Premium
Directional DBS increases side‐effect thresholds—A prospective, double‐blind trial
Author(s) -
Dembek Till A.,
Reker Paul,
VisserVandewalle Veerle,
Wirths Jochen,
Treuer Harald,
Klehr Martin,
Roediger Jan,
Dafsari Haidar S.,
Barbe Michael T.,
Timmermann Lars
Publication year - 2017
Publication title -
movement disorders
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.352
H-Index - 198
eISSN - 1531-8257
pISSN - 0885-3185
DOI - 10.1002/mds.27093
Subject(s) - deep brain stimulation , physical medicine and rehabilitation , crossover study , subthalamic nucleus , parkinson's disease , medicine , therapeutic window , clinical trial , essential tremor , prospective cohort study , randomized controlled trial , audiology , psychology , surgery , placebo , disease , alternative medicine , pathology , pharmacology
Objective The objective of this study was to investigate whether directional deep brain stimulation (DBS) of the subthalamic nucleus in Parkinson's disease (PD) offers increased therapeutic windows, side‐effect thresholds, and clinical benefit. Methods In 10 patients, 20 monopolar reviews were conducted in a prospective, randomized, double‐blind design to identify the best stimulation directions and compare them to conventional circular DBS regarding side‐effect thresholds, motor improvement, and therapeutic window. In addition, circular and best‐directional DBS were directly compared in a short‐term crossover. Motor outcome was also assessed after an open‐label follow‐up of 3 to 6 months. Results Stimulation in the individual best direction resulted in significantly larger therapeutic windows, higher side‐effect thresholds, and more improvement in hand rotation than circular DBS. Rigidity and finger tapping did not respond differentially to the stimulation conditions. There was no difference in motor efficacy or stimulation amplitudes between directional and circular DBS in the short‐term crossover. Follow‐up evaluations 3 to 6 months after implantation revealed improvements in motor outcome and medication reduction comparable to other DBS studies with a majority of patients remaining with a directional setting. Conclusion Directional DBS can increase side‐effect thresholds while achieving clinical benefit comparable to conventional DBS. Whether directional DBS improves long‐term clinical outcome needs to be investigated in the future. © 2017 International Parkinson and Movement Disorder Society