Deep brain stimulation (DBS) with electric field steering may avoid areas responsible for side effects. This prospective randomized cross-over trial compared omnidirectional (OS) and directional (DS) subthalamic DBS in 19 patients. Electromyographically measured rigidity was the primary outcome. Motor and non-motor scores were secondary outcomes. There were no significant differences between OS and DS. In the acute setting, both conditions improved motor scores compared to no stimulation. Motor symptoms improved after 3 weeks of OS relative to acute measurements, whereas they worsened under DS. The more ventral the active contact, and the less the motor improvement sweet spot was stimulated, the greater the benefit of DS over OS for executive function. Accurate OS of the dorsal subthalamic nucleus ensures motor and non-motor improvements. While DS can mitigate executive decline stemming from off-target stimulation, it may lead to worse motor outcomes. Larger, long-term studies are needed to confirm these findings. (Registration: subthalamic steering for therapy optimization in Parkinson’s Disease ClinicalTrials.gov: NCT03548506, 2018-06-06).

使用电场控制的深部脑刺激 （DBS） 可能会避开导致副作用的区域。这项前瞻性随机交叉试验比较了 19 例患者的全向 （OS） 和定向 （DS） 丘脑底 DBS。肌电图测量的硬度是主要结局。运动和非运动评分是次要结局。OS 和 DS 之间没有显著差异。在急性情况下，与无刺激相比，这两种情况都提高了运动评分。相对于急性测量，OS 3 周后运动症状有所改善，而在 DS 下恶化。主动接触的腹侧越多，刺激的运动改善甜蜜点越少，DS 对执行功能的好处就越大。丘脑底核的准确 OS 可确保运动和非运动的改善。虽然 DS 可以减轻因脱靶刺激引起的执行力下降，但它可能会导致更差的运动结果。需要更大规模的长期研究来证实这些发现。（注册：帕金森病治疗优化的丘脑底转向 ClinicalTrials.gov：NCT03548506,2018-06-06）。