Directional Deep Brain Stimulation for Parkinson's Disease: Results of an International Crossover Study With Randomized, Double-Blind Primary Endpoint

Schnitzler, Alfons; Mir, Pablo; Brodsky, Matthew; Verhagen, Leo; Groppa, Sergiu; Álvarez, Ramiro; Evans, Andrew; Blázquez, Marta; Nagel, Sean J.; Pilitsis, Julie G.; Poetter‐Nerger, Monika; Tse, Winona; Almeida, Leonardo; Tomycz, Nestor D.; Jimenez‐Shahed, Joohi; Libionka, Witold; Carrillo, Fátima; Hartmann, Christian; Groiss, Stefan Jun; Gläser, Martin; Defresne, Florence; Karst, Edward; Cheeran, Binith; Vesper, Jan

doi:10.1111/ner.13407

Cited by 38 publications

(40 citation statements)

References 32 publications

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“…30 The PROGRESS trial examined the changes in therapeutic window of 234 patients with PD implanted with bilateral segmented electrodes in the subthalamic nucleus. 31 Similarly to the other studies, this trial showed expansion of the therapeutic window by an average of 41% in 90.6% of patients when implementing directional stimulation compared with omnidirectional DBS; however, there were no significant improvements in stimulator battery life or motor outcomes. 31 Interestingly, the PROGRESS trial did find that both clinicians and patients preferred dDBS over omnidirectional DBS stimulation.…”

Section: Clinical Outcomes Data For Directional Deep Brain Stimulationsupporting

confidence: 54%

Directional Deep Brain Stimulation in the Treatment of Parkinson's Disease

Mishra¹,

Ramdhani²

2022

Neurology

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Deep brain stimulation (DBS) is a treatment modality that has been shown to improve the clinical outcomes of individuals with movement disorders, including Parkinson's disease. Directional DBS represents an advance in the field that allows clinicians to better modulate the electrical stimulation to increase therapeutic gains while minimizing side effects. In this review, we summarize the principles of directional DBS, including available technologies and stimulation paradigms, and examine the growing clinical study data with respect to its use in Parkinson's disease.

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Section: Clinical Outcomes Data For Directional Deep Brain Stimulationsupporting

confidence: 54%

Directional Deep Brain Stimulation in the Treatment of Parkinson's Disease

Mishra¹,

Ramdhani²

2022

Neurology

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“…Indirectly, this is an indication of its usefulness in optimizing stimulation outcomes. In this context it should be noted that the Progress study did not find differences in UPDRS-III scores, whereas patient and clinician preference significantly favored directional DBS over non-directional [1]. One way to interpret those results is that small but important benefits, for instance on gait, or side effects such as dysarthria may wash out in UPDRS-III summary scores but are important to patients and may motivate the clinician to change stimulation parameters.…”

Section: Discussionmentioning

confidence: 89%

“…Directional deep brain stimulation (d-DBS) axially displaces the volume of tissue activated towards the intended target and away from neighboring structures, potentially improving the benefit and reducing side effects of stimulation. A large prospective, randomized, multicenter, crossover study evaluating d-DBS has demonstrated a wider therapeutic window (TW) with directional stimulation than with conventional, omnidirectional stimulation in 90% of cases [1]. While a large TW intuitively seems advantageous, it is not clear how often and for what reasons directional stimulation is used in clinical practice.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2022

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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

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“…In particular, the stimulation amplitude for symptom relief was reduced, while the threshold for the induction of side effects was incremented. The real-world differences between directional and omnidirectional STN-DBS in PD patients were recently assessed in a large, prospective, international, multicenter, double-blind randomized crossover study 35 .…”

Section: Discussionmentioning

confidence: 99%

Short pulse and directional thalamic deep brain stimulation have differential effects in parkinsonian and essential tremor

Hidding

Schaper

Gulberti

et al. 2022

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The aim of this study was to assess the effects of novel stimulation algorithms of deep brain stimulation (short pulse and directional stimulation) in the ventrointermediate thalamus and posterior subthalamic area (VIM/PSA-DBS) on tremor in Parkinson’s disease (PD) and to compare the effects with those in essential tremor (ET). We recruited six PD patients (70.8 ± 10.4 years) and seven ET patients (64.4 ± 9.9 years) with implanted VIM/PSA-DBS in a stable treatment condition (> 3 months postoperatively). Tremor severity and ataxia were assessed in four different stimulation conditions in a randomized order: DBS switched off (STIM OFF), omnidirectional stimulation with 60 µs (oDBS60), omnidirectional stimulation with 30 µs (oDBS30), directional stimulation at the best segment with 60 µs (dDBS60). In both patient groups, all three DBS stimulation modes reduced the total tremor score compared to STIM OFF, whereas stimulation-induced ataxia was reduced by oDBS30 and partially by dDBS60 compared to oDBS60. Tremor reduction was more pronounced in PD than in ET due to a limited DBS effect on intention and action-specific drawing tremor in ET. In PD and ET tremor, short pulse or directional VIM/PSA-DBS is an effective and well tolerated therapeutic option.Trial registration: The study was registered in the DRKS (ID DRKS00025329, 18.05.2021, German Clinical Trials Register, DRKS—Deutsches Register Klinischer Studien).

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Directional Deep Brain Stimulation for Parkinson's Disease: Results of an International Crossover Study With Randomized, Double-Blind Primary Endpoint

Cited by 38 publications

References 32 publications

Directional Deep Brain Stimulation in the Treatment of Parkinson's Disease

Directional Deep Brain Stimulation in the Treatment of Parkinson's Disease

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

Short pulse and directional thalamic deep brain stimulation have differential effects in parkinsonian and essential tremor

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