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.

中文翻译：

---

基于影像的丘脑底核深部脑刺激治疗帕金森病

背景

随着提供高度个性化但耗时且复杂的编程的复杂引线设计的最新发展，对深部脑刺激 (DBS) 参数的成像引导优化的需求正在增加。

客观的

本研究的目的是比较帕金森病 (PD) 运动症状的变化和 DBS 编程使用 GUIDE XT™ 实现的相应静电场 (VEsF) 的变化- 术前磁共振成像 (MRI) 和术后计算机断层扫描 (CT) 扫描融合的特定解剖结构与标准护理临床程序。

方法

进行了临床评估，以根据 29 名 PD 和双侧定向导联的丘脑底核 (STN) DBS 患者的临床效果确定最佳参数集。第二个 DBS 程序是在 GUIDE XT™ 中生成的，该程序基于最佳位于背外侧 STN 内的 VEsF。比较了运动症状的减少（运动障碍协会统一帕金森病评定量表，MDS-UPDRS）和两个项目的相应 VEsF 的重叠。

结果

与关闭状态相比，临床和影像引导编程导致 MDS-UPDRS 评分显着降低。使用 GUIDE XT™ 衍生的 DBS 程序控制运动症状并不劣于标准临床程序。两个 VEsF 的重叠与程序在运动症状减少方面的差异无关。

结论

使用 GUIDE XT™ 进行定向 DBS 导联的成像引导编程是可能的，无需计算背景，与临床编程相比，可实现非劣质运动症状控制。因此，基于患者特定影像数据的 DBS 程序可以作为临床测试的起点，并可以促进更有效的 DBS 编程。