Sustained Therapeutic Benefits Using Image-Guided Programming at Activation of Deep Brain Stimulation for Parkinson's...

Area of Science:

• Neurosurgery
• Neurology
• Biomedical Engineering

Background:

• Deep brain stimulation (DBS) efficacy for Parkinson's disease (PD) relies on precise parameter optimization.
• Programming DBS parameters is a time-intensive process for individual patients.
• Image-guided programming (IGP) presents a potential solution to expedite DBS programming.

Purpose of the Study:

• To assess the real-world effectiveness of an IGP tool for initial programming of bilateral subthalamic nucleus (STN) or globus pallidus internus (GPi) DBS in PD patients.
• To evaluate the impact of IGP on programming efficiency and long-term motor function.
• To analyze the stability of IGP-determined stimulation settings over time.

Main Methods:

• A prospective substudy (GUIDE XT) of the Vercise DBS Registry enrolled 57 PD patients.
• Evaluated time for initial programming, Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS) Part III scores at baseline, 6 months, and 1 year.
• Analyzed patient/clinician global impression of change, continued use of IGP settings, and stimulation field model (SFM) overlap.

Main Results:

• Significant motor function improvement (MDS-UPDRS III) at 6 months (55%) and 1 year (45%) post-activation (P < 0.0001).
• Average initial programming session duration was 39.4 ± 4.4 minutes, with 55% completed in under 30 minutes.
• IGP-determined settings remained stable in 52% (6 months) and 43% (1 year) of patients; average SFM overlap was 92% at 1 year.

Conclusions:

• IGP enables efficient initial DBS programming sessions for Parkinson's disease.
• The use of IGP leads to stable stimulation parameters.
• IGP facilitates sustained long-term motor improvements in PD patients undergoing DBS.