Session Time: 1:45pm-3:15pm
Location: Exhibit Hall C
Objective: Here, we present our 3-month clinical experience with subthalamic directional DBS in treating Parkinson’s disease (PD) symptoms.
Background: Directional Deep Brain Stimulation (DBS) is the latest innovation that enables the clinician to customize the stimulation field based on the final lead position. Although acute directional lead programming experiences in movement disorder patients have been disseminated, there is no published evidence of the resulting chronic clinical efficacy.
Methods: Twelve patients were bilaterally implanted in the subthalamic nucleus with the Infinity Directional System (St. Jude Medical) for treatment of PD symptoms. During the initial programming session, omnidirectional stimulation (ODS) was utilized if the patient experienced satisfactory symptom relief with no stimulation-related side effects (SRSEs). If SRSEs were observed, uni- or bi-directional stimulation (DS) was used. UPDRS III and levodopa equivalent dose (LED) calculations were utilized to compare changes in clinical efficacy and medication usage, respectively, between baseline and the 3-month post-activation visit.
Results: Six patients (50%) were programmed using DS to achieve the most optimal therapeutic efficacy while avoiding SRSEs. At the 3-month visit, UPDRS III was about one third lower in MED OFF/STIM ON compared to MED OFF/STIM OFF in both ODS (31%) and DS (30%) group. Compared to presurgical baseline MED OFF values, MED OFF/STIM ON showed an improvement of 18% in ODS patients and 25% in the DS group. UPDRS III scores in MED OFF/STIM OFF were higher than baseline MED OFF results (19% in the ODS group, 8% in the DS group) possibly due to tremor rebound. Mean LED decreased by 310mg (33%) and 452mg (29%) in the ODS and DS groups, respectively, compared to baseline.
Conclusions: Limitations for this retrospective analysis include lack of double-blinded assessments as well as a limited sample size. Directional current steering may provide clinically significant symptom relief in PD patients, especially if beneficial effects gained by omnidirectional stimulation are constrained by accompanying side effects. Larger, randomized clinical trials are essential to validate this observation.
To cite this abstract in AMA style:C. Hartmann, L. Venkatesan, P. Slotty, J. Vesper, A. Schnitzler. Clinical utility of chronic directional subthalamic Deep Brain Stimulatoin in Parkinson’s Disease [abstract]. Mov Disord. 2017; 32 (suppl 2). https://www.mdsabstracts.org/abstract/clinical-utility-of-chronic-directional-subthalamic-deep-brain-stimulatoin-in-parkinsons-disease/. Accessed December 7, 2023.
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MDS Abstracts - https://www.mdsabstracts.org/abstract/clinical-utility-of-chronic-directional-subthalamic-deep-brain-stimulatoin-in-parkinsons-disease/