Objective: To compare the results of a Parkinson’s disease (PD) cohort submitted to subthalamic deep brain stimulation (STN-DBS) with image-guided programming (IGP) and conventional programming (CP).

Background: Technological advances in STN-DBS in PD have led to increasingly complex programming sessions, with sub-optimal benefit in some cases after several adjustments. In this context, IGP can be a useful tool in clinical practice. Technological advances in STN-DBS in PD have led to increasingly complex programming sessions, with sub-optimal benefit in some cases after several adjustments. In this context, IGP can be a useful tool in clinical practice.

Method: Retrospective, comparative study of a cohort of PD that underwent STN-DBS programmed according to volumetric reconstruction of the stimulation field (BrainLab software) and undergoing CP (monopolar review). Pre- and post-operative clinical data, motor scale scores (MDS-UPDRS parts III and IV), neurostimulation parameters, number of visits, programming adjustments, levodopa equivalent daily dose and adverse effects were compared.

Results: 45 patients were included: 17 with IGP and 28 with CP. There were no significant differences in either group in the MDS-UPDRS part III score in “med-off/stim-off” (54 95%CI[48-60] vs 52 95%CI[49-56],p=0.75) and levodopa equivalent daily dose (900±548 vs 1024±893,p=0.505) pre-operatively. One year after surgery, there were also no differences in the percentage motor improvement in “med-on/stim-on” (71.4% CI95%[66-77] vs 69% CI95%[65-73],p=0.498) and in levodopa equivalent daily dose reduction (71.5% CI95%[62-81] vs 62.5% CI95%[57-68],p=0.075). However, in the IGP group a tendency to a more advanced programming was carried out in the first neurostimulation session (70.6% vs 50%, p=0.222). A significant impact on the number of subsequent visits (p<0.001), as well as in the number of minor (p=0.015) and major (p=0.002) adjustments of the stimulation parameters until the achievement of the expected motor benefit was noticed in the IGP group.

Conclusion: This study highlights the potential of applying IGP in clinical practice, particularly in reducing the number of visits and the time taken to titrate stimulation, allowing patients to benefit more quickly from the benefits of STN-DBS.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/image-guided-programming-versus-conventional-programming-in-deep-brain-stimulation-comparative-study-of-a-parkinsons-disease-cohort-and-subthalamic-neurostimulation/