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

Jessica A. Karl; Jessica Joyce; Bichun Ouyang; Leo Verhagen Metman

doi:10.1007/s40120-022-00381-5

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

Jessica A. Karl^*, Jessica Joyce, Bichun Ouyang, Leo Verhagen Metman

^*Corresponding author for this work

Neurology

Research output: Contribution to journal › Article › peer-review

11 Scopus citations

Abstract

Introduction: Directional deep brain stimulation (d-DBS) axially displaces the volume of tissue activated (VTA) towards the intended target and away from neighboring structures potentially improving benefit and reducing side effects (SE) of stimulation. A clinical trial evaluating d-DBS demonstrated a wider therapeutic window (TW) with directional electrodes. While this seems advantageous, it remains unclear when and why directional stimulation is chosen clinically. To evaluate the implementation of d-DBS in our practice we examined the prevalence of and motivation for directional programming. Methods: A retrospective review was completed in consecutive patients with Parkinson’s disease (PD)/essential tremor (ET) implanted with the Abbott Infinity system from December 2016 to January 2020. At 3, 12, 24, and 36 months we extracted post-DBS stimulation parameters; use of directional electrodes and other advanced programming techniques; and reasons for directional programming. Results: Fifty-six patients with PD and 18 patients with ET (104 and 33 leads, respectively) were identified. The numbers of patients programmed with a directional electrode in at least one DBS lead in PD and ET, respectively, were 22/56 (39%) and 13/18 (72%) at 3 months; 19/48 (40%) and 8/12 (67%) at 12 months; 12/31 (39%) and 5/8 (63%) at 24 months; and 6/9 (67%) and 1/2 (50%) at 36 months. In PD and ET, reasons for using directional stimulation were better symptom control, less SE, or combination of better symptom control/SE; additional reasons in ET were improved battery/TW%. Conclusion: Over a 36-month time period 39–68% of patients with PD and 50–72% of patients with ET had at least one lead programmed directionally in order to either improve symptom control or reduce side effects, an option not available with conventional omnidirectional stimulation. Initially directional electrodes were used in ET more frequently than PD, likely because of the less complex nature of programming for a monosymptomatic disorder. However, over time this shifted as we gained directional experience and sought solutions to reduce worsening symptoms.

Original language	English (US)
Pages (from-to)	1309-1318
Number of pages	10
Journal	Neurology and Therapy
Volume	11
Issue number	3
DOIs	https://doi.org/10.1007/s40120-022-00381-5
State	Published - Sep 2022

Funding

Jessica A. Karl receives honoraria for consulting services from Abbott and AbbVie, and research support from Abbott. Leo Verhagen Metman receives honoraria for consulting services form AbbVie, Abbott, Avion, and research support from Abbott, Boston Sci., Medtronic, AbbVie, Neuroderm, Addex, UCB, and NIH. Jessica Joyce and Bichun Ouyang have no disclosures and have no conflict of interest. There was no funding or sponsorship received for this study or publication of this article. All named authors 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. Conceptualization: Jessica A. Karl and Leo Verhagen Metman; Methodology including data collection: Jessica A. Karl, Jessica Joyce, Bichun Ouyang, and Leo Verhagen Metman; Formal analysis and investigation: Jessica A. Karl, Bichun Ouyang, and Leo Verhagen Metman; Writing—original draft preparation: Jessica A. Karl and Leo Verhagen Metman; Writing—review and editing: Jessica A. Karl, Jessica Joyce, Bichun Ouyang, and Leo Verhagen Metman. Jessica A. Karl receives honoraria for consulting services from Abbott and AbbVie, and research support from Abbott. Leo Verhagen Metman receives honoraria for consulting services form AbbVie, Abbott, Avion, and research support from Abbott, Boston Sci., Medtronic, AbbVie, Neuroderm, Addex, UCB, and NIH. Jessica Joyce and Bichun Ouyang have no disclosures and have no conflict of interest. We have received approval from Rush University IRB01 Registration number IRB00000530). This study was performed in accordance with the Helsinki Declaration of 1964, and its later amendments. A waiver of consent was applied for this study. The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

Keywords

Deep brain stimulation
Directional deep brain stimulation
Essential tremor
Parkinson’s disease

ASJC Scopus subject areas

Clinical Neurology
Neurology

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10.1007/s40120-022-00381-5

Cite this

@article{53489aa4dca5482580b8131f293da1d7,

title = "Long-Term Clinical Experience with Directional Deep Brain Stimulation Programming: A Retrospective Review",

abstract = "Introduction: Directional deep brain stimulation (d-DBS) axially displaces the volume of tissue activated (VTA) towards the intended target and away from neighboring structures potentially improving benefit and reducing side effects (SE) of stimulation. A clinical trial evaluating d-DBS demonstrated a wider therapeutic window (TW) with directional electrodes. While this seems advantageous, it remains unclear when and why directional stimulation is chosen clinically. To evaluate the implementation of d-DBS in our practice we examined the prevalence of and motivation for directional programming. Methods: A retrospective review was completed in consecutive patients with Parkinson{\textquoteright}s disease (PD)/essential tremor (ET) implanted with the Abbott Infinity system from December 2016 to January 2020. At 3, 12, 24, and 36 months we extracted post-DBS stimulation parameters; use of directional electrodes and other advanced programming techniques; and reasons for directional programming. Results: Fifty-six patients with PD and 18 patients with ET (104 and 33 leads, respectively) were identified. The numbers of patients programmed with a directional electrode in at least one DBS lead in PD and ET, respectively, were 22/56 (39%) and 13/18 (72%) at 3 months; 19/48 (40%) and 8/12 (67%) at 12 months; 12/31 (39%) and 5/8 (63%) at 24 months; and 6/9 (67%) and 1/2 (50%) at 36 months. In PD and ET, reasons for using directional stimulation were better symptom control, less SE, or combination of better symptom control/SE; additional reasons in ET were improved battery/TW%. Conclusion: Over a 36-month time period 39–68% of patients with PD and 50–72% of patients with ET had at least one lead programmed directionally in order to either improve symptom control or reduce side effects, an option not available with conventional omnidirectional stimulation. Initially directional electrodes were used in ET more frequently than PD, likely because of the less complex nature of programming for a monosymptomatic disorder. However, over time this shifted as we gained directional experience and sought solutions to reduce worsening symptoms.",

keywords = "Deep brain stimulation, Directional deep brain stimulation, Essential tremor, Parkinson{\textquoteright}s disease",

author = "Karl, {Jessica A.} and Jessica Joyce and Bichun Ouyang and {Verhagen Metman}, Leo",

note = "Funding Information: Jessica A. Karl receives honoraria for consulting services from Abbott and AbbVie, and research support from Abbott. Leo Verhagen Metman receives honoraria for consulting services form AbbVie, Abbott, Avion, and research support from Abbott, Boston Sci., Medtronic, AbbVie, Neuroderm, Addex, UCB, and NIH. Jessica Joyce and Bichun Ouyang have no disclosures and have no conflict of interest. Funding Information: There was no funding or sponsorship received for this study or publication of this article. All named authors 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. Conceptualization: Jessica A. Karl and Leo Verhagen Metman; Methodology including data collection: Jessica A. Karl, Jessica Joyce, Bichun Ouyang, and Leo Verhagen Metman; Formal analysis and investigation: Jessica A. Karl, Bichun Ouyang, and Leo Verhagen Metman; Writing—original draft preparation: Jessica A. Karl and Leo Verhagen Metman; Writing—review and editing: Jessica A. Karl, Jessica Joyce, Bichun Ouyang, and Leo Verhagen Metman. Jessica A. Karl receives honoraria for consulting services from Abbott and AbbVie, and research support from Abbott. Leo Verhagen Metman receives honoraria for consulting services form AbbVie, Abbott, Avion, and research support from Abbott, Boston Sci., Medtronic, AbbVie, Neuroderm, Addex, UCB, and NIH. Jessica Joyce and Bichun Ouyang have no disclosures and have no conflict of interest. We have received approval from Rush University IRB01 Registration number IRB00000530). This study was performed in accordance with the Helsinki Declaration of 1964, and its later amendments. A waiver of consent was applied for this study. The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request. Publisher Copyright: {\textcopyright} 2022, The Author(s).",

year = "2022",

month = sep,

doi = "10.1007/s40120-022-00381-5",

language = "English (US)",

volume = "11",

pages = "1309--1318",

journal = "Neurology and Therapy",

issn = "2193-8253",

publisher = "Springer Healthcare",

number = "3",

}

TY - JOUR

T1 - Long-Term Clinical Experience with Directional Deep Brain Stimulation Programming

T2 - A Retrospective Review

AU - Karl, Jessica A.

AU - Joyce, Jessica

AU - Ouyang, Bichun

AU - Verhagen Metman, Leo

N1 - Funding Information: Jessica A. Karl receives honoraria for consulting services from Abbott and AbbVie, and research support from Abbott. Leo Verhagen Metman receives honoraria for consulting services form AbbVie, Abbott, Avion, and research support from Abbott, Boston Sci., Medtronic, AbbVie, Neuroderm, Addex, UCB, and NIH. Jessica Joyce and Bichun Ouyang have no disclosures and have no conflict of interest. Funding Information: There was no funding or sponsorship received for this study or publication of this article. All named authors 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. Conceptualization: Jessica A. Karl and Leo Verhagen Metman; Methodology including data collection: Jessica A. Karl, Jessica Joyce, Bichun Ouyang, and Leo Verhagen Metman; Formal analysis and investigation: Jessica A. Karl, Bichun Ouyang, and Leo Verhagen Metman; Writing—original draft preparation: Jessica A. Karl and Leo Verhagen Metman; Writing—review and editing: Jessica A. Karl, Jessica Joyce, Bichun Ouyang, and Leo Verhagen Metman. Jessica A. Karl receives honoraria for consulting services from Abbott and AbbVie, and research support from Abbott. Leo Verhagen Metman receives honoraria for consulting services form AbbVie, Abbott, Avion, and research support from Abbott, Boston Sci., Medtronic, AbbVie, Neuroderm, Addex, UCB, and NIH. Jessica Joyce and Bichun Ouyang have no disclosures and have no conflict of interest. We have received approval from Rush University IRB01 Registration number IRB00000530). This study was performed in accordance with the Helsinki Declaration of 1964, and its later amendments. A waiver of consent was applied for this study. The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request. Publisher Copyright: © 2022, The Author(s).

PY - 2022/9

Y1 - 2022/9

N2 - Introduction: Directional deep brain stimulation (d-DBS) axially displaces the volume of tissue activated (VTA) towards the intended target and away from neighboring structures potentially improving benefit and reducing side effects (SE) of stimulation. A clinical trial evaluating d-DBS demonstrated a wider therapeutic window (TW) with directional electrodes. While this seems advantageous, it remains unclear when and why directional stimulation is chosen clinically. To evaluate the implementation of d-DBS in our practice we examined the prevalence of and motivation for directional programming. Methods: A retrospective review was completed in consecutive patients with Parkinson’s disease (PD)/essential tremor (ET) implanted with the Abbott Infinity system from December 2016 to January 2020. At 3, 12, 24, and 36 months we extracted post-DBS stimulation parameters; use of directional electrodes and other advanced programming techniques; and reasons for directional programming. Results: Fifty-six patients with PD and 18 patients with ET (104 and 33 leads, respectively) were identified. The numbers of patients programmed with a directional electrode in at least one DBS lead in PD and ET, respectively, were 22/56 (39%) and 13/18 (72%) at 3 months; 19/48 (40%) and 8/12 (67%) at 12 months; 12/31 (39%) and 5/8 (63%) at 24 months; and 6/9 (67%) and 1/2 (50%) at 36 months. In PD and ET, reasons for using directional stimulation were better symptom control, less SE, or combination of better symptom control/SE; additional reasons in ET were improved battery/TW%. Conclusion: Over a 36-month time period 39–68% of patients with PD and 50–72% of patients with ET had at least one lead programmed directionally in order to either improve symptom control or reduce side effects, an option not available with conventional omnidirectional stimulation. Initially directional electrodes were used in ET more frequently than PD, likely because of the less complex nature of programming for a monosymptomatic disorder. However, over time this shifted as we gained directional experience and sought solutions to reduce worsening symptoms.

AB - Introduction: Directional deep brain stimulation (d-DBS) axially displaces the volume of tissue activated (VTA) towards the intended target and away from neighboring structures potentially improving benefit and reducing side effects (SE) of stimulation. A clinical trial evaluating d-DBS demonstrated a wider therapeutic window (TW) with directional electrodes. While this seems advantageous, it remains unclear when and why directional stimulation is chosen clinically. To evaluate the implementation of d-DBS in our practice we examined the prevalence of and motivation for directional programming. Methods: A retrospective review was completed in consecutive patients with Parkinson’s disease (PD)/essential tremor (ET) implanted with the Abbott Infinity system from December 2016 to January 2020. At 3, 12, 24, and 36 months we extracted post-DBS stimulation parameters; use of directional electrodes and other advanced programming techniques; and reasons for directional programming. Results: Fifty-six patients with PD and 18 patients with ET (104 and 33 leads, respectively) were identified. The numbers of patients programmed with a directional electrode in at least one DBS lead in PD and ET, respectively, were 22/56 (39%) and 13/18 (72%) at 3 months; 19/48 (40%) and 8/12 (67%) at 12 months; 12/31 (39%) and 5/8 (63%) at 24 months; and 6/9 (67%) and 1/2 (50%) at 36 months. In PD and ET, reasons for using directional stimulation were better symptom control, less SE, or combination of better symptom control/SE; additional reasons in ET were improved battery/TW%. Conclusion: Over a 36-month time period 39–68% of patients with PD and 50–72% of patients with ET had at least one lead programmed directionally in order to either improve symptom control or reduce side effects, an option not available with conventional omnidirectional stimulation. Initially directional electrodes were used in ET more frequently than PD, likely because of the less complex nature of programming for a monosymptomatic disorder. However, over time this shifted as we gained directional experience and sought solutions to reduce worsening symptoms.

KW - Deep brain stimulation

KW - Directional deep brain stimulation

KW - Essential tremor

KW - Parkinson’s disease

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

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