Objective: To evaluate how clinicians are implementing directional DBS technology in their routine care.

Background: Directional DBS is a new technology, which increases the clinician’s programming possibilities, but also its complexity. Little is known on how clinicians are dealing with these issues in daily practice.

Methods: An online survey was sent to 86 physicians with questions about their experience with directional STN DBS, practical issues regarding programming, and the clinical effect of directional DBS.

Results: A total of 29 physicians responded. Reactions showed considerable differences between directional DBS practices and protocols across centers. The reduction of stimulation-induced side-effects is the main reason to opt for directional DBS, with some clinicians also believing in a better motor effect of directional DBS when compared to ring-mode stimulation. However, the majority of physicians need more time to program directional DBS compared to ring-mode DBS, with programming times ranging from 0.5 to 5 hours in the first visit, and from 1 to 15 hours of programming time in the first 6 months of stimulation. The preferred approach to programming was a monopolar review of the 4 ring levels, with a subsequent directional review of the best ring level.

Conclusions: There is large practice variation regarding the application of directional DBS. This finding suggests that a uniform programming protocol is not yet determined. Evidence from prospective research is needed to evaluate whether, given the extra programming complexity, directional DBS has added value in the treatment of Parkinson’s disease.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/directional-deep-brain-stimulation-first-experiences-in-centers-across-the-globe/