title: Directional deep brain stimulation of the subthalamic nucleus: A pilot study using a novel neurostimulation device.
abstract: A novel neurostimulation system allows steering current in horizontal directions by combining segmented leads and multiple independent current control. The aim of this study was to evaluate directional DBS effects on parkinsonian motor features and adverse effects of subthalamic neurostimulation.
  
  
  
  Seven PD patients implanted with the novel directional DBS system for bilateral subthalamic DBS underwent an extended monopolar review session during the first postoperative week, in which current thresholds were determined for rigidity control and stimulation-induced adverse effects using either directional or ring-mode settings.
  
  
  
  Effect or adverse effect thresholds were modified by directional settings for each of the 14 STN leads. Magnitude of change varied markedly between leads, as did orientation of optimal horizontal current steering.
  
  
  
  Directional current steering through chronically implanted segmented electrodes is feasible, alters adverse effect and efficacy thresholds in a highly individual manner, and expands the therapeutic window in a monopolar review as compared to ring-mode DBS. © 2016 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.
authors.affiliation: Department of Neurology, University Clinic of Würzburg, Würzburg, Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Steigerwald
authors.affiliation: Department of Neurology, University Clinic of Würzburg, Würzburg, Germany.
authors.forename: Lorenz
authors.initials: L
authors.lastname: Müller
authors.affiliation: Department of Neurosurgery, University Clinic of Würzburg, Würzburg, Germany.
authors.forename: Silvia
authors.initials: S
authors.lastname: Johannes
authors.affiliation: Department of Neurosurgery, University Clinic of Würzburg, Würzburg, Germany.
authors.forename: Cordula
authors.initials: C
authors.lastname: Matthies
authors.affiliation: Department of Neurology, University Clinic of Würzburg, Würzburg, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Volkmann
mesh_terms: D046690:Deep Brain Stimulation / Q000009:adverse effects* / Q000295:instrumentation* / Q000379:methods; D004567:Electrodes, Implanted / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000628:therapy*; D010865:Pilot Projects; D020531:Subthalamic Nucleus
keywords: Parkinson's disease; deep brain stimulation