Objective: We evaluated the effectiveness of image-guided programming (IGP) in patients with Parkinson’s disease (PD) who underwent bilateral subthalamic nucleus (STN) – deep brain stimulation (DBS).

Background: IGP in DBS provides an opportunity to optimize and personalize lead configuration and parameter settings in patients with PD. Despite its apparent potential, the role of IGP in clinical practice is not clearly elucidated.

Method: We acquired new lead configurations from IGP with Stimview™ XT technology (Boston Scientific, CA), in 30 PD patients who underwent STN DBS with directional DB2202 electrodes (Boston Scientific, CA) from 2019 to 2022. A blinded researcher chose the IGP-based stimulation location. If there was a discrepancy between the clinically chosen and the IGP-based stimulation location, we enrolled the subjects and applied new stimulation parameters based on IGP. The clinical outcome was assessed using the Movement Disorders Society-Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) part III and IV, 1 month after applying the IGP-based stimulation.

Results: Among 30 patients, a discrepancy between the stimulation locations chosen by IGP and by clinical evaluation was seen in at least one electrode of 19 patients (63.6%). The comparison of clinical outcomes before and after using IGP-based stimulation parameters, was completed in 12 participants. The IGP-based stimulation resulted in a significant reduction of the MDS-UPDRS part III and IV scores in 6 patients (50.0%), and equivocal changes of scores without side effects in 4 patients (33.3%). However, 2 patients (16.7%) showed worse scores or complained of uncontrolled side effects after applying the IGP-guided stimulation.

Conclusion: We presented real-world evidence that IGP in STN-DBS may enhance motor symptom control in patients with PD. IGP allows for personalized stimulation settings, which can be beneficial for PD patients who previously experienced suboptimal outcomes from STN-DBS based solely on clinical judgment.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/real-world-experiences-of-image-guided-programming-in-subthalamic-nucleus-deep-brain-stimulation-in-parkinsons-disease/