Umemura Atsushi, Mizuno Hideki, Maki Mina, Masago Atsuo
Department of Neurosurgery, Juntendo University, Tokyo, Japan.
Department of Neurosurgery, Ookuma Hospital, Nagoya, Japan.
Front Neurol. 2025 Jul 2;16:1618480. doi: 10.3389/fneur.2025.1618480. eCollection 2025.
Recent advancements in multiple independent current control (MICC) technology, combined with directional leads, have improved clinical outcomes in subthalamic nucleus deep brain stimulation (STN-DBS) for Parkinson's disease (PD). However, these advancements have also increased the complexity and duration of programming. This study aimed to evaluate the clinical utility of image-guided programming (IGP) in patients with stable postoperative symptoms.
Sixteen patients with advanced PD, who had undergone STN-DBS and exhibited stable symptoms for at least 6 months under conventional programming, were enrolled. An alternative stimulation program was developed using Stimview™ XT, a patient-specific image-guided interface, without altering pulse width or frequency. Stimulation fields were modified using horizontal and vertical current steering based on individual STN anatomy. Motor function was evaluated via the Unified Parkinson's Disease Rating Scale part III (UPDRS III) before, 1 h after, and 3 months post-reprogramming.
Image-guided current steering resulted in modifications in 29 of the 32 leads. Horizontal steering was newly introduced in 23 leads, while vertical adjustments were made in six leads. Nine patients reported immediate subjective improvement, and 15 of 16 opted to continue with the IGP-derived settings. Statistically significant improvements in Unified Parkinson's Disease Rating Scale (UPDRS) part III scores were observed 1 h after reprogramming ( < 0.05), and these improvements were sustained at the 3-month follow-up.
IGP provides a clinically effective, time-efficient strategy for refining current steering in STN-DBS, even in patients with stable symptoms under conventional settings. By leveraging individualized anatomical visualization, IGP enhances precision in targeting the dorsolateral STN, resulting in improved motor outcomes.
多重独立电流控制（MICC）技术的最新进展与定向导线相结合，改善了帕金森病（PD）丘脑底核深部脑刺激（STN-DBS）的临床疗效。然而，这些进展也增加了编程的复杂性和持续时间。本研究旨在评估图像引导编程（IGP）在术后症状稳定患者中的临床应用价值。
纳入16例晚期PD患者，这些患者接受了STN-DBS治疗，并且在传统编程下症状稳定至少6个月。使用Stimview™ XT（一种针对患者的图像引导界面）开发了一种替代刺激方案，且不改变脉冲宽度或频率。基于个体丘脑底核解剖结构，通过水平和垂直电流转向来修改刺激区域。在重新编程前、后1小时和3个月，通过统一帕金森病评定量表第三部分（UPDRS III）评估运动功能。
图像引导电流转向导致32根导线中的29根发生了改变。23根导线新引入了水平转向，6根导线进行了垂直调整。9例患者报告主观上立即有改善，16例中有15例选择继续使用IGP得出的设置。重新编程后1小时观察到统一帕金森病评定量表（UPDRS）第三部分评分有统计学意义的改善（<0.05），并且这些改善在3个月随访时持续存在。
即使在传统设置下症状稳定的患者中，IGP也为优化STN-DBS中的电流转向提供了一种临床有效、省时的策略。通过利用个体化的解剖可视化，IGP提高了靶向背外侧丘脑底核的精度，从而改善了运动结果。
