Image-Guided Programming Tool for DBS Programming Used with a Multiple-Source, Constant-Current System Reduces Initial Programming Time
Jason Aldred1, Theresa Zesiewicz2, Michael Okun3, Juan Ramirez Castaneda4, Leonard Verhagen Metman5, Corneliu Luca6, Ritesh Ramdhani7, Jennifer Durphy8, Yarema Bezchlibnyk2, Jonathan Carlson9, Kelly Foote3, Sepehr Sani5, Alexander Papanastassiou4, Jonathan Jagid6, David Weintraub7, Julie Pilitsis10, Lilly Chen11, Roshini Jain11
1Selkirk Neurology, 2University of South Florida, 3University of Florida, 4UT Health San Antonio, 5Rush University Medical Center, 6University of Miami, 7Northwell Health, 8Albany Medical Center, 9Inland Neurosurgery and Spine, 10Florida Atlantic University, 11Boston Scientific Neuromodulation
Objective:

We describe utilization of newly available image-guided programming (IGP) software for use as a deep brain stimulation (DBS) planning tool during initial programming in Parkinson’s disease (PD).

Background:

Optimization of DBS therapy usually consists of a trial-and-error process involving contact selection and appraisal of various stimulation parameters  which can be inefficient, lengthy, and/or burdensome. Reliable visualization of DBS lead location and Volume of Tissue Activation (VTA) in relation to patient-specific anatomy is now possible. Implementation of IGP software may improve efficiency while achieving patient-specific therapy optimization.

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Design/Methods:

In a large, ongoing, prospective, multicenter outcomes study (NCT02071134), IGP software is used during initial programming after implantation of an MICC-based Directional DBS System (Vercise, Boston Scientific). The IGP software uses a pre-op MRI and a post-op CT to display lead localization and VTA. Using Brainlab Elements software, pre- and post-op images are fused, voxel-by-voxel segmented, and lead is located (performed automatically). During the study, time to reach effective stimulation settings upon conclusion of initial programming is collected.

Results:

To date, 59-patients (mean age 62.9-years, 75% male) with 10.5-years of disease were enrolled. Initial programming of bilateral directional leads, where IGP software was utilized, lasted a mean of 35.6 ± 4.3 minutes, and 62% of patients completed these sessions in ≤30 minutes (70% GPi, 61% STN).

Conclusions:

Use of IGP software reduced the time required to achieve optimal therapeutic settings in daily clinical practice. IGP software may therefore allow for more rapid achievement of therapeutic and well-tolerated settings further optimizing use of directional DBS stimulation As such, shorter and more efficient DBS programming sessions may free-up time to address other patient needs and reduce programming times, thereby resulting in better resource utilization. In this regard, further studies with use of IGP are now needed.

10.1212/WNL.0000000000201900