# Sustained Therapeutic Benefits Using Image‐Guided Programming at Activation of Deep Brain Stimulation for Parkinson's Disease

## TL;DR

This study shows that image-guided programming for deep brain stimulation in Parkinson's disease leads to faster setup and long-term motor improvements.

## Contribution

The study demonstrates the real-world effectiveness of image-guided programming for DBS in Parkinson's patients over a year.

## Key findings

- Motor function improved by 55% at 6 months and 45% at 1 year post-activation.
- Initial programming using IGP took an average of 39.4 minutes, with 55% completed in under 30 minutes.
- IGP-suggested settings remained stable in over half of patients for up to a year.

## Abstract

The efficacy of deep brain stimulation (DBS) for Parkinson's disease (PD) depends on optimizing stimulation parameters for each patient, a time‐sensitive process. Image‐guided programming (IGP) offers a promising method to streamline this.

The objective was to evaluate the real‐world effectiveness of an IGP tool with directional leads during the initial programming of bilateral subthalamic nucleus (STN) or globus pallidus internus (GPi) DBS in PD patients.

A total of 57 PD patients (46 bilateral STN, 11 bilateral GPi) from the Vercise DBS Registry (NCT#02071134) were enrolled into the GUIDE XT substudy. Time for initial programming using IGP, Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS‐UPDRS) Part III at baseline, 6‐months, and 1‐year postactivation, Global Impression of Change from patients and clinicians, and the continued use of IGP‐suggested settings were analyzed. Stimulation field model (SFM) overlap between initial and 1‐year target volumes was also examined.

Motor function significantly improved at 6 months and 1 year (55% and 45%, P < 0.0001) compared to baseline, as assessed by MDS‐UPDRS III (Meds OFF/Stim ON). Initial programming sessions of bilateral leads using IGP (n = 56) lasted 39.4 ± 4.4 minutes (mean ± standard error [SE]), whereas it was completed in less than 30 minutes in 55% of subjects. Contact selection, polarity, and fractionalization determined at initial programing using IGP remained unchanged in 52% and 43% of subjects (n = 21) up to 6 months and 1 year, respectively. The average SFM overlap for all subjects was 92% (SE: 15%) at the 1‐year visit.

IGP facilitates efficient initial programming sessions, providing stable settings that result in long‐term motor improvements.