Objective: Implementation of directional stimulation of subthalamic nucleus with segmented leads guided by local field potential (LFP) recordings in order to personalize DBS parameters, optimize therapeutic window and minimizing side effects.

Background: Novel directional electrodes may have the advantage over the conventional ones of avoiding adverse effects, however the programming optimization could be very time-consuming.

Methods: Since March 2016 to December 2017, 14 patients have been implanted with 28 directional Vercise Cartesia leads (Boston SC). Mean age of patients were 54,6 years (37-74 years). Mean evolution was 9,2 years (5-18). Postoperatively CT scans/ MRI fusion were performed to asses lead placement. Local field potentials of all contacts from each lead in bipolar montage were recorded 5 days after surgery to analyze beta band peaks. Therapeutic window effect for rigidity were assessed blinded to LFP results at least 1 week after surgery.

Results: No postoperative complications after directional leads implantation were observed in any patient. LFP analyses showed significant beta peaks in 100% of patients. Directional deep brain stimulation guided by LFP widened therapeutic window to 39% compared to spherical stimulation. Negative correlation between beta band and final score for rigidity was found to be statistical significant (R -0,31). Contacts with higher beta power were selected for chronic stimulation of the subthalamic nucleus with good clinical response, obtaining 78% improvement in UPDRS-III, 82% reduction of medication.

Conclusions: Deep subthalamic stimulation with directional leads is safe and efficient. Local field potentials and beta oscillations could optimize settings parameters and alleviating programming burden as it seems to predict the optimal directional contact for improving rigidity. In advance, these neurophysiological parameters may be taken into consideration to personalize directional stimulation and can be time saving tools for programming.

References: Directional local field potentials: A tool to optimize deep brain stimulation. Tinkhauser G, Pogosyan A, Debove I, Nowacki A, Shah S.A, Seidel K, Tan H, Brittain J.S, Petermann K, di Biase L, Oertel M, Pollo C, Brown P, Schuepbach M. Mov Disord. 2018 Jan;33(1):159-164.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/directional-deep-brain-stimulation-in-parkinsons-disease-guided-by-local-field-potentials/