Directional steering

Abstract

This study provides Class IV evidence that for patients with Parkinson disease, steering DBS current is well tolerated, increases the threshold for side effects, and may improve the therapeutic window of subthalamic nucleus DBS as compared with current standard spherical stimulation.

Intraoperative acceleration measurements to quantify improvement in tremor during deep brain stimulation surgery

“…The idea of directional stimulation [5,19] has been extensively researched, and new leads [6,31] [10], but also on EMG and acceleration signals of tremor [3]. For such technologies to be practically useful and rapidly applicable, intraoperative quantitative evaluations of disease manifestations such as tremor and rigidity might play an important role.…”

Directional leads for deep brain stimulation: Opportunities and challenges

“…6 Directional leads-within limits-may address these issues, allowing stimulation to be directed toward the functional target and away from side-effect structures. 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.…”

“…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). By using a directional lead, it may thus be possible to improve outcomes and cause fewer adverse effects, including dyskinesia in patients with low thresholds for stimulation-induced dyskinesia.…”

“…This may foster our understanding of motor and nonmotor effects of DBS and of the physiology of movement, cognition, and mood. 10 Directional DBS may also be useful in smaller or nonspherical targets that are currently investigated for other disorders, such as the fornix for dementia, 17 nonmotor STN for obsessive-compulsive disorder, 18 medial forebrain bundle in psychiatric disorders such as major depression, 19 and the thalamus or the pallidum for Tourette syndrome. 20 The fornix, for example, is too small and thus vulnerable as a target to be directly implanted but is stimulated by a lead adjacent to the fiber tract.…”

DiODe: Directional Orientation Detection of Segmented Deep Brain Stimulation Leads: A Sequential Algorithm Based on CT Imaging

“…Directional stimulation due to the independent activation of segmented electrodes allows for increased side-effect thresholds, and thus expands the therapeutic window [2-6]. However, without detailed knowledge about the lead’s orientation with regard to the patient’s anatomy, programming directional DBS settings relies on tedious and cumbersome trial and error processes.…”