To investigate how deep brain stimulation (DBS) parameters selected based on anatomy using GuideXT® software correlate with those derived via physiological observations in Parkinson's disease (PD) patients implanted with bilateral subthalamic nucleus (STN) DBS.

Traditional DBS programming utilizing a monopolar review is effective at identifying optimal settings in PD patients but can be time consuming. GuideXT® software aims to facilitate device activation by localizing the DBS lead within patient-specific anatomy.

Four patients were implanted bilaterally with directional Boston Scientific Cartesia® DBS leads in the STN. GuideXT® software was used to predict the starting point for initial programing. Monopolar reviews were conducted approximately 6 months post device activation and were blindly analyzed by two experienced programmers. GuideXT® predictions and DBS settings at last follow-up (7 to 13 months post-op) were simplified to discrete levels and directional contacts. Classification of similarity between DBS predictions was determined based on matching stimulation levels regardless of directionality. Medication diaries and Unified Parkinson's Disease Rating Scale (UPDRS) scores were obtained at baseline and follow up.

Mean age at surgery was 70.75 ±9.95 years. GuideXT® predictions showed 88% similarity when compared with stable DBS settings at last follow up. Based on programmer, predictions derived from monopolar reviews were 63% or 50% similar to GuideXT predictions, and 50% or 38% similar to final DBS parameters at a mean follow up of 10.31±3.37 months. Post implantation total levodopa equivalent daily dose was reduced by 79% compared to pre-operative baseline. Total and motor UPDRS scores on stimulation and medications averaged 8.75 ±10.80 and 6.5 ±5.92 points decrease respectively, resulting in 28% and 39% improvement from baseline assessment.

Patients reported motor improvement on stable DBS settings that remained comparable to original GuideXT® based stimulation predictions. The advantage of these settings is evident by motor symptom control and reduction in medication burden.