Directional deep brain stimulation of the subthalamic nucleus: A pilot study using a novel neurostimulation device

Abstract

IntroductionA novel neurostimulation system allows steering current in horizontal directions by combining segmented leads and multiple independent current control. The aim of this study was to evaluate directional DBS effects on parkinsonian motor features and adverse effects of subthalamic neurostimulation.MethodsSeven PD patients implanted with the novel directional DBS system for bilateral subthalamic DBS underwent an extended monopolar review session during the first postoperative week, in which current thresholds were determined for rigidity control and stimulation‐induced adverse effects using either directional or ring‐mode settings.ResultsEffect or adverse effect thresholds were modified by directional settings for each of the 14 STN leads. Magnitude of change varied markedly between leads, as did orientation of optimal horizontal current steering.ConclusionDirectional current steering through chronically implanted segmented electrodes is feasible, alters adverse effect and efficacy thresholds in a highly individual manner, and expands the therapeutic window in a monopolar review as compared to ring‐mode DBS. © 2016 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society

Comparative Study of Robot-Assisted versus Conventional Frame-Based Deep Brain Stimulation Stereotactic Neurosurgery

“…Lead displacement with lateral deviations ≥1.40 mm during subthalamic nucleus DBS were shown to be likely associated with unfavorable spread of electrical current into adjacent eloquent areas leading to extensive stimulation-induced side effects [27]. Despite good compensatory mechanisms of directional leads, Steigerwald et al [28] clearly point out that the employment of this novel technology “must never be an excuse for lowering the surgical standard and precision of surgical lead placement”. With a mean deviation of 0.76 mm, the ROSA Brain can be considered a precise tool for lead implantation that not only features high accuracy, but also high reliability.…”

Determining the Orientation of Directional Deep Brain Stimulation Electrodes Using 3D Rotational Fluoroscopy

“…5 Recently, DBS electrode leads with electrode contacts that are split into 3 parts along the circumference of the electrode became available. 6,7 Distributing the stimulation among these electrode segments allows steering of the electrical field in a predefined direction. In the subthalamic nucleus, DBS by this approach theoretically allows one to steer the field away from the internal capsule while at the same time allowing a better coverage of the nucleus and relevant pathways (eg, hyperdirect pathway), with a possibly better therapeutic window.…”

Directional leads for deep brain stimulation: Opportunities and challenges

“…As such, these novel leads can widen the therapeutic window by lowering the efficacy threshold and increasing the side-effect threshold, 10,11 as indicated in a recent pilot study. 12 A larger therapeutic window allows greater programming flexibility, as the expected beneficial effects of DBS may be reached at a lower current amplitude or higher current amplitudes could be attainable before side effects appear 11 -this is important when increasing the stimulation amplitude to optimize DBS efficacy during follow-up. 13 When used chronically, directional DBS may reduce the incidence of side effects that cannot be tested intraoperatively (eg, gait, cognitive, or behavioral disturbances) 10 and in patients with a narrow therapeutic window despite good location of the lead as verified by intraoperative testing, microrecordings, or imaging, as well as in patients operated under general anesthesia precluding clinical testing (eg, for dysarthria).…”