Objective: To evaluate the use of segmented lead technology in clinical routine in patients undergoing subthalamic nucleus deep brain stimulation (STN-DBS).

Background: Due to the small size of the STN, a primary target of DBS in PD patients, side effects can arise from slight suboptimal placement of DBS leads. The new technology of directional leads may provide an option for current shaping with the aim to direct the volume of activated tissue (VTA) towards the sensorimotor STN sweet spot for PD and thereby reducing side effects while allowing optimal stimulation intensity.

Methods: We implanted 38 PD patients targeting the STN using directional leads (Boston Scientific). Leads are implanted using MRI based preoperative planning, intraoperative microelectrode recording and macrostimulation. In 31/38 patients that reached the 3 months follow-up, a standard monopolar review was performed using ring mode stimulation. In case of DBS-induced side effects or limited efficacy, further testing was performed for each segmented contact. Eight patients reached the 12 months follow-up visit with standard UPDRS testing. Stimulation parameters were collected from all patients at follow up visits to evaluate the percentage of patients using directional mode for chronic DBS.

Results: Patients’ mean age was 62 ± 8 years (36-75y, 9 female) and mean disease duration 11 ± 4 years (4-19y). After 3 months FU, 13/31 (42%) patients were stimulated using directional mode and 16/31 (52%) patients in ring mode. For the remaining 2 patients the mode was not finally defined during FU and 7 patients just recently underwent DBS surgery. Directional mode was not always used for both hemispheres [n=23 (37%) leads in directional mode, and n=35 (56%) in ring mode].

Conclusions: Here, we present first clinical experience using directional leads for STN DBS in PD patients. In about 37% of hemispheres directional settings have been chosen. Although directional leads offer a vast variety of stimulation refinement, they impose a challenge towards clinicians’ time and experience as well as patients to test different stimulation. By further analyzing motor assessment, we hope to expand the knowledge about a possible decrease of side effects while preserving motor improvement through more specific targeting of the STN DBS sweet spot in PD patients.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/single-centre-experiences-of-directional-leads-in-parkinson-patients/