gms | German Medical Science

71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

21.06. - 24.06.2020

Directional versus conventional DBS leads – a retrospective cohort analysis

Direktionale versus klassische DBS-Elektroden – eine retrospektive Analyse

Meeting Abstract

  • Patrick Fricke - Universitätsklinikum Würzburg, Neurochirurgische Klinik und Poliklinik, Würzburg, Deutschland
  • presenting/speaker Robert Nickl - Universitätsklinikum Würzburg, Neurochirurgische Klinik und Poliklinik, Würzburg, Deutschland
  • Leonie Massa - Universitätsklinikum Würzburg, Neurochirurgische Klinik und Poliklinik, Würzburg, Deutschland
  • Hannah Christin - Universitätsklinikum Würzburg, Neurochirurgische Klinik und Poliklinik, Würzburg, Deutschland
  • Florian Lange - Universitätsklinikum Würzburg, Neurologische Klinik und Poliklinik, Würzburg, Deutschland
  • Philipp Capetian - Universitätsklinikum Würzburg, Neurologische Klinik und Poliklinik, Würzburg, Deutschland
  • Martin Reich - Universitätsklinikum Würzburg, Neurologische Klinik und Poliklinik, Würzburg, Deutschland
  • Ralf-Ingo Ernestus - Universitätsklinikum Würzburg, Neurochirurgische Klinik und Poliklinik, Würzburg, Deutschland
  • Jens Volkmann - Universitätsklinikum Würzburg, Neurologische Klinik und Poliklinik, Würzburg, Deutschland
  • Cordula Matthies - Universitätsklinikum Würzburg, Neurochirurgische Klinik und Poliklinik, Würzburg, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie. sine loco [digital], 21.-24.06.2020. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocP216

doi: 10.3205/20dgnc502, urn:nbn:de:0183-20dgnc5025

Published: June 26, 2020

© 2020 Fricke et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Objective: Deep brain stimulation is a well-established treatment for Parkinson's Disease. Directional deep brain stimulation (dDBS) leads offer the opportunity of steering current in horizontal and vertical directions and expands the therapeutic window in individuals compared to ring mode. Till present day, evaluation of directional leads compared to conventional leads (cDBS) in implantation strategies, programming advantages and clinical outcome is an ongoing process. Here we focus on a retrospective description of our non-matched pre/-post dDBS-era cohort of patients with PD.

Methods: The period from 2013 -2018 was chosen because of very uniform DBS technology applied in 43 (14 female) patients with PD by STN-DBS in our institution. Since 2016, 24 of these were implanted with directional DBS leads. We retrospectively analyzed lead deviation compared to the planned target one year after surgery, motor outcome according to UPDRS-III scores and stimulation parameters for both groups.

Results: 19 patients were in the cDBS group (5 female) and 24 in the dDBS-group (9 female). Age differed significant for both groups with cDBS 55.9 years and dDBS 64.4 y (p<0.01). Precision of lead position was comparable in both groups (p=.366). Patients’ UPDRS-III scores improved similarly in both groups with a Stim-ON/Med-OFF improvement of 75% of the initial levodopa response, with similar rates of good to excellent responders. After one year, 20 of 46 D-leads in the dDBS-group were activated in ring mode and 26 of 46 D-leads in directional mode; of those 11 leads were activated also with vertical steering. D-mode stimulation needed less current (2.9mA) than conventional mode (3.7mA), p. = .04.

Conclusion: This is the first retrospective cohort analysis of directional vs. conventional DBS leads. Accuracy of the implantation at one year post surgery was similar in both groups. The stimulation amplitude was smaller in the dDBS group, reflecting previous results, providing a larger therapeutic window for directional stimulation. 75% of the dDBS patients were stimulated with at least one lead with horizontal steering for the best clinical effect at one year post surgery indicating a benefit of this programming option. On a group level, UPDRS-III improvement was comparable in both groups, although the dDBS group was significantly older. To address advantages of horizontal and/ or vertical steering for the future, we recommend a prospective evaluation in matched groups.