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

Long-Term Clinical Experience with Directional Deep Brain Stimulation Programming: A Retrospective Review

“…While the uniformity of programming between the two clinicians is advantageous to summarize the experience in their practice, it does not allow generalization and other DBS programmers may have different experiences. However, data from other centers suggest a similar early adaptation rate [2][3][4][5]9]. As time goes by, directional programming will likely be more utilized, buoyed by programming strategies that do not rely on trial-and-error method of programming, but instead on visualization software or biomarker use (such as beta oscillations) to identify optimal stimulation sites within the target, and the corresponding electrode segments.…”

“…In general, we used directional stimulation more frequently in patients with ET than patients with PD, although by 36 months post DBS surgery a larger percentage of patients with PD were programmed with a directional electrode. Similarly, Zitman et al reported that a larger percentage of patients with leads implanted in the VIM were programmed with a directional electrode compared to the STN and GPi [ 5 ]. In our practice the main reasons for using directional electrodes in PD and ET were to avoid side effects and to improve symptom control.…”

“…While a large TW intuitively seems advantageous, it is not clear how often and for what reasons directional stimulation is used in clinical practice. Existing reports on directional DBS in clinical practice have shown use of directional electrodes in 50–70% of patients but some only report on essential tremor (ET), provide only short-term data, or do not separate directional programming from other advanced programming techniques [ 2 – 5 ]. The aim of the current study was to determine the rate of adoption of d-DBS in our practice over time in patients with Parkinson’s disease (PD) and ET.…”

Deep brain stimulation in dystonia: factors contributing to variability in outcome in short and long term follow-up

“…These systems offer pulse widths below 60 μs and leads with segmented contacts allowing directional stimulation and which provides a larger therapeutic windows before stimulation-induced side-effects are encountered, however their overall long term superiority compared to nondirectional stimulation has not been demonstrated. A recent study of 51 PD, tremor and dystonia patients half of whom had received directional, low pulse width capable systems found that advanced programming features (only shorter pulse widths) were employed as the preferred chronic stimulation parameters in only of 2 of 7 dystonia patients [77 ▪ ]. DBS devices which record local field potentials from the target (brain sensing) are now available and foreshadow adaptive DBS in dystonia where stimulation is applied selectively to suppress abnormal oscillatory activity detected [78].…”

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

“…Since its introduction in the mid-2010s, directional deep brain stimulation (dDBS) has been preferred by PD patients and programming physicians, even though directional programming has been reported to be more time consuming [ 5 , 9 , 10 ]. Commercially available dDBS systems consist of an implantable pulse generator (IPG), coiled extensions, and two directional leads with electrodes in a 1-3-3-1 order in contrast to the traditional DBS system with electrodes arranged in a 1-1-1-1 manner [ 11 ].…”