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

Josefine Waldthaler; Miriam Bopp; Nele Kühn; Bugrahan Bacara; Merle Keuler; Marko Gjorgjevski; Barbara Carl; Lars Timmermann; Christopher Nimsky; David J Pedrosa

doi:10.1016/j.brs.2021.07.064

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

Brain Stimul. 2021 Sep-Oct;14(5):1109-1117. doi: 10.1016/j.brs.2021.07.064. Epub 2021 Aug 2.

Authors

Affiliations

¹ Department of Neurology, University of Marburg, Germany; CMBB - Center for Mind, Brain and Behavior, University of Marburg, Germany. Electronic address: josefine.waldthaler@staff.uni-marburg.de.
² CMBB - Center for Mind, Brain and Behavior, University of Marburg, Germany; Department of Neurosurgery, University of Marburg, Germany.
³ Department of Neurology, University of Marburg, Germany.
⁴ Department of Neurosurgery, University of Marburg, Germany.
⁵ Department of Neurosurgery, University of Marburg, Germany; Department of Neurosurgery, Helios Dr. Horst Schmidt Kliniken, Wiesbaden, Germany.
⁶ Department of Neurology, University of Marburg, Germany; CMBB - Center for Mind, Brain and Behavior, University of Marburg, Germany.

PMID: 34352356
DOI: 10.1016/j.brs.2021.07.064

Abstract

Background: The need for imaging-guided optimization of Deep Brain Stimulation (DBS) parameters is increasing with recent developments of sophisticated lead designs offering highly individualized, but time-consuming and complex programming.

Objective: The objective of this study was to compare changes in motor symptoms of Parkinson's Disease (PD) and the corresponding volume of the electrostatic field (VEsF) achieved by DBS programming using GUIDE XT™, a commercially available software for visualization of DBS leads within the patient-specific anatomy from fusions of preoperative magnetic resonance imaging (MRI) and postoperative computed tomography (CT) scans, versus standard-of-care clinical programming.

Methods: Clinical evaluation was performed to identify the optimal set of parameters based on clinical effects in 29 patients with PD and bilateral directional leads for Subthalamic Nucleus (STN) DBS. A second DBS program was generated in GUIDE XT™ based on a VEsF optimally located within the dorsolateral STN. Reduction of motor symptoms (Movement Disorders Society Unified Parkinson's Disease Rating Scale, MDS-UPDRS) and the overlap of the corresponding VEsF of both programs were compared.

Results: Clinical and imaging-guided programming resulted in a significant reduction in the MDS-UPDRS scores compared to off-state. Motor symptom control with GUIDE XT™-derived DBS program was non-inferior to standard clinical programming. The overlap of the two VEsF did not correlate with the difference in motor symptom reduction by the programs.

Conclusions: Imaging-guided programming of directional DBS leads using GUIDE XT™ is possible without computational background and leads to non-inferior motor symptom control compared with clinical programming. DBS programs based on patient-specific imaging data may thus serve as starting point for clinical testing and may promote more efficient DBS programming.

Keywords: Deep brain stimulation; Directional leads; Idiopathic Parkinson's disease; Programming; Subthalamic nucleus.

MeSH terms

Deep Brain Stimulation*
Humans
Magnetic Resonance Imaging
Parkinson Disease* / diagnostic imaging
Parkinson Disease* / therapy
Subthalamic Nucleus* / diagnostic imaging
Treatment Outcome