{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T12:46:05Z","timestamp":1791895565171,"version":"4.3.4"},"reference-count":40,"publisher":"BMJ","issue":"2","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J Neurol Neurosurg Psychiatry"],"accepted":{"date-parts":[[2024,7,25]]},"published-print":{"date-parts":[[2025,2]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Since their introduction in 2015, directional leads have practically replaced conventional leads for deep brain stimulation (DBS) in Parkinson\u2019s disease (PD). Yet, the benefits of directional DBS (dDBS) over omnidirectional DBS (oDBS) remain unclear. This meta-analysis and systematic review compares the literature on dDBS and oDBS for PD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Database searches included Pubmed, Cochrane (CENTRAL) and EmBase, using relevant keywords such as \u2018directional\u2019, \u2018segmented\u2019, \u2018brain stimulation\u2019 and \u2018neuromodulation\u2019. The screening was based on the title and abstract.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>23 papers reporting on 1273 participants (1542 leads) were included. The therapeutic window was 0.70 mA wider when using dDBS (95% CI 0.13 to 1.26 mA, p=0.02), with a lower therapeutic current (0.41 mA, 95% CI 0.27 to 0.54 mA, p=0.01) and a higher side-effect threshold (0.56 mA, 95% CI 0.38 to 0.73 mA, p&lt;0.01). However, there was no relevant difference in mean Unified Parkinson\u2019s Disease Rating Scale III change after dDBS (45.8%, 95% CI 30.7% to 60.9%) compared with oDBS (39.0%, 95% CI 36.9% to 41.2%, p=0.39), in the medication-OFF state. Median follow-up time for dDBS and oDBS studies was 6 months and 3 months, respectively (range 3\u201312 for both). The use of directionality often improves dyskinesia, dysarthria, dysesthesia and pyramidal side effects. Directionality was used in 55% of directional leads at 3\u20136 months, remaining stable over time (56% at a mean of 14.1 months).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>These findings suggest that stimulation parameters favour dDBS. However, these do not appear to have a significant impact on motor scores, and the availability of long-term data is limited. dDBS is widely accepted, but clinical data justifying its increased complexity and cost are currently sparse.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>PROSPERO registration number<\/jats:title>\n                    <jats:p>CRD42023438056.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/jnnp-2024-333947","type":"journal-article","created":{"date-parts":[[2024,9,20]],"date-time":"2024-09-20T13:20:20Z","timestamp":1726838420000},"page":"188-198","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":17,"title":["Directional deep brain stimulation electrodes in Parkinson\u2019s disease: meta-analysis and systematic review of the literature"],"prefix":"10.1136","volume":"96","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4915-7899","authenticated-orcid":false,"given":"Victor","family":"Hvingelby","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fareha","family":"Khalil","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Flavia","family":"Massey","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Hoyningen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"San San","family":"Xu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Candelario-McKeown","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harith","family":"Akram","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Foltynie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5668-5545","authenticated-orcid":false,"given":"Patricia","family":"Limousin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ludvic","family":"Zrinzo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie T","family":"Kr\u00fcger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,9,20]]},"reference":[{"key":"2025011602550664000_96.2.188.1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1205158"},{"key":"2025011602550664000_96.2.188.2","doi-asserted-by":"publisher","DOI":"10.1111\/ene.13255"},{"key":"2025011602550664000_96.2.188.3","first-page":"189","article-title":"Deep brain stimulation for intractabile epilepsy","volume":"60","author":"Morace","year":"2016","journal-title":"J Neurosurg Sci"},{"key":"2025011602550664000_96.2.188.4","doi-asserted-by":"publisher","DOI":"10.1016\/j.biopsych.2019.01.017"},{"key":"2025011602550664000_96.2.188.5","doi-asserted-by":"publisher","DOI":"10.1080\/14737175.2020.1749049"},{"key":"2025011602550664000_96.2.188.6","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/awu102"},{"key":"2025011602550664000_96.2.188.7","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000000823"},{"key":"2025011602550664000_96.2.188.8","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(15)00087-3"},{"key":"2025011602550664000_96.2.188.9","unstructured":"Krauss P , Kr\u00fcger M . 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