Boston Scientific Deep Brain Stimulation

Is there a false sense of security when using 'directional' DBS leads? You bet. Why are we not using the 'picture' to guide deep brain stimulation programming? Almost all implanted DBS leads these days are equipped w/ programmable segments and we have entered a 'more complex' era for DBS programming. Rolland and colleagues in @journal_PD tackle this challenge. Key points: - Reasonable targeting of the sensorimotor regions of STN (and GPi) are important to outcome in Parkinson's disease. - The authors contend that use of the segments on a DBS lead could be a crucial factor for best outcome. - Use of these 'directional leads' theoretically 'increases stimulation specificity.' - In this very small study, 64% of cases requiring refinement, the computer program which used the imaging data 'improved clinical efficacy or reduced mild side effects, predominantly by facilitating the use of directional stimulation (93% of refinements).' My take: Let's be careful here, as no amount of expert programming will make up for a grossly suboptimally placed DBS lead. The concern many of us in the field have, is that people will develop false confidence to quickly implant a DBS lead; and that programming the segments in the clinic setting will make up for a suboptimal placement. This is, in my opinion, 'misguided.' In my view, we should work hard to place the DBS lead(s) into an optimal location and use the segments to slightly refine outcome. I think of it like a great sculpture that is nearly complete and the use of segments is like 'using the chisel to complete the detail on an already developed figure.' Will the use of image guided programming save time and assist clinical refinement in some cases? Of course it will. Should we use imaging to guide programming of directional leads? Definitely. Though I like the Rolland paper I would suggest to folks using DBS segments for programming this advice; 'Magna di currant, parva neglegunt.' The gods take care of large things, but neglect small things. content.iospress.com/articles/journ… #Parkinsons #deepbrainstimulation @DBSThinkTank @leaddbs