Artikel
Implantation of directional leads improves patient outcome after deep brain stimulation in Parkinson’s disease
Implantation von direktionalen Elektroden führt zu einer verbesserten Ergebnisqualität der tiefen Hirnstimulation bei Patienten mit idiopathischen Parkinsonsyndrom
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Veröffentlicht: | 4. Juni 2021 |
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Objective: Recent developments of more complex lead designs for deep brain stimulation with a greater number of contacts and the ability to alter the shape of stimulation fields were introduced to enlarge the therapeutic window in deep brain stimulation. We evaluated, whether these directional leads have also an impact on short-term patient outcome.
Methods: Twenty patients in total underwent deep brain stimulation into the subthalamic nucleus (STN-DBS) and were divided to the following two groups: ten patients being operated with non-directional leads (group 1) and further ten patients underwent surgery with directional leads (Boston Scientific) (group 2). The postoperative improvements were measured 3 months after DBS surgery and compared to preoperative conditions. The programming algorithm was equal in both groups. Group 2 was only stimulated directionally.
Results: No hemorrhage or permanent side effects occurred. The Unified Parkinson’s Disease Rating Scale (UPDRS) III (on medication/on stimulation) showed a reduction of 52% in group 1 and 73% in group 2 compared to preoperative UPDRS III (on medication), while the levodopa equivalence dose (LED) could be reduced by 59% (group 1) and 63% (group 2). No differences were observed for UPDRS IV in both groups (reduction of 73% in group 1 and 71% in group 2). The needed stimulation amplitude was 2.5V in group 1 and 2.2V in group 2.
Conclusion: Patient outcome after STN-DBS measured by reduction of UPDRS III and LED was better in patients with implanted directional leads. The impact of directional leads on the outcome of DBS patients should be confirmed with a prospective blinded trial with long-term follow-up.