Is a multi array-contact lead able to improve STN-DBS in Parkinson’s Disease?

Abstract

Background Multi-directional electrodes in STN-DBS give the possibility to steer the high frequency current into the direction for clinical improvement and moreover recording of multi-array local field potential recordings (LFPs) give the possibility to determine the spatiotemporal distribution of oscillatory power across the STN that is related to the symptomatology in PD patients. Ultimately this information can be used as a feedback to optimize the stimulation parameters. Methods Eight PD patients were included in the study. After micro-electrode recording (MER), to determine the boundaries of the STN, temporarily a prototype of a new 32-contact DBS lead was inserted during the DBS procedure. Different modes of current steering were employed to improve motor symptoms and patients were scored on beneficial and adverse effects. Prior to and immediately after stimulation the distribution of spectral power was recorded by LFPs and spatiotemporal changes were evaluated with Fourier analysis. Results Thresholds of the effects of spherical stimulation were comparable to thresholds of stimulation through the conventional electrode at the same location in 89% of the cases. In eight of fourteen side effects, steering stimulation current increased the threshold for side effects by ⩾ 1 mA compared to spherical stimulation. The size of the therapeutic window could be widened in patient 6, 7 and 8 by steering stimulation in the posterior, posterior and anterior direction, respectively. LFP recordings prior to stimulation yielded the boundaries of the STN by showing increased spectral power particularly in the 13–40 Hz range. Recordings across all directions showed distinct spatiotemporal patterns of neuronal activity, which were related to the pattern of stimulation and the PD symptoms of the patient. Conclusions With a new DBS lead it is possible to steer stimulation current in STN-DBS such that it leads to a larger therapeutic window than with conventional spherical stimulation. Simultaneous LFP recordings across the entire STN provide spatial information about the location of the STN and its disease-related electrical activity. This may potentially be of benefit in predicting how to steer the current towards the sensorimotor part, while avoiding adverse effects.