Image-guided optimization of current steering in STN-DBS for Parkinson's disease

Area of Science:

• Neurosurgery
• Neurology
• Biomedical Engineering

Background:

• Advancements in multiple independent current control (MICC) and directional leads have improved subthalamic nucleus deep brain stimulation (STN-DBS) for Parkinson's disease (PD).
• These technological improvements increase the complexity and duration of programming sessions.

Purpose of the Study:

• To evaluate the clinical utility of image-guided programming (IGP) for STN-DBS.
• To assess IGP's effectiveness in patients with stable postoperative Parkinson's disease symptoms.

Main Methods:

• Sixteen patients with advanced PD and stable symptoms underwent reprogramming using Stimview™ XT, an image-guided interface.
• Current steering was adjusted horizontally and vertically based on individual STN anatomy, without altering pulse width or frequency.
• Motor function was assessed using the Unified Parkinson's Disease Rating Scale part III (UPDRS III) before, 1 hour after, and 3 months post-reprogramming.

Main Results:

• Image-guided current steering led to modifications in 29 of 32 leads, with new horizontal steering in 23 leads and vertical adjustments in six.
• Nine patients reported immediate subjective improvement, and 15 of 16 chose to continue with the IGP-derived settings.
• Significant improvements in UPDRS III scores were observed 1 hour post-reprogramming and sustained at 3 months.

Conclusions:

• IGP is a clinically effective and time-efficient method for optimizing current steering in STN-DBS.
• IGP enhances precision in targeting the dorsolateral STN by utilizing individualized anatomical visualization.
• This approach leads to improved motor outcomes in Parkinson's disease patients, even those with previously stable symptoms.