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Long-Term Clinical Experience with Directional Deep Brain Stimulation Programming: A Retrospective Review

INTRODUCTION: Directional deep brain stimulation (d-DBS) axially displaces the volume of tissue activated (VTA) towards the intended target and away from neighboring structures potentially improving benefit and reducing side effects (SE) of stimulation. A clinical trial evaluating d-DBS demonstrated...

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Autores principales: Karl, Jessica A., Joyce, Jessica, Ouyang, Bichun, Verhagen Metman, Leo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Healthcare 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9338213/
https://www.ncbi.nlm.nih.gov/pubmed/35776383
http://dx.doi.org/10.1007/s40120-022-00381-5
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author Karl, Jessica A.
Joyce, Jessica
Ouyang, Bichun
Verhagen Metman, Leo
author_facet Karl, Jessica A.
Joyce, Jessica
Ouyang, Bichun
Verhagen Metman, Leo
author_sort Karl, Jessica A.
collection PubMed
description INTRODUCTION: Directional deep brain stimulation (d-DBS) axially displaces the volume of tissue activated (VTA) towards the intended target and away from neighboring structures potentially improving benefit and reducing side effects (SE) of stimulation. A clinical trial evaluating d-DBS demonstrated a wider therapeutic window (TW) with directional electrodes. While this seems advantageous, it remains unclear when and why directional stimulation is chosen clinically. To evaluate the implementation of d-DBS in our practice we examined the prevalence of and motivation for directional programming. METHODS: A retrospective review was completed in consecutive patients with Parkinson’s disease (PD)/essential tremor (ET) implanted with the Abbott Infinity system from December 2016 to January 2020. At 3, 12, 24, and 36 months we extracted post-DBS stimulation parameters; use of directional electrodes and other advanced programming techniques; and reasons for directional programming. RESULTS: Fifty-six patients with PD and 18 patients with ET (104 and 33 leads, respectively) were identified. The numbers of patients programmed with a directional electrode in at least one DBS lead in PD and ET, respectively, were 22/56 (39%) and 13/18 (72%) at 3 months; 19/48 (40%) and 8/12 (67%) at 12 months; 12/31 (39%) and 5/8 (63%) at 24 months; and 6/9 (67%) and 1/2 (50%) at 36 months. In PD and ET, reasons for using directional stimulation were better symptom control, less SE, or combination of better symptom control/SE; additional reasons in ET were improved battery/TW%. CONCLUSION: Over a 36-month time period 39–68% of patients with PD and 50–72% of patients with ET had at least one lead programmed directionally in order to either improve symptom control or reduce side effects, an option not available with conventional omnidirectional stimulation. Initially directional electrodes were used in ET more frequently than PD, likely because of the less complex nature of programming for a monosymptomatic disorder. However, over time this shifted as we gained directional experience and sought solutions to reduce worsening symptoms. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40120-022-00381-5.
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spelling pubmed-93382132022-07-31 Long-Term Clinical Experience with Directional Deep Brain Stimulation Programming: A Retrospective Review Karl, Jessica A. Joyce, Jessica Ouyang, Bichun Verhagen Metman, Leo Neurol Ther Original Research INTRODUCTION: Directional deep brain stimulation (d-DBS) axially displaces the volume of tissue activated (VTA) towards the intended target and away from neighboring structures potentially improving benefit and reducing side effects (SE) of stimulation. A clinical trial evaluating d-DBS demonstrated a wider therapeutic window (TW) with directional electrodes. While this seems advantageous, it remains unclear when and why directional stimulation is chosen clinically. To evaluate the implementation of d-DBS in our practice we examined the prevalence of and motivation for directional programming. METHODS: A retrospective review was completed in consecutive patients with Parkinson’s disease (PD)/essential tremor (ET) implanted with the Abbott Infinity system from December 2016 to January 2020. At 3, 12, 24, and 36 months we extracted post-DBS stimulation parameters; use of directional electrodes and other advanced programming techniques; and reasons for directional programming. RESULTS: Fifty-six patients with PD and 18 patients with ET (104 and 33 leads, respectively) were identified. The numbers of patients programmed with a directional electrode in at least one DBS lead in PD and ET, respectively, were 22/56 (39%) and 13/18 (72%) at 3 months; 19/48 (40%) and 8/12 (67%) at 12 months; 12/31 (39%) and 5/8 (63%) at 24 months; and 6/9 (67%) and 1/2 (50%) at 36 months. In PD and ET, reasons for using directional stimulation were better symptom control, less SE, or combination of better symptom control/SE; additional reasons in ET were improved battery/TW%. CONCLUSION: Over a 36-month time period 39–68% of patients with PD and 50–72% of patients with ET had at least one lead programmed directionally in order to either improve symptom control or reduce side effects, an option not available with conventional omnidirectional stimulation. Initially directional electrodes were used in ET more frequently than PD, likely because of the less complex nature of programming for a monosymptomatic disorder. However, over time this shifted as we gained directional experience and sought solutions to reduce worsening symptoms. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40120-022-00381-5. Springer Healthcare 2022-07-01 /pmc/articles/PMC9338213/ /pubmed/35776383 http://dx.doi.org/10.1007/s40120-022-00381-5 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by-nc/4.0/Open AccessThis article is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which permits any non-commercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Original Research
Karl, Jessica A.
Joyce, Jessica
Ouyang, Bichun
Verhagen Metman, Leo
Long-Term Clinical Experience with Directional Deep Brain Stimulation Programming: A Retrospective Review
title Long-Term Clinical Experience with Directional Deep Brain Stimulation Programming: A Retrospective Review
title_full Long-Term Clinical Experience with Directional Deep Brain Stimulation Programming: A Retrospective Review
title_fullStr Long-Term Clinical Experience with Directional Deep Brain Stimulation Programming: A Retrospective Review
title_full_unstemmed Long-Term Clinical Experience with Directional Deep Brain Stimulation Programming: A Retrospective Review
title_short Long-Term Clinical Experience with Directional Deep Brain Stimulation Programming: A Retrospective Review
title_sort long-term clinical experience with directional deep brain stimulation programming: a retrospective review
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9338213/
https://www.ncbi.nlm.nih.gov/pubmed/35776383
http://dx.doi.org/10.1007/s40120-022-00381-5
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