Directional DBS superior to omnidirectional DBS

Directional deep brain stimulation (DBS) in Parkinson’s disease (PD) yielded a wider therapeutic window and a lower therapeutic current strength than conventional omnidirectional DBS in the prospective blinded crossover PROGRESS study [1]. Directional DBS was also preferred by subjects.

Patients receiving subthalamic nucleus DBS for PD received omnidirectional stimulation for 3 months, followed by directional stimulation for another 3 months. Superiority of directional stimulation required a wider therapeutic window in >60% of patients after 3 months (primary endpoint). For non-inferiority of directional stimulation, this percentage was set at 40% (secondary endpoint).

A directional DBS system was implanted in 234 subjects, without intracranial haemorrhages or infections occurring. There were 13 serious adverse events in 12 patients (5.1%). Using directional stimulation, the therapeutic window was wider in 90.7% of patients at 3 months and in 89.3% at 12 months. Mean relative increase in therapeutic window at 3 months was 40% with directional versus omnidirectional stimulation (2.98±1.38 mA and 2.11±1.33 mA, respectively). With directional programming, therapeutic current strength was decreased by 39% after 3 months and by 34% at 12 months. Activation of a single segment increased the therapeutic window in 86.8% of patients at 3 months, and 84.3% at 12 months. After 6 months, 102/193 subjects (53%) blinded to stimulation type preferred the period with directional stimulation, while 50/193 (26%) preferred the omnidirectional period. There was no difference in therapeutic efficacy measured by Unified Parkinson’s Disease Rating Scale (UPDRS)-III motor score.

1. Schnitzler A, et al. Abstract O3014, EAN 2020.

 



Posted on 9 September 202017 May 2024