonian symptoms in OFF-medication state. We observed no significant difference in clinical improvement between two groups. In patients with directional leads, mean OFF-state UPDRS-3 improved from 52.9 to 17.5; UPDRS-2 from 24.7 to 8.5 (compared to 50.0 to 11.9 and 22.2 to 9.5, respectively, in patients with conventional leads). Mean LEDD reduced from 1699 to 700mg and from 1780 to 649mg, respectively. Leads were carefully screened for the best level, then segmented ones – for the best direction of stimulation. At 3-month follow-up, in patients with segmented electrodes, directionality was used in 15 leads (9 patients, 56%). To the 6-month follow-up, 18 leads was programmed directionally (11 patients, 69%). Directionality was employed either for better efficacy or avoidance of side effects.

Conclusion: Early results of application of segmented electrodes are promising. Directional leads might permit more flexibility in programming and outcome optimization. Regarding higher complexity of programming, new automated algorithms of finding the best DBS settings are warranted.

References: 1. Dembek TA, Reker P, Visser-Vandewalle V, Wirths J, Treuer H, Klehr M, Roediger J, Dafsari HS, Barbe MT, Timmermann L. Directional DBS increases side-effect thresholds-A prospective, double-blind trial. Mov Disord. 2017 Oct;32(10):1380-1388. doi: 10.1002/mds.27093 2. Rebelo P, Green AL, Aziz TZ, Kent A, Schafer D, Venkatesan L, Cheeran B. Thalamic Directional Deep Brain Stimulation for tremor: Spend less, get more. Brain Stimul. 2018 May – Jun;11(3):600-606. doi: 10.1016/j.brs.2017.12.015 3. Shao MM, Liss A, Park YL, DiMarzio M, Prusik J, Hobson E, Adam O, Durphy J, Sukul V, Danisi F, Feustel P, Slyer J, Truong H, Pilitsis JG. Early Experience With New Generation Deep Brain Stimulation Leads in Parkinson’s Disease and Essential Tremor Patients. Neuromodulation. 2019 Aug 21. doi: 10.1111/ner.13034

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MDS Abstracts - https://www.mdsabstracts.org/abstract/directional-versus-conventional-subthalamic-deep-brain-stimulation-for-advanced-parkinsons-disease-short-term-outcomes-of-a-pilot-study/