Objective: To survey the long term effectiveness of the directional mode setting programs for Parkinson Disease patients with Subthalamic Deep Brain Stimulation (STN-DBS).

Background: Background: STN-DBS is a symptomatic established treatment for advanced Parkinson Disease (PD). Appropriate programming is essential for maximizing the effect of the therapy. Inappropriate setting results stimulation evoked complications such as capsular response or psychiatric problems. Directional lead is developed for fine stimulation controls. We evaluated long term outcome of STN-DBS using directional mode settings.

Method: Methods: We include forty-eight PD patients receiving STN-DBS in this study. These forty-eight patients received bilateral STN-DBS using Boston Scientific Vercise series IPGs and Boston Scientific Twist eight contacts DBS leads or Cartesia Directional leads. These patients were divided into two groups. Directional mode (DL) settings group includes patients implanted with directional leads and receiving DL setting programs. Patients implanted with conventional leads, or directional leads receiving ring mode setting programs were included to conventional (CV) setting group. We evaluated and compared long-term outcome of motor symptoms and DBS program at twelve and twenty-six weeks after implantation between DL setting group and CV setting group.

Results: Results: twenty-eight patients received DBS with directional lead, and eighteen of them received DL settings. There was no significant difference in UPDRS-III reduction rate (58.1% in DL and 58.9% in CV). The current value of the DL setting was lower than conventional mode settings (4.10±0.55mA in DL and 6.58±2.70mA in CV (p<0.05)).

Conclusion: Conclusions: although we could not detect the difference for motor improvement between the devices, the lower current was needed for DL settings compared to conventional settings. That meant directional mode DBS needed lower current for motor control. DL stimulation is hard to evoke complications, because lower stimulation is difficult to evoke complications. As the disease progresses, it is sometimes necessary to strengthen the current values, so the DL settings leaves room for future adjustment.

« Back to 2019 International Congress

MDS Abstracts - https://www.mdsabstracts.org/abstract/long-term-outcome-of-stn-dbs-for-parkinson-disease-patients-using-directional-mode-setting-programs/