Abstract Details

Title The Use of Omni vs. Directional Programming in Parkinson Disease and Essential Tremor DBS Patients

Topic Movement Disorders

Presentation(s) P1 - Poster Session 1 (5:30 PM-6:30 PM)

Poster/Presentation
Number 10-021

Objective

To evaluate the benefit of omni vs directional deep brain stimulation (DBS) programming in patients with Parkinson disease (PD) and essential tremor (ET).

Background Previously, DBS leads used only ring electrodes (omni stimulation) which generated a spherical electrical field. Recently, directional leads were introduced which consist of two middle contacts with three radially segmented electrodes and two ring electrodes at the highest and lowest contacts. Segmented electrodes steer stimulation in a particular direction which can reduce side effects and improve efficacy. There is limited literature on the use of segmented electrodes in DBS for PD and ET.

Design/Methods All patients who underwent DBS placement (Nov 2016 to July 2018) with directional leads (Abbott) were identified and programming was reviewed to assess the use of segmented contacts.

Results A total of 101 directional leads were implanted – 71 for PD in the subthalamic nucleus (STN) and 30 for ET in the ventral intermediate nucleus of the thalamus (Vim). In PD patients, the segmented contacts were used for cathodal stimulation in 64.7% of the leads (n=46). Of these, 28.2% (n=13) utilized directional programming and the remainder were using the omni mode of programming. In ET patients, 58.6% of the leads used the segmented contacts for cathodal stimulation and of these 35.2% utilized directional programming. In this cohort, the primary reasons for using directional programming included avoiding side effects or lowering energy needed to achieve therapeutic benefit.

Conclusions Directional leads may enhance programming capabilities; however, it appears that segmented electrodes allowing directional programming may be underutilized. Further studies are warranted to assess the full potential of directional programming.

Authors/Disclosures
Vibhash D. Sharma, MD, FAAN (University of Texas Southwestern Medical Center) PRESENTER	Dr. Sharma has nothing to disclose.
Kelly E. Lyons, PhD (University of Kansas Medical Center)	Dr. Lyons has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Praxis. Dr. Lyons has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Sage. Dr. Lyons has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Parkinson's Foundation. Dr. Lyons has a non-compensated relationship as a President with International Essential Tremor Foundation that is relevant to AAN interests or activities.
Jules Nazzaro (Boston University Medical Center)	No disclosure on file
Rajesh Pahwa, MD, FAAN (University of Kansas Medical Center)	Dr. Pahwa has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Abbott. Dr. Pahwa has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for AbbVie. Dr. Pahwa has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for ACADIA. Dr. Pahwa has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Amneal. Dr. Pahwa has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Lundbeck. Dr. Pahwa has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Supernus. Dr. Pahwa has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Insightec. Dr. Pahwa has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Jaaz. Dr. Pahwa has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Fasikl. Dr. Pahwa has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Genetech. Dr. Pahwa has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Merz. Dr. Pahwa has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Mitsubishi Tanabe. Dr. Pahwa has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Photopharmics. The institution of Dr. Pahwa has received research support from Abbott. The institution of Dr. Pahwa has received research support from Abbvie. The institution of Dr. Pahwa has received research support from Biogen. The institution of Dr. Pahwa has received research support from Parkinson Foundation. The institution of Dr. Pahwa has received research support from Roche. The institution of Dr. Pahwa has received research support from Sage. The institution of Dr. Pahwa has received research support from Sun Pharma. The institution of Dr. Pahwa has received research support from Theravance. The institution of Dr. Pahwa has received research support from Neuroderm. The institution of Dr. Pahwa has received research support from Ask Bio. The institution of Dr. Pahwa has received research support from Blue Rock. The institution of Dr. Pahwa has received research support from Cerevance. The institution of Dr. Pahwa has received research support from Fasikl. The institution of Dr. Pahwa has received research support from Scion. The institution of Dr. Pahwa has received research support from UCB. The institution of Dr. Pahwa has received research support from Ono. The institution of Dr. Pahwa has received research support from Intra-cellular Therapies. The institution of Dr. Pahwa has received research support from Ask Bio. The institution of Dr. Pahwa has received research support from Michael J Fox Foundation . The institution of Dr. Pahwa has received research support from Neuron 23. The institution of Dr. Pahwa has received research support from Roche.

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