Abstract
Several single-center studies and one large multicenter clinical trial demonstrated that directional deep brain stimulation (DBS) could optimize the volume of tissue activated (VTA) based on the individual placement of the lead in relation to the target. The ability to generate axially asymmetric fields of stimulation translates into a broader therapeutic window (TW) compared to conventional DBS. However, changing the shape and surface of stimulating electrodes (directional segmented vs. conventional ring-shaped) also demands a revision of the programming strategies employed for DBS programming. Model-based approaches have been used to predict the shape of the VTA, which can be visualized on standardized neuroimaging atlases or individual magnetic resonance imaging. While potentially useful for optimizing clinical care, these systems remain limited by factors such as patient-specific anatomical variability, postsurgical lead migrations, and inability to account for individual contact impedances and orientation of the systems of fibers surrounding the electrode. Alternative programming tools based on the functional assessment of stimulation-induced clinical benefits and side effects allow one to collect and analyze data from each electrode of the DBS system and provide an action plan of ranked alternatives for therapeutic settings based on the selection of optimal directional contacts. Overall, an increasing amount of data supports the use of directional DBS. It is conceivable that the use of directionality may reduce the need for complex programming paradigms such as bipolar configurations, frequency or pulse width modulation, or interleaving. At a minimum, stimulation through directional electrodes can be considered as another tool to improve the benefit/side effect ratio. At a maximum, directionality may become the preferred way to program because of its larger TW and lower energy consumption.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 25-41 |
| Number of pages | 17 |
| Journal | Neurology and Therapy |
| Volume | 9 |
| Issue number | 1 |
| DOIs | |
| State | Published - Jun 1 2020 |
Funding
Aristide Merola is supported by NIH (KL2 TR001426) and has received speaker honoraria from CSL Behring, Abbvie, and Cynapsus Therapeutics. He has received Grant support from Lundbeck. Alberto Romagnolo has received Grant support and speaker honoraria from AbbVie, speaker honoraria from Chiesi Farmaceutici and travel Grants from Lusofarmaco, Chiesi Farmaceutici, Medtronic, and UCB Pharma. Vibhor Krishna has received research Grant from Medtronic, Boston Scientific, and Abbott. Srivatsan Pallavaram is a Medical Science Advisor (Medical Affairs) at Abbott Labs and receives salary for his services. Stephen Carcieri is an employee at Boston Scientific and receives salary for his services. Steven Goetz is an employee at Medtronic and receives salary for his services. George Mandybur has received consulting agreement with Boston Scientific and Abbott, as well as research Grants from Boston Scientific. Andrew P. Duker and Brian Dalm have nothing to declare. John D. Rolston has consulting agreements with NeuroPace and Medtronic, and stock in Axion Biosystems. He received funding from the NIH (NCATS KL2 TR002539 and NINDS K23 NS114178). Alfonso Fasano sits in the advisory board of Evotion, Inbrain Neuroelectronics and Cortics, received honoraria for consultancies from Apple, Abbvie, Abbott, BrainLab, Boston Scientific, Chiesi farmaceutici, Ipsen, Medtronic, Sunovion, and UCB; honoraria for participation in advisory boards from Abbvie, Boston Scientific, and Ipsen; research Grants from Abbvie, Boston Scientific, Cummings Foundation, Dystonia Medical Research Foundation Canada, Michael J. Fox Foundation, Medtronic, and University of Toronto. Leo Verhagen sits in the advisory boards of Abbott Neuromodulation, AbbVie Inc, Biogen Inc. He is in the editorial board of Neurology and Therapy and Brain Sciences. He has received consultancies from Abbott, AbbVie Inc, and Boston Scientific, and research support from Medtronic, Boston Scientific, Abbott, AbbVie, Neuroderm, Biogen Inc, and Prilenia therapeutics. He has received NIH funding (R01 NS40902) as a site-PI. Leo Verhagen is a member of the journal’s Editorial Board. No funding or sponsorship was received for this study or publication of this article. All named authors (Dr. Merola, Dr. Romagnolo, Dr. Krishna, Dr. Pallavaram, Dr. Carcieri, Dr. Goetz, Dr. Mandybur, Dr. Duker, Dr. Dalm, Dr. Rolston, Dr. Fasano, and Dr. Verhagen Metman) meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published. Aristide Merola is supported by NIH (KL2 TR001426) and has received speaker honoraria from CSL Behring, Abbvie, and Cynapsus Therapeutics. He has received Grant support from Lundbeck. Alberto Romagnolo has received Grant support and speaker honoraria from AbbVie, speaker honoraria from Chiesi Farmaceutici and travel Grants from Lusofarmaco, Chiesi Farmaceutici, Medtronic, and UCB Pharma. Vibhor Krishna has received research Grant from Medtronic, Boston Scientific, and Abbott. Srivatsan Pallavaram is a Medical Science Advisor (Medical Affairs) at Abbott Labs and receives salary for his services. Stephen Carcieri is an employee at Boston Scientific and receives salary for his services. Steven Goetz is an employee at Medtronic and receives salary for his services. George Mandybur has received consulting agreement with Boston Scientific and Abbott, as well as research Grants from Boston Scientific. Andrew P. Duker and Brian Dalm have nothing to declare. John D. Rolston has consulting agreements with NeuroPace and Medtronic, and stock in Axion Biosystems. He received funding from the NIH (NCATS KL2 TR002539 and NINDS K23 NS114178). Alfonso Fasano sits in the advisory board of Evotion, Inbrain Neuroelectronics and Cortics, received honoraria for consultancies from Apple, Abbvie, Abbott, BrainLab, Boston Scientific, Chiesi farmaceutici, Ipsen, Medtronic, Sunovion, and UCB; honoraria for participation in advisory boards from Abbvie, Boston Scientific, and Ipsen; research Grants from Abbvie, Boston Scientific, Cummings Foundation, Dystonia Medical Research Foundation Canada, Michael J. Fox Foundation, Medtronic, and University of Toronto. Leo Verhagen sits in the advisory boards of Abbott Neuromodulation, AbbVie Inc, Biogen Inc. He is in the editorial board of Neurology and Therapy and Brain Sciences. He has received consultancies from Abbott, AbbVie Inc, and Boston Scientific, and research support from Medtronic, Boston Scientific, Abbott, AbbVie, Neuroderm, Biogen Inc, and Prilenia therapeutics. He has received NIH funding (R01 NS40902) as a site-PI. Leo Verhagen is a member of the journal?s Editorial Board. This article is based on previously conducted studies and does not contain any studies with human participants or animals performed by any of the authors.
Keywords
- Contact
- Deep brain stimulation
- Directionality
- Lead
- Parkinson disease
- Programming
ASJC Scopus subject areas
- Clinical Neurology
- Neurology