Deep Brain Stimulation: When to Test Directional?

Debove, Ines; Petermann, Katrin; Nowacki, Andreas; Nguyen, Thuy-Anh Khoa; Tinkhauser, Gerd; Michelis, Joan Philipp; Muellner, Julia; Amstutz, Deborah; Bargiotas, Panagiotis; Fichtner, Jens; Schläppi, Janine Ai; Krack, Paul; Schuepbach, Michael; Pollo, Claudio; Lachenmayer, Martin Lenard (2023). Deep Brain Stimulation: When to Test Directional? Movement disorders clinical practice, 10(3), pp. 434-439. Wiley 10.1002/mdc3.13667

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BACKGROUND

Directional deep brain stimulation (DBS) allows for steering of the stimulation field, but extensive and time-consuming testing of all segmented contacts is necessary to identify the possible benefit of steering. It is therefore important to determine under which circumstances directional current steering is advantageous.

METHODS

Fifty two Parkinson's disease patients implanted in the STN with a directional DBS system underwent a standardized monopolar programming session 5 to 9 months after implantation. Individual contacts were tested for a potential advantage of directional stimulation. Results were used to build a prediction model for the selection of ring levels that would benefit from directional stimulation.

RESULTS

On average, there was no significant difference in therapeutic window between ring-level contact and best directional contact. However, according to our standardized protocol, 35% of the contacts and 66% of patients had a larger therapeutic window under directional stimulation compared to ring-mode. The segmented contacts warranting directional current steering could be predicted with a sensitivity of 79% and a specificity of 57%.

CONCLUSION

To reduce time required for DBS programming, we recommend additional directional contact testing initially only on ring-level contacts with a therapeutic window of less than 2.0 mA.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology
04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurosurgery
10 Strategic Research Centers > ARTORG Center for Biomedical Engineering Research

UniBE Contributor:

Debove, Ines, Petermann, Katrin, Nowacki, Andreas, Nguyen, Thuy Anh Khoa, Tinkhauser, Gerd, Michelis, Joan Philipp, Müllner, Julia Nicole Maria, Amstutz, Deborah, Bargiotas, Panagiotis, Fichtner, Jens, Schläppi, Janine Ai, Krack, Paul, Schüpbach, Michael, Pollo, Claudio, Lachenmayer, Lenard

Subjects:

600 Technology > 610 Medicine & health
500 Science > 570 Life sciences; biology

ISSN:

2330-1619

Publisher:

Wiley

Language:

English

Submitter:

Pubmed Import

Date Deposited:

24 Mar 2023 16:09

Last Modified:

24 Mar 2023 23:27

Publisher DOI:

10.1002/mdc3.13667

PubMed ID:

36949800

Uncontrolled Keywords:

Parkinson's disease current steering deep brain stimulation directional electrodes subthalamic nucleus

BORIS DOI:

10.48350/180615

URI:

https://boris.unibe.ch/id/eprint/180615

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