RT Journal Article
T1 Directional Deep Brain Stimulation for Parkinson's Disease: Results of an International Crossover Study With Randomized, Double-Blind Primary Endpoint.
A1 Schnitzler, Alfons
A1 Mir, Pablo
A1 Brodsky, Matthew A
A1 Verhagen, Leonard
A1 Groppa, Sergiu
A1 Alvarez, Ramiro
A1 Evans, Andrew
A1 Blazquez, Marta
A1 Nagel, Sean
A1 Pilitsis, Julie G
A1 Pötter-Nerger, Monika
A1 Tse, Winona
A1 Almeida, Leonardo
A1 Tomycz, Nestor
A1 Jimenez-Shahed, Joohi
A1 Libionka, Witold
A1 Carrillo, Fatima
A1 Hartmann, Christian J
A1 Groiss, Stefan Jun
A1 Glaser, Martin
A1 Defresne, Florence
A1 Karst, Edward
A1 Cheeran, Binith
A1 Vesper, Jan
A1 PROGRESS Study Investigators, 
K1 Deep brain stimulation
K1 Parkinson's disease
K1 directional programming
K1 therapeutic window
AB Published reports on directional deep brain stimulation (DBS) have been limited to small, single-center investigations. Therapeutic window (TW) is used to describe the range of stimulation amplitudes achieving symptom relief without side effects. This crossover study performed a randomized double-blind assessment of TW for directional and omnidirectional DBS in a large cohort of patients implanted with a DBS system in the subthalamic nucleus for Parkinson's disease. Participants received omnidirectional stimulation for the first three months after initial study programming, followed by directional DBS for the following three months. The primary endpoint was a double-blind, randomized evaluation of TW for directional vs omnidirectional stimulation at three months after initial study programming. Additional data recorded at three- and six-month follow-ups included stimulation preference, therapeutic current strength, Unified Parkinson's Disease Rating Scale (UPDRS) part III motor score, and quality of life. The study enrolled 234 subjects (62 ± 8 years, 33% female). TW was wider using directional stimulation in 183 of 202 subjects (90.6%). The mean increase in TW with directional stimulation was 41% (2.98 ± 1.38 mA, compared to 2.11 ± 1.33 mA for omnidirectional). UPDRS part III motor score on medication improved 42.4% at three months (after three months of omnidirectional stimulation) and 43.3% at six months (after three months of directional stimulation) with stimulation on, compared to stimulation off. After six months, 52.8% of subjects blinded to stimulation type (102/193) preferred the period with directional stimulation, and 25.9% (50/193) preferred the omnidirectional period. The directional period was preferred by 58.5% of clinicians (113/193) vs 21.2% (41/193) who preferred the omnidirectional period. Directional stimulation yielded a wider TW compared to omnidirectional stimulation and was preferred by blinded subjects and clinicians.
YR 2022
FD 2022-02-02
LK http://hdl.handle.net/10668/17847
UL http://hdl.handle.net/10668/17847
LA en
DS RISalud
RD Apr 6, 2025