Image-guided programming improves motor control in chronic subthalamic nucleus deep brain stimulation in Parkinson's disease: A prospective study.

Abstract

BackgroundImage-guided programming (IGP) enables optimization and personalization of deep brain stimulation (DBS) for patients with Parkinson's disease. Although its role in initial programming has been examined, evidence for its value in chronic stimulation remains limited. We aimed to evaluate the effectiveness of IGP in individuals with Parkinson's disease receiving chronic subthalamic nucleus (STN)-DBS with conventional programming (CP).MethodsWe reviewed optimal stimulation configurations using IGP with STIMVIEW™ XT in 30 patients with PD implanted with directional DB2202 electrodes. When discrepancies were identified between CP- and IGP-derived configurations, stimulation parameters were adjusted. Motor outcomes were assessed using the Movement Disorder Society-Unified PD Rating Scale (MDS-UPDRS) Parts III and IV and levodopa equivalent daily dose (LEDD) at baseline and 1 month after switching to IGP.ResultsDiscrepancies between CP- and IGP-selected configurations were found in at least one electrode in 20 patients (66.7%), and 18 were included in the analysis. Of these, 11 (61.1%) showed improvement in MDS-UPDRS Part III and/or IV scores, 4 (22.2%) showed no change, and 3 (16.7%) worsened. Mean MDS-UPDRS Part III scores significantly decreased from 20.7 ± 16.5 to 16.9 ± 13.3 (p = 0.008), and LEDD from 655.2 ± 326.6 mg to 609.9 ± 311.1 mg (p = 0.046). Discrepancies occurred more often in stimulation direction than level, and IGP-based stimulation was applied bilaterally in most individuals.ConclusionIGP for STN-DBS can improve motor symptom control in patients with Parkinson's disease. It may benefit those with suboptimal outcomes under CP and represent a practical approach for individualized DBS management.