Reduced Programming Time and Strong Symptom Control Even in Chronic Course Through Imaging-Based DBS Programming

Abstract

Objectives: Deep brain stimulation (DBS) programming is based on clinical response testing. Our clinical pilot trial assessed the feasibility of image-guided programing using software depicting the lead location in a patient-specific anatomical model.Methods: Parkinson's disease patients with subthalamic nucleus-DBS were randomly assigned to standard clinical-based programming (CBP) or anatomical-based (imaging-guided) programming (ABP) in an 8-week crossover trial. Programming characteristics and clinical outcomes were evaluated.Results: In 10 patients, both programs led to similar motor symptom control (MDS-UPDRS III) after 4 weeks (medicationOFF/stimulationON; CPB: 18.27 ± 9.23; ABP: 18.37 ± 6.66). Stimulation settings were not significantly different, apart from higher frequency in the baseline program than CBP (p = 0.01) or ABP (p = 0.003). Time spent in a program was not significantly different (CBP: 86.1 ± 29.82%, ABP: 88.6 ± 29.0%). Programing time was significantly shorter (p = 0.039) with ABP (19.78 ± 5.86 min) than CBP (45.22 ± 18.32).Conclusion: Image-guided DBS programming in PD patients drastically reduces programming time without compromising symptom control and patient satisfaction in this small feasibility trial.

Programming of subthalamic nucleus deep brain stimulation for Parkinson’s disease with sweet spot-guided parameter suggestions

“…For instance, Pavese et al (2020) suggested current amplitudes that required adjustments in most of their patients. In contrast, Lange et al (2021) did not use VTA estimations. In their view, these estimations made simplifying assumptions that would not adequately reflect the complexity of stimulated brain tissue.…”

“…Imaging-guided suggestions can help reduce the time needed to program directional leads. For instance, Lange et al (2021) reported an average of 20 min with imaging-guided programming compared to an average of 45 min with traditional programming for a patient implanted bilaterally with directional leads. Of note, they used the visualization in Guide XT to preselect a contact that faced the dorsolateral subthalamic nucleus.…”

“…The suggestions themselves were not tested in patients for motor improvement and should therefore be viewed as an indirect validation. To our knowledge, four other studies tested imaging-guided suggestions in patients and found similar motor improvement compared to traditional clinical programming (Pourfar et al, 2015;Pavese et al, 2020;Lange et al, 2021;Waldthaler et al, 2021). These studies generated suggestions manually with a visualization software such as Guide XT but attempted to target the whole dorsolateral 10.3389/fnhum.2022.925283 subthalamic nucleus and not a sweet spot.…”

MaDoPO: Magnetic Detection of Positions and Orientations of Segmented Deep Brain Stimulation Electrodes: A Radiation-Free Method Based on Magnetoencephalography

“…The postoperative detection of electrode positions is essential for several aspects, such as to verify the implanted electrode position, to evaluate therapeutic and adverse effects of DBS, and to facilitate and guide stimulation programming [ 4 ]. Segmented contacts of a directional electrode may allow the stimulation field to be generated in a desired direction, so this technology also requires knowledge of the precise electrode orientation in the brain to fully realize its benefits.…”

“…While DBS is most commonly used to treat movement disorders, such as Parkinson’s disease and essential tremor, it is increasingly being investigated for its therapeutic potential regarding a range of other brain diseases, including conditions such as neuropathic pain and epilepsy. Estimating the volume of tissue activated (VTA) has demonstrated clinical advantages in programming efficacy [ 4 ] and provides a method for optimizing stimulation while avoiding side effects. Conventional DBS electrodes, which have a linear array of ring contacts, offer limited control over an approximately spherical VTA.…”