Libra dbs system

Detailed methods of the original 12 center prospective, controlled trial were previously published.¹³ At the beginning of the parent trial, all participants underwent unilateral VIM DBS surgery with an option for second side surgery a minimum of 6 months after initial implant. As the study progressed, there was an amendment to the protocol allowing patients to receive bilateral simultaneous VIM DBS implants upfront (for purposes of this sub analysis, we did not include these patients (n = 8)). Implantation of the constant current Libra DBS system (St. Jude Medical/Abbott Neuromodulation Division, Plano, TX, USA) was performed according to each center's standard surgical procedures. Patient's DBS stimulation settings were optimized as part of routine clinical practice. Medication therapy could be adjusted as clinically indicated throughout the study.

Patients were implanted bilaterally with one DBS lead per hemisphere (4 electrode contacts per lead) as previously published (Riva-Posse et al., 2017 (link)). The frame-based stereotactic surgical procedure combined deterministic tractography and high-resolution T1-Weighted structural MRI to identify the desired target at the intersection of four white-matter bundles in the SCC region (Riva-Posse et al., 2017 (link)) using a standard intraoperative planning workstation (StealthStation, Medtronic, Louisville, CO) (Figure 1).
Twelve patients were implanted with the Libra DBS system (St Jude Medical, Plano, TX). These electrodes have the following specifications: diameter: 1.4 mm, length: 1.5 mm [electrodes 2–4], length: 3 mm [electrode 1], center-to-center: 3 mm, inter-electrode space: 1.5 mm. The remaining two patients received Activa PC+S 3387 leads (electrodes with diameter:1.27 mm, length: 1.5 mm, center-to-center: 3 mm, inter-electrode space 1.5 mm) (Medtronic, Minneapolis, MN). A nomenclature of L1-L4 and R1-R4 was used for the four ventral-to-dorsal electrodes within the left (L) and right (R) hemispheres respectively, for both types of leads.