Torres Viviana, Del Giudice Kirsys, Roldán Pedro, Rumià Jordi, Muñoz Esteban, Cámara Ana, Compta Yaroslau, Sánchez-Gómez Almudena, Valldeoriola Francesc
Parkinson's Disease and Movement Disorders Unit, Neurology Service, Institut de Neurociencies, Hospital Clínic of Barcelona, Barcelona, Catalonia, Spain.
Neurosurgery Service, Institut de Neurociencies, Hospital Clínic of Barcelona, Barcelona, Catalonia, Spain.
NPJ Parkinsons Dis. 2024 Jan 27;10(1):29. doi: 10.1038/s41531-024-00639-9.
Deep brain stimulation (DBS) is an effective treatment for patients with Parkinson's disease (PD). However, some patients may not respond optimally to clinical programming adjustments. Advances in DBS technology have led to more complex and time-consuming programming. Image-guided programming (IGP) could optimize and improve programming leading to better clinical outcomes in patients for whom DBS programming is not ideal due to sub-optimal response. We conducted a prospective single-center study including 31 PD patients with subthalamic nucleus (STN) DBS and suboptimal responses refractory to clinical programming. Programming settings were adjusted according to the volumetric reconstruction of the stimulation field using commercial postoperative imaging software. Clinical outcomes were assessed at baseline and at 3-month follow-up after IGP, using motor and quality of life (QoL) scales. Additionally, between these two assessment points, follow-up visits for fine-tuning amplitude intensity and medication were conducted at weeks 2, 4, 6, and 9. After IGP, twenty-six patients (83.9%) experienced motor and QoL improvements, with 25.8% feeling much better and 38.7% feeling moderately better according to the patient global impression scale. Five patients (16.1%) had no clinical or QoL changes after IGP. The MDS-UPDRS III motor scale showed a 21.9% improvement and the DBS-IS global score improved by 41.5%. IGP optimizes STN-DBS therapy for PD patients who are experiencing suboptimal clinical outcomes. These findings support using IGP as a standard tool in clinical practice, which could save programming time and improve patients' QoL.
脑深部电刺激（DBS）是帕金森病（PD）患者的一种有效治疗方法。然而，一些患者可能对临床程控调整反应不佳。DBS技术的进步导致了更复杂、耗时的程控。图像引导程控（IGP）可以优化和改进程控，从而使因反应欠佳而导致DBS程控不理想的患者获得更好的临床结果。我们进行了一项前瞻性单中心研究，纳入了31例接受丘脑底核（STN）DBS治疗且对临床程控反应欠佳的PD患者。使用商用术后成像软件根据刺激区域的容积重建来调整程控设置。在基线以及IGP术后3个月随访时，使用运动和生活质量（QoL）量表评估临床结果。此外，在这两个评估点之间，在第2、4、6和9周进行了微调幅度强度和药物治疗的随访。IGP术后，26例患者（83.9%）运动和QoL得到改善，根据患者整体印象量表，25.8%的患者感觉好多了，38.7%的患者感觉有所好转。5例患者（16.1%）IGP术后临床和QoL无变化。MDS-UPDRS III运动量表显示改善了21.9%，DBS-IS整体评分提高了41.5%。IGP优化了临床结果欠佳的PD患者的STN-DBS治疗。这些发现支持将IGP作为临床实践中的标准工具，这可以节省程控时间并改善患者的QoL。
