Rigon Leonardo, Bove Francesco, Izzo Alessandro, Montano Nicola, Brusa Livia, Cerroni Rocco, De Biase Alessandro, di Biase Lazzaro, D'Alessandris Giorgio Quintino, Genovese Danilo, Pecoraro Pasquale Maria, Peppe Antonella, Rizzo Marina, Stefani Alessandro, Suppa Antonio, Bentivoglio Anna Rita, Calabresi Paolo, Piano Carla
Department of Neuroscience, Università Cattolica del Sacro Cuore, Rome, Italy.
IRCCS San Camillo Hospital, Venice, Italy.
J Parkinsons Dis. 2025 Mar;15(2):409-420. doi: 10.1177/1877718X241305725. Epub 2025 Mar 16.
BackgroundAdvances in STN-DBS technology, among which directional stimulation, improved Parkinson's disease (PD) treatment efficacy, while increasing the clinical programming complexity. Lead localization software may aid the stimulation contact selection process.ObjectiveWe aimed to assess the concordance between imaging-suggested (IGP) and conventional-programming (CP) selected stimulation contacts one year after surgery and its impact on motor outcomes.MethodsSixty-four PD patients with bilateral STN-DBS were enrolled. Lead localization was reconstructed with Brainlab software. For each electrode, the vertical contact level and, when applicable, the directionality predicted by the lead reconstruction software to be the most effective were established and compared to the stimulation parameters clinically activated one-year post-surgery. IGP/CP concordance ratio was calculated for both stimulation level and directional contacts. Post-operative modifications of PD motor symptoms severity were compared among groups of concordant and discordant IGP/CP programming.ResultsOne-year post-surgery, IGP/CP concordance was 80% for active stimulation vertical contact level and 51% for directionality. No significant difference in motor outcomes was found between IGP/CP concordant and discordant patients for contact level activation, whereas patients with concordant IGP/CP active directional stimulation (c-Direction) showed superior motor outcomes at one-year follow-up than those discordant (d-Direction) (UPDRS-III stimulation-induced improvement: c-Direction = -25.66 ± 13.74 vs. d-Direction = -12.54 ± 11.86; p = 0.011).ConclusionsVisual reconstruction software correctly predicted the most clinically effective stimulation contact levels in most patients. Imaging therefore facilitates classic STN-DBS clinical programming while assuring similar outcomes. Moreover, better motor outcomes were reached by patients with concordant IGP/CP directional parameters, suggesting that visualization can represent an added value in particular for directional stimulation programming.
背景
脑深部电刺激术（STN-DBS）技术取得了进展，其中定向刺激提高了帕金森病（PD）的治疗效果，但同时增加了临床编程的复杂性。电极定位软件可能有助于刺激触点的选择过程。
目的
我们旨在评估术后一年影像学提示（IGP）和传统编程（CP）选择的刺激触点之间的一致性及其对运动结果的影响。
方法
纳入64例接受双侧STN-DBS治疗的PD患者。使用Brainlab软件重建电极定位。对于每个电极，确定铅重建软件预测的最有效的垂直触点水平以及适用时的方向，并与术后一年临床激活的刺激参数进行比较。计算刺激水平和定向触点的IGP/CP一致性比率。比较IGP/CP编程一致和不一致组之间PD运动症状严重程度的术后变化。
结果
术后一年，主动刺激垂直触点水平的IGP/CP一致性为80%，方向性为51%。在触点水平激活方面，IGP/CP一致和不一致的患者在运动结果上没有显著差异，而IGP/CP主动定向刺激一致（c-Direction）的患者在一年随访时的运动结果优于不一致（d-Direction）的患者（统一帕金森病评定量表第三部分（UPDRS-III）刺激诱导的改善：c-Direction = -25.66±13.74 vs. d-Direction = -12.54±11.86；p = 0.011）。
结论
视觉重建软件在大多数患者中正确预测了最有效的临床刺激触点水平。因此，影像学有助于经典的STN-DBS临床编程，同时确保相似的结果。此外，IGP/CP定向参数一致的患者获得了更好的运动结果，这表明可视化对于定向刺激编程尤其具有附加价值。
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