Objective: To evaluate, in patients with Parkinson’s disease (PD) undergoing subthalamic deep brain stimulation (STN-DBS), two methods for the initial programming of directional leads.

Background: DBS leads allowing directional stimulation could expand therapeutic window (TW) and improve managing of side effects [1]. However, no standardized programming guidelines are available so far.

Method: Eight patients were randomized to being programmed starting with either standard ring-mode (‘standard’) or with steered (‘steered’) stimulation. Initial programming was conducted in an open-label fashion during 5 weekly visits. TW, side effect type and threshold, UPDRS-III scores, and levodopa equivalent daily dose (LEDD) were recorded for each patient.

Results: Mean ages were similar (62.8±7.4 years in the standard stimulation vs. 64.0 ± 9.2 years in the steered stimulation, p= 0.84), as was disease duration (8.8±2.9 years vs. 12.0±1.0 years, p= 0.12). There was a significant difference between mean TW in standard vs. steered groups (2.0±0.7 mA vs. 2.4±0.9 mA, respectively, p= 0.036) and threshold for side effects (3.6±1.0 mA vs. 4.05±1.1 mA, respectively, p= 0.003). At the end of the study, all but one patient were on steered stimulation. Reasons for switching programming included dyskinesias (2 patients), dysarthria (1 patient) and stimulation-induced dystonia (1 patient). The only patient who maintained ring stimulation had dysarthria which improved after switching to low frequency stimulation. Side effects occurring in the steered group included one patient one patient with dyskinesias thought to be related to ongoing lesional effect. At the end of the study, all patients were considered to be optimally programmed, with improvement of side effects, with the exception of the patient with lesional-related dyskinesia. A mean 38.75% reduction of LEED (p=0.004) and 41.95% of UPDRS-III (p=0.008) was achieved compared to before DBS.

Conclusion: Steering stimulation increases the TW of electrodes and allows programming flexibility for managing side effects.

References: 1. Dembek TA, Reker P, Visser-Vandewalle V, et al. Directional DBS increases side-effect thresholds – A prospective double-blind trial. Mov Disord 2017;32:1380-1388.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/initial-programming-in-stn-dbs-for-parkinsons-disease-standard-vs-steered-stimulation/