How Many Patients would Benefit from Steering Technology for Deep Brain Stimulation?

The actual use of directional steering and shorter pulse width in selected patients undergoing deep brain stimulation

“…In a previous multicenter survey [5], clinicians estimated that 21% of their patients implanted with standard leads would have benefitted from directional stimulation instead. The proportion of these patients was higher for GPi (48%) or thalamus (40%) targets than for STN (12,8%).…”

“…It is hypothesized that limiting stimulation-induced side-effects are an issue only in a small number of patients, while the majority of patients would benefit sufficiently from well-placed standard leads [5,6]. Currently, there are no parameters to predict which patients would potentially benefit from advanced stimulation features and for which patients these would be superfluous.…”

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

“…Whether or not this translates into improved patient outcome remains unclear and might depend on the underlying condition and target. It was estimated that 40% of patients with thalamic DBS (including ZI and PSA) and 48% of patients with GPi DBS might experience side-effects that limit the therapeutic benefit, compared to 12% of STN DBS patients [75], and the former might therefore benefit most from directional stimulation.…”

Current Practice and the Future of Deep Brain Stimulation Therapy in Parkinson's Disease

“…2), widening the therapeutic threshold. 68 Some of the leads shape the field of stimulation through multiple independent current control of their different contacts as well as steer it through segmented electrodes. The Vercise system from Boston Scientific 55,66 uses a multiple independent current control system, and the St. Jude Medical DBS Infinity system (St. Jude Medical, LLC), recently approved in the United States, can utilize a segmented lead.…”

“…Current steering technologies have been aimed at changing the size of the stimulation field and also by using segmented contacts to point stimulation toward beneficial regions and away from suboptimal areas (e.g., internal capsule). Contarino et al 68 in a questionnaire survey of DBS providers in the Netherlands identified that an average of 21% of patients might benefit from using steering technology, as they were limited by side effects of dysarthria and muscle contractions. Interestingly, they reported that a higher proportion of patients with GPi and thalamic leads could benefit from steering compared with STN leads (respectively, 48% and 39% vs. 13%) 68 ; however, many experts would consider STN-related side effects a very attractive use for this technology.…”