2024 American Academy of Neurology Abstract Website

Jason Aldred¹, Theresa Zesiewicz², Michael Okun³, Juan Ramirez Castaneda⁴, Leonard Verhagen Metman⁵, Corneliu Luca⁶, Ritesh Ramdhani⁷, Jennifer Durphy⁸, Yarema Bezchlibnyk², Jonathan Carlson⁹, Kelly Foote¹⁰, Sepehr Sani¹¹, Alexander Papanastassiou¹², Jonathan Jagid¹³, David Weintraub¹⁴, Julie Pilitsis¹⁵, Ben Reese¹⁶, Lilly Chen¹⁶, Rajat Shivacharan¹⁷, Edward Goldberg¹⁷
¹Selkirk Neurology, ²University of South Florida, ³University of Florida Fixel Institute of Neurological Diseases, ⁴Methodist Physicians. Neurosurgery and Neurology Specialists, ⁵Northwestern University, ⁶University of Miami, ⁷Northwell Health, ⁸Albany Medical Center, ⁹Inland Neurosurgery and Spine, ¹⁰University of Florida, ¹¹Rush University Medical Center, ¹²University of Texas, San Antonio, ¹³University of Miami School of Medicine, ¹⁴Nassau University Medical Center, ¹⁵Florida Atlantic University, ¹⁶Boston Scientific Neuromodulation, ¹⁷Boston Scientific

Objective:

Assessment of Parkinson's disease (PD) patient outcomes using an image-guided programming (IGP) applied during initial deep brain stimulation (DBS) programming, either with STN or GPi as brain target.

Background:

Optimization of DBS programming can be a lengthy, empirical trial-and-error process potentially leading to extended programming sessions and frequent visits. An IGP-based platform can help visualize lead location relative to anatomy with capability of reducing programming times and aiding active contact(s) selection through direct visualization and targeting of Stimulation Field Models (SFMs).

Design/Methods:

Novel IGP software (GUIDE XT, Boston Scientific) was evaluated from an ongoing prospective, multicenter, registry (NCT02071134) in which preoperative MRI and post-operative CT scans were provided to localize the DBS lead relative to each subject's anatomy and to select programming parameters per alignment with SFMs. Time to reach effective DBS settings during the initial programming session was collected, along with device-aided suggested stimulation settings.

Results:

To date, 57-subjects (mean age 62.9-years, 77% male) with 10.1-years of disease duration have been enrolled. Initial programming sessions (post-implant), where IGP provided settings for directional leads, lasted 39.4±4.4 minutes (mean ± SE). Fifty-five percent (31/56) completed initial programming of bilateral directional leads with the IGP in <30-minutes. Motor function (mean MDSUPDRS Ill scores [Meds OFF]) was significantly improved by 55% (n=45) and 45% (n=37) at 6-and 12-months, respectively. Of 21 patients for whom follow-up programming information out to 6- and 12-months was available, 52% and 43% of DBS programs remained unchanged from initial setting (i.e., no change in active contact(s) and cathodic/anodic distribution of current), respectively, as suggested by IGP.

Conclusions:

These results indicate that use of this tool is associated with rapid initial programming sessions and clinically significant motor improvement. Though optimization was subjective in this evaluation, and there was no control group, this tool revealed promising time-based and motor outcomes.