Abstract Details

Title Vertically-Stacked Single Segment Activation (V-SSA) as a Programming Approach for Directional DBS in Globus Pallidus Internus (GPi) in Parkinson’s Disease (PD) Patients: First Clinical Case Series

Topic Movement Disorders

Presentation(s) P2 - Poster Session 2 (8:00 AM-9:00 AM)

Poster/Presentation
Number 3-002

Objective Programming approach to optimize outcomes in PD patients implanted in GPi with directional DBS systems and to analyze volumes of tissue activation (VTAs) in GPi.

Background STN and GPi have been shown to be effective DBS targets for treatment of advanced PD. Studies indicate that stimulation of GP as a whole has robust effect on bradykinesia. However, unless DBS lead is placed proximal to border of GPe and GPi, it may not be possible to stimulate GP as a whole using non-directional stimulation without stimulating neighboring structures. In this work, we report using directional DBS in GP.

Design/Methods During monopolar review, we tested non-directional and directional electrode montages to determine optimum therapeutic-window (TW). We refer to co-activation of single-segments aligned in same direction from two segmented levels as V-SSA. VTA analysis was done using Sim4Life v4.0 and the MIDA model.

Results Review of clinical settings of 7 GPi-DBS implantations in 4 PD patients optimized for outcomes and TW revealed that V-SSA was used in 6 out of 7 implants. For these implants, mean and median VTA overlaps with GP were 89% (±12%) and 93%, respectively. Mean and median of ratio of VTAs in GPe to GPi were 5.75 (±11.08) and 1.3, respectively. The mean settings were 2.67 mA at 67 µs and 153 Hz. The implant that was not on V-SSA was on a complex bipolar-montage with only 60% of its VTA in GP. It had a ratio of VTA in GPe to GPi of 0.5 and settings of 2.1 mA at 150 µs (2.25 times that for V-SSA leads) and 180 Hz.

Conclusions Our results suggest that V-SSA may optimize therapy while focusing activation volumes to within GP. Consistent with some earlier work with non-directional leads, optimal stimulation region may not necessarily be restricted to GPi but some combination of GPe and GPi.

Authors/Disclosures
Muhammad W. Anjum, MD (LSUHSC-S Department of Neurology) PRESENTER	Dr. Anjum has nothing to disclose.
	No disclosure on file
Yasar A. Torres-Yaghi, MD	Dr. Torres-Yaghi has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Acorda. Dr. Torres-Yaghi has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Abbvie. Dr. Torres-Yaghi has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Amneal. Dr. Torres-Yaghi has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Abbott. Dr. Torres-Yaghi has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Kyowa Kirin. Dr. Torres-Yaghi has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Teva. Dr. Torres-Yaghi has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Sunovion .
	No disclosure on file
	No disclosure on file
Fahd Amjad, MD (Georgetown University Hospital)	Dr. Amjad has received personal compensation in the range of $50,000-$99,999 for serving as a Consultant for TEVA. Dr. Amjad has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Acadia. Dr. Amjad has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Merz. Dr. Amjad has received personal compensation in the range of $0-$499 for serving as a Consultant for abbvie. Dr. Amjad has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Amneal. Dr. Amjad has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Kyowna Kirin. Dr. Amjad has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Neurocrine. Dr. Amjad has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for This information is included in the consultant disclosure. The institution of Dr. Amjad has received research support from Roche.
David Zhang, PhD (Genentech, Inc.)	No disclosure on file
Fernando L. Pagan, MD, F�鶹��ýӳ�� (Georgetown University Hospital Dept of Neurology)	Dr. Pagan has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Acorda. Dr. Pagan has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Adamas. Dr. Pagan has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Amneal. Dr. Pagan has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Merz. Dr. Pagan has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Kyowa Kirin. Dr. Pagan has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Sunovion. Dr. Pagan has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Teva. Dr. Pagan has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for US World Meds. Dr. Pagan has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Supernus. Dr. Pagan has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Abbvie. Dr. Pagan has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Acorda. Dr. Pagan has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Adamas. Dr. Pagan has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Amneal. Dr. Pagan has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Sunovion. Dr. Pagan has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Teva. Dr. Pagan has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Neurocrine. Dr. Pagan has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Sunovion. Dr. Pagan has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Supernus. Dr. Pagan has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Journal of Clinical Parkinsonism and related Disorders. Dr. Pagan has stock in Keiferx. The institution of Dr. Pagan has received research support from US World Meds. The institution of Dr. Pagan has received research support from Novartis.

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