Imaging-based programming of subthalamic nucleus deep brain stimulation in Parkinson's disease

Area of Science:

• Neurology
• Neurosurgery
• Biomedical Engineering

Background:

• Deep Brain Stimulation (DBS) programming is becoming increasingly complex due to advanced lead designs requiring individualized optimization.
• Current programming methods can be time-consuming and require significant expertise.

Purpose of the Study:

• To compare the efficacy of imaging-guided DBS programming using GUIDE XT™ software against standard clinical programming for Parkinson's Disease (PD) motor symptoms.
• To evaluate the relationship between the volume of the electrostatic field (VEsF) and motor symptom improvement.

Main Methods:

• 29 PD patients with bilateral Subthalamic Nucleus (STN) directional DBS leads underwent clinical evaluation for optimal parameters.
• A second DBS program was generated using GUIDE XT™ software, visualizing leads within patient-specific MRI/CT anatomy.
• Motor symptom reduction (MDS-UPDRS) and VEsF overlap between the two programming methods were compared.

Main Results:

• Both clinical and imaging-guided programming significantly reduced motor symptoms (MDS-UPDRS) compared to the off-state.
• GUIDE XT™-derived DBS programming achieved non-inferior motor symptom control compared to standard clinical programming.
• The overlap of the VEsFs from both programming methods did not correlate with the observed differences in motor symptom reduction.

Conclusions:

• Imaging-guided programming of directional DBS leads with GUIDE XT™ is feasible without requiring a computational background.
• This method provides non-inferior motor symptom control for PD patients, serving as a potential starting point for clinical testing.
• Patient-specific imaging data can promote more efficient DBS programming.