7 T MRI Connectivity-Guided Reprogramming Improves Deep Brain Stimulation Motor Outcome in Parkinson's Disease

Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is an established treatment for Parkinson's disease (PD). Using 7-Tesla (7 T) MRI connectivity analysis to visualize the patient-specific STN motor subdivision, we hypothesize that reprogramming patients who are stimulated outside of this subdivision can improve their motor outcome substantially, without occurrence of adverse effects.

To determine whether connectivity-guided reprogramming improves motor outcome in PD patients treated with STN-DBS.

Patients who underwent STN-DBS with 7 T MRI probabilistic tractography (2022-2024) were evaluated after standardized follow-up. Their volume of tissue activated (VTA) was visualized with clinical guided programming. Patients were reprogrammed if their VTA did not overlap with the connectivity-defined STN motor subdivision. Follow-up outcome was assessed using the Movement Disorders Society Unified Parkinson's Disease Rating Scale motor part (MDS-UPDRS III; OFF medication, ON stimulation state) and hours OFF per day (MDS-UPDRS IV).

Twelve patients were included, of whom nine were reprogrammed. Mean MDS-UPDRS III score after classic programming improved by 16 ± 27% compared to baseline (48 ± 14 to 40 ± 13), and improved significantly further to 42 ± 26% after connectivity-guided reprogramming (28 ± 8; p = 0.005). Furthermore, OFF time after classic programming decreased from 5 ± 3 h at baseline to 3 ± 2 h, and decreased further to 2 ± 2 h after reprogramming. No stimulation-induced adverse effects were reported after parameter adjustments.

7 T MRI connectivity-guided (re)programming of STN-DBS can provide substantial improvement in motor outcome in PD patients and reduce OFF time, without occurrence of side-effects. Furthermore, response rate to DBS increases, enhancing overall DBS effectiveness in PD.