Objective: Deep brain stimulation in the subthalamic nucleus (STN) is routinely proposed to parkinsonian patients. Introduction of directional leads offer more flexibility for programming but may also increase the complexity and duration of the procedure. Here we assess whether Guide XT, a new patient-specific imaging software, is helpful to refine stimulation parameters and to simplify the time consuming programming process

Background: Clinical examination of the stimulation effect for each contact is the empirical method to set up stimulation parameters. Guide XT models the volume of activated tissue and provides semi-automatic lead localization and segmentation of deep brain structures in order to visualize leads position anatomical structures relative to putative stimulation fields.

Method: We evaluated all parkinsonian patients who were implanted with bilateral directional leads in the STN. After the surgery, patients were programmed and followed by the neurological team while blinded from anatomical data. All parameters were reviewed (ring or directional mode) and optimized based on standard clinical evaluation. One year after surgery, Guide XT was used to analyze imaging data by the neurosurgical team to choose the best stimulation configuration and parameters blinded from clinical data. Clinically determined parameters were then compared to imaging-based parameters.

Results: Sixteen patients were included in the study (11 males, 5 females, 59.1 ± 5.5 years old, disease duration 12.3 ± 7.4 years). The stimulation depth was similar between imaging and clinical settings in 75% of cases. Stimulation direction was similar between imaging and clinical settings in 18.75% of cases. Ring mode was selected in 62.5% with the clinical procedure and in 25% with the imaging procedure.

Conclusion: Predicted depth of stimulation using imaging data and empirically determined stimulation using clinical effects showed good concordance. Clinician used mainly ring mode stimulation despite imaging data suggesting a potentially better stimulation configuration using directional mode, possibly due to the complexity of the clinical evaluation. Imaging-guided parameters settings refined with clinical evaluation could therefore help to optimize parameters and limit non-motor side effects and need to be further evaluated

« Back to 2019 International Congress

MDS Abstracts - https://www.mdsabstracts.org/abstract/could-we-optimize-the-stimulation-parameters-setting-of-directional-leads-with-a-patient-specific-imaging-software-in-implanted-parkinsonian-patients/