Objective: To assess the relationship between lead location in the subthalamic nucleus (STN) and deep brain stimulation (DBS) outcomes as reported in the INTREPID clinical trial.

Background: Location of the DBS lead within the STN as well as the proper optimization of stimulation parameters are considered to play a critical role in determining clinical outcomes in patients with Parkinson’s disease (PD). While the sensorimotor region of the STN is generally targeted, there is no consensus on the optimal site for lead placement. Although a simple determination of lead location relative to regional STN anatomies does not show a strong correlation with motor outcomes, there remains a consensus that motor outcomes are strongly affected by the location of the lead within the STN.¹  Some of the controversy may be attributed to the neuroanatomical variability across patients and difficulty with accurate postoperative localization of the lead within the STN. Therefore, obtaining thorough and exhaustive information regarding the precise location of the lead, the volume of tissue activated by the stimulation field relative to anatomical targets, and any correlation of these aspects to clinical effects would likely be of great importance when treating patients using DBS to manage PD motor symptoms.

Method: INTREPID (ClinicalTrials.gov Identifier: NCT01839396) is a multi-center, prospective, double-blinded randomized controlled trial. Subjects with advanced PD were implanted bilaterally in the STN with a multiple-source, constant current DBS System (Vercise, Boston Scientific). Lead location and corresponding volume of tissue activated was calculated using a new visualization tool (GUIDE XT, Boston Scientific). Analysis regarding correlation to clinical outcomes at one year follow up is currently being conducted.

Results: Results from analyses related to lead location, volume of tissue activation, and corresponding clinical outcomes in the INTREPID study cohort of 160 subjects will be presented.

Conclusion: Assessment of DBS lead localization and associated stimulation parameters will offer an opportunity to further evaluate the role these variables may have on observed clinical outcomes in PD patients. Results of this study will also provide the rationale for patient specific targeting of the STN to optimize motor outcomes.

References: 1. Nestor KA, Jones JD, Butson CR, et al. Coordinate-based Lead Location Does Not Predict Parkinson’s Disease Deep Brain Stimulation Outcome. PLoS One. Apr 2014; 9(4): e93524.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/correlation-of-lead-location-with-clinical-outcomes-in-a-double-blinded-randomized-controlled-trial-evaluating-subthalamic-deep-brain-stimulation-in-parkinsons-disease-intrepid/