Real-Life Experience on Directional Deep Brain Stimulation in Patients with Advanced Parkinson’s Disease

Abstract

Directional deep brain stimulation (dDBS) is preferred by patients with advanced Parkinson’s disease (PD) and by programming neurologists. However, real-life data of dDBS use is still scarce. We reviewed the clinical data of 53 PD patients with dDBS to 18 months of follow-up. Directional stimulation was favored in 70.5% of dDBS leads, and single segment activation (SSA) was used in 60% of dDBS leads. Current with SSA was significantly lower than with other stimulation types. During the 6-month follow-up, a 44% improvement in the Unified Parkinson’s Disease Rating Scale (UPDRS-III) points and a 43% decline in the levodopa equivalent daily dosage (LEDD) was observed. After 18 months of follow-up, a 35% LEDD decrease was still noted. The Hoehn and Yahr (H&Y) stages and scores on item no 30 “postural stability” in UPDRS-III remained lower throughout the follow-up compared to baseline. Additionally, dDBS relieved non-motor symptoms during the 6 months of follow-up. Patients with bilateral SSA had similar clinical outcomes to those with other stimulation types. Directional stimulation appears to effectively reduce both motor and non-motor symptoms in advanced PD with minimal adverse effects in real-life clinical care.

Directional electrodes in deep brain stimulation: Results of a survey by the European Association of Neurosurgical Societies (EANS)

“…However, this number increased substantially one year after the initiation of stimulation. This trend is supported by the literature where the number of patients on directional modes varies from 33 % to 85 % for the STN and 39 %–92 % for the VIM, with a trend towards larger numbers on directional modes as time progresses ( Veerappan et al, 2021 ; Rammo et al, 2021 ; Mishra et al, 2023 ; Karl et al, 2022 ; Reker and Steffen, 2020 ; Zitman et al, 2021 ; Koivu et al, 2022 ).…”

Deep Brain Stimulation (Dbs) in Patients With Parkinson's Disease: An Integrative Review on Effectiveness, Indications and Complications

“…The study noted that most patients showed significant improvement in motor symptoms after the procedure, but some patients still had psychiatric symptoms, such as depression and anxiety, after the procedure. For Koivu et al (2022) the choice of the DBS target area can affect the effectiveness of the procedure and must be individualized for each patient. These results highlight the importance of careful individualized evaluation of patients before deciding to indicate the DBS procedure.…”

“…The study by Koivu et al (2022) presents an analysis of the clinical outcomes of patients with advanced Parkinson's disease treated with directional deep brain stimulation (DBS). The retrospective study used a group of patients with advanced PD who underwent directional DBS.…”