Early Experience With New Generation Deep Brain Stimulation Leads in Parkinson’s Disease and Essential Tremor Patients

Tremor and Quality of Life in Patients With Advanced Essential Tremor Before and After Replacing Their Standard Deep Brain Stimulation With a Directional System

“…A number of studies using directional DBS leads (d-leads) in the Vim for tremor (15)(16)(17)22) and the STN for Parkinson's disease have been published (16,(23)(24)(25)(26). Most demonstrated a theoretical superiority of d-leads over standard leads with a wider therapeutic window and lower therapeutic current strength or lower total electric energy delivered.…”

“…The use of directional DBS leads may provide a solution for these patients who require increased stimulation to ameliorate their symptoms but are troubled with unwanted side-effects. The initial clinical studies using directional leads for Vim DBS showed an increased therapeutic window and reduced total current strength, but no clinical benefit over standard leads (15)(16)(17). This inability to measure additional clinical benefit with directional leads may have been due to the fact that those patients only had relatively mild tremor and a short follow-up (six months).…”

Deep Brain Stimulation-Related Surgical Site Infections: A Systematic Review and Meta-Analysis

“…Other preventive measures, such as the preoperative Staphylococcus aureus screening and decolonization, nonshaving of cranial hair and preoperative antiseptic wash were not associated with reduced risk of SSIs in the present study; however, larger studies are needed to further address these potential factors in order to allow firm conclusions to be drawn. Lastly, a hypothesis might be that the infection rates may be lower if bilateral DBS systems are kept separate (bilateral IPG for bilateral leads) rather than having both systems run together to a single IPG, which often results in reopening incisions (114)(115)(116); large prospective studies could investigate the potential association of keeping the bilateral DBS systems separately with the risk of DBSrelated SSIs.…”

Deep-Brain Stimulation for Essential Tremor and Other Tremor Syndromes: A Narrative Review of Current Targets and Clinical Outcomes

“…Current commercial systems typically consist of ring contacts segmented in three sections that can be individually activated, although many other designs have been proposed [69]. Early experience has shown that directional stimulation can increase the therapeutic window while reducing the therapeutic current strength relative to omnidirectional stimulation [70][71][72][73][74]. Whether or not this translates into improved patient outcome remains unclear and might depend on the underlying condition and target.…”