Identifying the "Sweet Spot" for GPi DBS Programming

Clinical success of deep brain stimulation (DBS) depends on accurate electrode placement and stimulation within the brain targets. This study aims to explore the optimal stimulation site in the globus pallidus interna (GPi) to address the existing knowledge gap.

A retrospective chart review included Parkinson's disease (PD) patients who underwent GPi DBS between 2020 and 22 at our institution. We used stimulation data at six months post-op to generate a stimulation field model (SFM) for each lead and aggregated to generate volumetric stimulation heatmaps. Primary outcome measure was Clinical Global Impression-Change (CGI-C) scale, determined by response in contralateral tremor, rigidity and bradykinesia, correlated with SFM to generate ideal locations for stimulation in GPi. The secondary outcome measures were difference in pre- and post-DBS Movement Disorders Society-Unified Parkinson's disease Rating Scale (MDS-UPDRS) III scores.

Twenty-two PD patients with 36 GPi leads were included. Mean age: 64 ± 8.5 years; 67 % were male. For right GPi leads, 11/16 (69 %) had CGI-C of 1 and 5/16 (31 %) had 2. For left GPi leads, 13/20 (65 %) and 7/20 (35 %) had CGI-C of 1 and 2, respectively. MDS-UPDRS improved from 33.5 to 19.7 (41 %) post-op (p = 0.0003) with significant reduction in levodopa equivalent dosage (p = 0.00043).

We identified the "sweet spot" corresponding with CGI-C of 1 in the postero-lateral and mid region of GPi on axial and coronal sequences, respectively. Our findings support the previously reported limited evidence in the literature and can be helpful in image-guided DBS programming in patients with PD.