Objective: The objective of this study was to determine if patient-specific anatomical imaging can be leveraged to optimize monopolar review.

Background: Parkinson’s disease (PD) is a highly disabling condition. Recent advances in directional DBS leads have improved the ability for spatial selectivity of the stimulation target. However, most methods are still highly dependent on intraoperative electrophysiological recordings. These measures, while informative, are complex and add to procedure time. Here, we propose a method to use standard patient imaging along with currently existing atlases to guide stimulation and optimize monopolar review.

Method: We are retrospectively reviewing clinical imaging data (MRI and CT) and de-identified clinical notes from PD patients who received an Infinity DBS implant for PD. We pre-processed and co-registered pre-operative MRI (T1 and T2) and post-operative CT before transforming patient imaging into standard space. We are now conducting a connectivity analysis, based on coordinates and volume of tissue activated (VTA), to determine the best stimulation contact. Lastly, we will compare results from image-analysis with clinically chosen contact and information about the use of those contact from the corresponding notes.

Results: We have identified 17 PD patients who underwent DBS of the subthalamic nucleus at a single center in US. We are currently conducting analysis of the data and will present the results at the meeting.

Conclusion: Patient-specific models combined with standard imaging-based connectivity atlases can provide added guidance to determine stimulation location. Standard clinical imaging should be combined with connectivity data to improve spatial selectivity and determine optimal stimulation lead contacts.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/leveraging-patient-specific-models-to-optimize-dbs-monopolar-review/