Objective: To determine the most effective and efficient STN-DBS programming method in PD comparing LFP-GP and IGP focusing on motor improvement, quality of life and programming efficiency.

Background: Deep brain stimulation of the subthalamic nucleus (STN-DBS) is an established treatment for Parkinson’s disease (PD), yet optimal programming remains challenging.¹ Traditional methods rely on expert evaluation,² while emerging techniques, such as local field potential guided programming (LFP-GP) and image-guided programming (IGP), offer more efficient alternatives.^3,4,5,6.

Method: This prospective, randomized, blinded, two-arm crossover trial (October 2024–September 2025) includes PD patients with recent STN-DBS implantation and neurostimulators capable of sensing beta oscillations. Patients are randomized to LFP-GP or IGP two weeks after surgery and after these initial 2 weeks switch to the opposite programming (IGP or LFP-GP) with no changes in dopaminergic medication. IGP uses software for image reconstruction, while LFP-GP relies on beta power modulation. Clinical efficacy is assessed via MDS-UPDRS (I-IV), PDQ-39, and NMSS. Additional comparisons include total electrical energy delivered, programming time, stimulation parameters, and adverse events.

Results: Preliminary findings from 12 enrolled patients (mean age: 64 years; disease duration: 10.25 years; LEDD: 1180mg) show comparable clinical efficacy for both methods. One patient was excluded due to severe tremor that precluded LFP-GP. The analysis included 11 patients. IGP was significantly faster than LFP-GP (p < 0.001). Friedman’s test showed significant differences in contact selection (p = 0.001), with poor concordance (Kappa = 0.15). IGP favored ventral contacts, while LFP-GP selected more dorsal contacts (Figure 1).

Conclusion: Both methods achieved similar clinical outcomes, but IGP was significantly more time-efficient. Discrepancies in contact selection highlight fundamental differences between the approaches, despite no different outcomes were observed. Final results will be analyzed when recruitment is completed.

Change in contact selection

References: 1. Lozano AM. Deep brain stimulation for Parkinson’s disease. Parkinsonism Relat Disord. 2001;7:199-203.
2. Kühn AA, Volkmann J. Innovations in deep brain stimulation methodology. Movement Disorders. 2017;32(1):11-19.
3. Lange F, Steigerwald F, Malzacher T, et al. Reduced Programming Time and Strong Symptom Control Even in Chronic Course Through Imaging-Based DBS Programming. Front Neurol. 2021;12.
4. Strelow JN, Dembek TA, Baldermann JC, et al. Low beta-band suppression as a tool for DBS contact selection for akinetic-rigid symptoms in Parkinson’s disease. Parkinsonism Relat Disord. 2023;112.
5. Chen PL, Chen YC, Tu PH, et al. Subthalamic high-beta oscillation informs the outcome of deep brain stimulation in patients with Parkinson’s disease. Front Hum Neurosci. 2022;16:958521.
6. Torres V, Del Giudice K, Roldán P, et al. Image-guided programming deep brain stimulation improves clinical outcomes in patients with Parkinson’s disease. NPJ Parkinsons Dis. 2024;10(1). doi:10.1038/s41531-024-00639-9

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MDS Abstracts - https://www.mdsabstracts.org/abstract/local-field-potential-vs-image-guided-programming-clinical-trial-for-optimization-the-deep-brain-stimulation-in-parkinsons-disease/