Pointing in the right direction: Motor improvements with directional versus circular DBS
medRxiv (Cold Spring Harbor Laboratory)(2023)
Abstract
Directional brain stimulation provides greater control of radial current spread than conventional ring-shaped electrodes. Whether this added flexibility can improve motor function is unclear. Here we examine whether directional and circular stimulation differentially change motor performance in patients with Parkinson’s disease. We measured motor behaviors in 31 patients who underwent unilateral subthalamic nucleus brain stimulation surgery (SUNDIAL, [NCT03353688][1]) from each of 8 configurations (6 directional contacts and their corresponding rings) during device activation. Objective measures of dexterity, gait, balance, and overall mobility were queried in a double-blind fashion in the practically defined “off” medication state versus preoperative baseline with stimulus amplitude at the center of the therapeutic window. The best versus the worst directional contact on a given row yields significant changes in performance across 5 motor tasks (p<0.001 each task). Specific stimulation directions can worsen function versus baseline, whereas the best direction yields greater improvement than ring stimulation (p=0.005, p=0.001, p=0.007, p<0.001, respectively, across tasks). Although directional DBS improves side effect thresholds versus ring stimulation (p<0.001), the side effect threshold and therapeutic window correlate only modestly with motor improvements. Resting beta power did not predict motor improvements by directional DBS across any of the motor tasks. Optimized directional subthalamic nucleus DBS yields better group-level motor performance than ring stimulation, in addition to known advantages related to tolerability. Prospective studies should evaluate whether these improvements persist over longer time intervals.
### Competing Interest Statement
The authors have declared no competing interest.
### Clinical Trial
NCT03353688
### Funding Statement
Funding Dr. Walker receives research funding from the National Institutes of Health (1UH3NS100553-38401), the Michael J. Fox Foundation (MJFF 15098)
### Author Declarations
I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.
Yes
The details of the IRB/oversight body that provided approval or exemption for the research described are given below:
Ethics committee/IRB of the University of Alabama at Birmingham gave ethical approval for this work
I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.
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I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).
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I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.
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All data produced in the present study are available upon reasonable request to the authors
[1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT03353688&atom=%2Fmedrxiv%2Fearly%2F2023%2F03%2F01%2F2023.02.27.23286503.atom
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Key words
motor improvements,circular dbs,direction
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