Objective: To assess the outcome of patients with advanced Parkinson’s disease (PD) treated with directional DBS.

Background: Subthalamic deep brain stimulation (STN-DBS) has proved to be an efficient option for treatment of advanced PD. Frequently, the benefit of STN-DBS stimulation is diminished by the side effects such as dysarthria, paresthesia and poor balance. These adverse effects could be averted with directional DBS. We report the outcome of first 12 patients with directional DBS treated in Finland.

Methods: The patient eligibility for DBS was based on general clinical guidelines. Levodopa equivalent doses (LED) and Unified Parkinson’s Disease Rating scale part III scores at medication off (UPDRS-III med off) were obtained at the screening visit and UPDRS-III at medication off, DBS on (UPDRS-III med off, DBS on) at the 3 months’ follow up. DBS operations were performed according to common clinical practice. Monopolar survey on DBS electrodes and the choice of the best active segment was conducted at 1 or 3 month’s programming.

Results: Bilateral directional DBS were applied with twelve patients with advanced PD. There were not any complications related to DBS operation. Median preoperative LED was 1016 mg (range 355 – 2777 mg) and at 3 months’ follow up LED was reduced to 652 mg (range 182 – 1148 mg). Baseline median UPDRS-III med off was 37 points (range 28 – 60 points), and 28 points (range 18-48 points) at 3 months’ follow up, 24 % decrease (Wilcoxon signed rank test=0.05). Three patients had one directional segment active bilaterally and four patients two segments bilaterally active at 3 months’ follow up. Two patients had two segments active unilaterally. Only three patients had bilaterally active ring-mode. Eleven patients had multiple programs with one or two active directional segments. Median amplitude was 2.6 mA (range 1.25 – 3.75 mA), pulse width 60 us (range 55 – 75 us) and frequency 130 Hz (range 130 – 180 Hz). No stimulation related side effects were reported. Therapeutic window for directional stimulation was 2 – 3.6 mA.

Conclusions: STN-DBS with directional stimulation improves motor symptoms in patients with advanced PD and enables LED reduction. Our results suggest that directional stimulation reduces frequent DBS-related side effects.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/the-outcome-of-directional-subthalamic-deep-brain-stimulation-in-advanced-parkinsons-disease/