دورية أكاديمية
An Institutional Experience of Directional Deep Brain Stimulation and a Review of the Literature.
| العنوان: | An Institutional Experience of Directional Deep Brain Stimulation and a Review of the Literature. |
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| المؤلفون: | Mishra A; Department of Neurosurgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Manhasset, NY, USA; Department of Neurology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Manhasset, NY, USA., Unadkat P; Department of Neurosurgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Manhasset, NY, USA; Elmezzi Graduate School of Molecular Medicine, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA., McBriar JD; Department of Neurosurgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Manhasset, NY, USA; Department of Neurology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Manhasset, NY, USA., Schulder M; Department of Neurosurgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Manhasset, NY, USA., Ramdhani RA; Department of Neurology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Manhasset, NY, USA. Electronic address: RRamdhani@northwell.edu. |
| المصدر: | Neuromodulation : journal of the International Neuromodulation Society [Neuromodulation] 2024 Apr; Vol. 27 (3), pp. 544-550. Date of Electronic Publication: 2023 Jan 17. |
| نوع المنشور: | Review; Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: Elsevier Country of Publication: United States NLM ID: 9804159 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1525-1403 (Electronic) Linking ISSN: 10947159 NLM ISO Abbreviation: Neuromodulation Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: 2022- : [New York] : Elsevier Original Publication: Malden, MA : Blackwell Science, c1998- |
| مواضيع طبية MeSH: | Deep Brain Stimulation* , Essential Tremor*/therapy , Parkinson Disease*/therapy , Subthalamic Nucleus*, Humans ; Retrospective Studies ; Treatment Outcome |
| مستخلص: | Introduction: Directional deep brain stimulation (dDBS) has been suggested to have a similar therapeutic effect when compared with the traditional omnidirectional DBS, but with an improved therapeutic window that yields optimized clinical effect owing to the ability to better direct, or "steer," electric current. We present our single-center, retrospective analysis of our experience in the use of dDBS in patients with movement disorders and provide a review of the literature. Materials and Methods: We identified all patients with Parkinson disease (PD) and essential tremor (ET) who received a dDBS system between 2018 and 2022 and retrospectively examined characteristics of their longitudinal treatment. A total of 70 leads were identified across 42 patients (28 PD, 14 ET). Results: Three types of systems were implemented (single-segment activation, 45.2% of patients; multiple independent current control, 50.0%; and local field potential sensing-enabled, 4.7%). The subthalamic nucleus or globus pallidus internus was targeted in PD, and the ventral intermediate nucleus of the thalamus in ET. Across the entire cohort (n = 70 leads), at initial programming, 54.2% of leads (n = 38) were programmed using directional stimulation. At the most recent reprogramming, 58.6% of leads (n = 41) implemented directionality. In patients with PD, the average decrease in levodopa-equivalent daily dose at six months after implantation was 35.4% ± 39.2%. Despite the ability to steer current to relieve stimulation-induced side effects, ten leads in six patients required surgical revision owing to electrode malposition. Conclusions: We show wide adaptability and implementation of directional stimulation, adding to the growing compendium of real-world uses of dDBS therapy. We used directionality to improve clinical response in both patients with PD and patients with ET and found that its programming flexibility was used at high rates long after implantation and initial programming. In patients with PD, dDBS led to a significant reduction in dopaminergic medication, suggesting sustained clinical improvement. Nonetheless, accurate surgical placement remains necessary to ensure optimal clinical outcomes. Competing Interests: Conflict of Interest The authors reported no conflict of interest. (Copyright © 2022 International Neuromodulation Society. Published by Elsevier Inc. All rights reserved.) |
| فهرسة مساهمة: | Keywords: Directional DBS; Parkinson disease; essential tremor; neuromodulation; subthalamic nucleus |
| تواريخ الأحداث: | Date Created: 20230119 Date Completed: 20240405 Latest Revision: 20240422 |
| رمز التحديث: | 20240423 |
| DOI: | 10.1016/j.neurom.2022.12.008 |
| PMID: | 36658078 |
| قاعدة البيانات: | MEDLINE |
| تدمد: | 1525-1403 |
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| DOI: | 10.1016/j.neurom.2022.12.008 |