Hardware Sophistications in Subthalamic Nucleus Deep Brain Stimulation for Parkinson's Disease; Is the Juice Worth the Squeeze?

BACKGROUND: New sophisticated deep brain stimulation (DBS) systems enabling steering of current and aiming at improving further motor outcome and decreasing side effects have virtually replaced old omnidirectional systems, despite being more labor-intensive and expensive. OBJECTIVES: The objective was to evaluate whether modern directional DBS resulted in better motor improvement compared to "old" omnidirectional DBS. METHODS: Publications on subthalamic nucleus (STN)-DBS from the "old" period were compared to modern publications, focusing on severity of motor symptoms at baseline and motor outcome at various intervals after surgery. RESULTS: Although patients from old DBS era had a more advanced disease at baseline than those treated with modern DBS hardware, they benefitted more from STN-DBS and showed a higher percentage decrease in dopaminergic medication. CONCLUSIONS: The new directional DBS does not result in better motor outcome compared to the older omnidirectional DBS. However, it may, in some cases, contribute to decreasing some side effects of stimulation such as dysarthria.