Objective: To compare traditional trial-and-error with neuroanatomical-3D-image software-assisted deep brain stimulation (DBS) programming in patients with Parkinson’s disease (PD) treated with subthalamic nucleus (STN) DBS.

Background: Initial programming of DBS settings in PD patients is challenging and time consuming due to the vast number of possible parameter combinations. A number of variables including individual variations in patients’ brain anatomy, the placement of the DBS leads and the occurrence of side effects must also be considered. GUIDE^TM (Boston Scientific) is a 3D-neuroantomical visual software that provides precise information on electrode placement in the STN. Patient’s preoperative MRI is fused with the postoperative CT. An automated algorithm locates the DBS leads in the postoperative CT and provides a 3D reconstruction of the DBS leads, STN, thalamus and red nucleus by using the Morel Atlas registered to the preoperative MRI.

Methods: 10 PD patients were included in the study. GUIDE^TM software was used to visualise the location of the implanted DBS leads relative to the STN target. Neurostimulation parameters were selected to create a stimulation field encompassing the dorsal part of the STN. On programming day, patients were assessed with both approaches using a cross-over design. For the GUIDE^TM assisted session, the patients were programmed directly with the DBS settings obtained with the stimulated field model. Stimulation parameters were adjusted, if necessary, to achieve optimal clinical response.

Results: In 7 patients, DBS settings obtained with GUIDE^TM visualization system led to a suboptimal clinical improvement. In 5 patients, an increase of current amplitude was required to achieve a satisfactory clinical improvement, whereas in 2 patients the selection of different contacts (usually the contact above the one selected with GUIDE^TM) was needed. After these adjustments, the magnitude of clinical improvement with the two approaches was comparable. Overall, programming time with GUIDE^TM software was significantly shorter than that using traditional programming approach.

Conclusions: Visualization of stimulation fields with GUIDE^TM software provides useful information to achieve clinical improvement comparable to that obtained with the traditional trial-and-error approach but with shorter and more efficient programming sessions.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/traditional-trial-and-error-versus-neuroanatomical-3d-image-software-assisted-deep-brain-stimulation-programming-in-patients-with-parkinsons-disease/