Objective: To determine if an image-guided programming (IGP) tool can enable shorter initial Deep Brain Stimulation (DBS) programming sessions and evaluate continued chronic use of recommended stimulation settings in Parkinson’s disease (PD) patients.

Background: Historically, optimization of DBS programming consists of a lengthy trial-and-error process potentially leading to extended programming sessions and frequent clinical visits. An IGP-based platform to visualize lead location relative to patient anatomy may be capable of reducing programming times and aiding active contact(s) selection through direct visualization and targeting of Stimulation Field Models (SFMs).

Method: Novel IGP software (GUIDE XT, Boston Scientific) was evaluated as part of an ongoing prospective, multicenter, registry (NCT02071134) in which pre-operative MRI and post-operative CT scans were provided in order to localize the DBS lead relative to each patient’s anatomy and to select of programming parameters which are aligned with SFMs.  Time to reach effective DBS settings during the initial programming session was collected, along with device aided suggested stimulation settings. DBS stimulation settings were also collected at follow-up visits.

Results: To date, 59-patients (mean age 62.9-years, 75% male) with 10.5-years of disease have been enrolled. Initial programming of bilateral directional leads, where IGP software was utilized, occurred at a mean of 35.6 ± 4.3 minutes, and 62% completed these sessions in ≤30 minutes (70% GPi, 61% STN). A smaller cohort of eighteen patients (with 36 leads) completed study visits up to 12 months following this visit and had programming information available. A 20-point improvement (n = 14) in motor function was noted at 6 months and sustained up to 1 year (n = 8) as assessed by MDS-UPDRS III scores in the medication off stimulation on condition. Fifty percent (18 of 36) of the programs provided at the initial device activation were still being utilized at 6 and 12 month visits.

Conclusion: Preliminary results suggest the use of IGP software reduced time required to achieve optimal therapeutic settings for bilateral STN DBS devices in daily clinical practice. Shorter, more efficient programming sessions will be potentially useful to clinicians as long as stable and efficacious DBS settings can be shown as clear outcomes.  This real-world database will address these challenges.

« Back to 2023 International Congress

MDS Abstracts - https://www.mdsabstracts.org/abstract/impact-of-image-guided-programming-igp-in-bilateral-stn-deep-brain-stimulation-on-programming-time-and-setting-outcomes/