Rolland Anne-Sophie, Touzet Gustavo, Carriere Nicolas, Mutez Eugenie, Kreisler Alexandre, Simonin Clemence, Kuchcinski Gregory, Chalhoub Najib, Pruvo Jean-Pierre, Defebvre Luc, Reyns Nicolas, Devos David, Moreau Caroline
Department of Medical Pharmacology, LICEND COEN Center, I-SITE ULNE, Lille Neuroscience & Cognition, INSERM UMR S1172, CHU Lille, University Lille, Lille, France.
Department of Neurosurgery, CHU Lille, LICEND COEN Center, Lille, France.
J Parkinsons Dis. 2024;14(1):111-119. doi: 10.3233/JPD-225126.
Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is a preferred treatment for parkinsonian patients with severe motor fluctuations. Proper targeting of the STN sensorimotor segment appears to be a crucial factor for success of the procedure. The recent introduction of directional leads theoretically increases stimulation specificity in this challenging area but also requires more precise stimulation parameters.
We investigated whether commercially available software for image guided programming (IGP) could maximize the benefits of DBS by informing the clinical standard care (CSC) and improving programming workflows.
We prospectively analyzed 32 consecutive parkinsonian patients implanted with bilateral directional leads in the STN. Double blind stimulation parameters determined by CSC and IGP were assessed and compared at three months post-surgery. IGP was used to adjust stimulation parameters if further clinical refinement was required. Overall clinical efficacy was evaluated one-year post-surgery.
We observed 78% concordance between the two electrode levels selected by the blinded IGP prediction and CSC assessments. In 64% of cases requiring refinement, IGP improved clinical efficacy or reduced mild side effects, predominantly by facilitating the use of directional stimulation (93% of refinements).
The use of image guided programming saves time and assists clinical refinement, which may be beneficial to the clinical standard care for STN-DBS and further improve the outcomes of DBS for PD patients.
丘脑底核（STN）的深部脑刺激（DBS）是治疗伴有严重运动波动的帕金森病患者的首选方法。准确靶向STN感觉运动节段似乎是该手术成功的关键因素。最近引入的定向电极理论上可提高在这一具有挑战性区域的刺激特异性，但也需要更精确的刺激参数。
我们研究了用于图像引导编程（IGP）的商用软件是否能通过为临床标准护理（CSC）提供信息并改善编程工作流程，使DBS的益处最大化。
我们前瞻性分析了32例连续植入双侧STN定向电极的帕金森病患者。在术后三个月评估并比较由CSC和IGP确定的双盲刺激参数。如果需要进一步的临床优化，则使用IGP来调整刺激参数。在术后一年评估总体临床疗效。
我们观察到，在由IGP预测和CSC评估选择的两个电极水平之间，一致性为78%。在64%需要优化的病例中，IGP改善了临床疗效或减轻了轻微副作用，主要是通过促进定向刺激的使用（93%的优化）。
使用图像引导编程可节省时间并有助于临床优化，这可能有利于STN-DBS的临床标准护理，并进一步改善帕金森病患者DBS的治疗效果。
