Objective: To describe DBS electrode localization using Lead-DBS reconstruction and explore its relationship with motor improvement measured by MDS-UPDRS III.

Background: Deep brain stimulation of the subthalamic nucleus (STN-DBS) is an established therapy for Parkinson’s disease (PD). Clinical outcomes depend partly on accurate electrode placement within the dorsolateral motor STN and on optimal postoperative programming. Imaging reconstruction tools such as Lead-DBS allow visualization of DBS electrodes relative to anatomical atlases and may assist clinical decision-making during postoperative programming. Data describing the use of imaging-guided DBS strategies in emerging programs from the Caribbean remain limited.

Method: We performed a prospective single-center case series of PD patients who underwent bilateral STN-DBS implantation. Postoperative imaging was reconstructed using Lead-DBS. Reconstructed DBS leads were classified according to their anatomical location within motor or non-motor STN territories based on atlas segmentation. Patients were categorized as non-motor STN if at least one electrode was located outside the motor STN territory. Motor outcomes were assessed using MDS-UPDRS III before surgery and at 3-month follow-up. Motor improvement was calculated as percentage change from baseline. Changes in levodopa equivalent daily dose (LEDD) were also evaluated. Differences between groups were explored using the Mann–Whitney U test.

Results: Seven patients were analyzed. Mean age at surgery was 62 years and mean disease duration was 9.7 years. Baseline MDS-UPDRS III OFF score was 54.1. At 3 months after STN-DBS, mean motor improvement was approximately 75%. Mean LEDD decreased from 923 mg/day preoperatively to 204 mg/day (≈78% reduction). Three patients had electrodes within the motor STN, while four had at least one electrode in non-motor STN regions. Motor improvement was 78% vs 73.9%, respectively (p=0.63).

Conclusion: Lead-DBS reconstruction confirmed appropriate electrode localization in this emerging DBS program. Substantial motor improvement and marked LEDD reduction were observed, supporting the feasibility of imaging-based DBS verification in the Dominican Republic.

Figure 1. Representative Lead-DBS reconstruction

Table 1. Patient characteristics

Table 2. Clinical outcome

References: 1. Waldthaler, J. et al. Imaging-based programming of subthalamic nucleus deep brain stimulation in Parkinson’s disease. Brain Stimul. 14, 1109–17; 10.1016/j.brs.2021.07.064 (2021).
2. Pavese, N., Tai, Y. F., Yousif, N., Nandi, D. & Bain P. G. Traditional Trial and Error versus Neuroanatomic 3-Dimensional Image Software-Assisted Deep Brain Stimulation Programming in Patients with Parkinson Disease. World Neurosurg. 134, e98–102; 10.1016/j.wneu.2019.09.106 (2020).
3. Torres V, Del Giudice K, Roldán P, Rumià J, Muñoz E, Cámara A, Compta Y, Sánchez-Gómez A, Valldeoriola F. Image-guided programming deep brain stimulation improves clinical outcomes in patients with Parkinson’s disease. NPJ Parkinsons Dis. 2024 Jan 27;10(1):29. doi: 10.1038/s41531-024-00639-9. PMID: 38280901; PMCID: PMC10821897.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/electrode-localization-in-stn-deep-brain-stimulation-using-image-reconstruction-from-an-emerging-dbs-program-in-the-dominican-republic/