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Impact of segmented leads for DBS

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Impact ofsegmentedleadsforDBS
 Jan Vesper, MD, PhD, JarekMaciaczykMD, PhD, Phillip Slotty MD, PhD(Heinrich Heine University, Dept. ofFunctionalNeurosurgeryandStereotaxy - Duesseldorf - GERMANY)

Deep Brain Stimulation is an established treatment modality in various movement disorders. Targets are usually located within the basal ganglia. Due to the proximity of thetargetpointstocriticalfunctionalstructuresasthe internal capsule, therapeuticyieldmightbe limited bysideeffects. Furthermoreenergyconsumptionispotentiallyhigher in conventional monopolar stimulation. Recently, segmented DBS leadshavebeenmadeavailable. This techniquecomeswiththepromiseofincreasedefficacyandsideeffectreduction. WethereforecomparedourpreliminarydatawithsegmentedleadswiththedatafromtheLibrastudyconducted 4 yearsago

 

The purposeoftheLibrastudy was toevaluatetheeffectsof a newDeep Brain Stimulation System forreducingsymptomsofadvanced, Parkinson’sdisease Also theActivitiesof Daily Living, UPDRS scores, Quality oflifeofsubject, deviceparametersincludingactivecontact in relationtoefficacy, frequency, type andseverityoftherapyrelatedAE’seventswereevaluated. 3 monthsdatafrompatientswithsegmentedleads (Infinity) 6 patients  will becomparedtotheLibradata (6 patients).

DBS Targeting was guidedbythreemicroelectroderecordingtractsand a directionalleadsystem (Infinity DBS, SJM) was implanted in an all-in-one GA setting in 6 patients. The segmentedcontactswereintensivelytested at 90µs and 130 Hz in the postoperative course. Distincteffect/side-effectpatternsforeachcontactwereobserved. ComparisonofParkinson’ssymptomsasdemonstratedbythe UPDRS motorscores in themedication “off” state at Baseline comparedtothemedication “off” withstimulation “on” 3 months after deviceimplantation. Nodifferences in efficacywhereseenbetweenLibraandInfinitydataamoingthose 6 patients. HowevercomparedtotheLibradata, nostimulationdependentsideeffectsoccurred in theInfinitygroup. Amplitude andfrequencydid not differ, howeverlower pulse width was used in 2 patients.

Segmentedleadsallowingcurrentsteeringoffernewperspectivesfor DBS and will likelyresult in increasedtreatmentefficacywhilereducingsideeffect at the same time. Whilethisistruefor DBS in general, therearecaseswithnogoodbenefit/side-effectratiocouldbeachievedwithconventional DBS. Sincethethresholdforsideeffectsishigher in segmentedleads, theyaremoreadaptabletothe individual patientsneedsandpotentiallyresulting in a longerbatterylife.

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