Abstract Details

Title Image-Guided Programing is Useful in DBS for Parkinson’s Disease

Topic Movement Disorders

Presentation(s) P4 - Poster Session 4 (8:00 AM-9:00 AM)

Poster/Presentation
Number 5-007

Objective To evaluate the utility of image guided DBS programming. We aimed to determine the correlation between optimal DBS electrode placement predicted by imaging guided software and clinician-determined monopolar review in PD patients with deep brain stimulation.

Background

The current paradigm for DBS programming, monopolar review - an empirical technique that is a time-consuming process that can last 60-90 minutes for each lead and is performed in a dopaminergic-off state.

Recent developments in imaging software with detailed anatomical atlases allow visualization of each individual electrode in relation to the target structure. Pre-operative MRI and post-operative CT images are fused to determine the precise location of individual contacts and allows an unbiased determination of best contact and is associated with decreased programing time.

Design/Methods An automatic software algorithm (Brainlab, Munich) was used to fuse preoperative MRI with postoperative CT and visualize the location of each electrode inside the STN or GPI. Two independent reviewers assessed the fusion images generated for 50 patients who had undergone DBS lead placement for Parkinson’s disease.

Results Our analysis included 50 patients,13 with GPi and 37 with STN implants. The majority of GPi contacts (71%) deemed best during initial monopolar review correlated with those predicted by the software and had full submersion in the target. In the case of STN, a strong correlation with the software was present in 42% of the cases for the left leads. However, the right STN contacts used for monopolar review had the largest percentage (48%) with no submersion in the target per the software.

Conclusions Optimal DBS contacts were successfully predicted by fusion images generated by the Brainlab software in the majority of patients with GPi targets and appreciable percentage of STN targets. This may help guide the monopolar review of patients who have undergone placement of deep brain stimulation electrodes.

Authors/Disclosures
Joshua Moll PRESENTER	Mr. Moll has nothing to disclose.
Hannah M. Bullock (University of Miami - Miller School of Medicine)	Ms. Bullock has nothing to disclose.
Sarah Marmol, MD	Dr. Marmol has nothing to disclose.
Jennifer Hislop, MD	Dr. Hislop has received personal compensation in the range of $100,000-$499,999 for serving as a Employee with Veterans Affairs.
Jonathan Jagid	Jonathan Jagid has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Miami Dade County State Attorneys office. The institution of Jonathan Jagid has received research support from Boston Scientific.
Ihtsham Haq, MD, FAAN (University of Miami Miller School of Medicine)	The institution of Dr. Haq has received research support from NINDS. The institution of Dr. Haq has received research support from the Parkinson's Foundation.
Corneliu C. Luca, MD (University of Miami)	Dr. Luca has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Boston Scientific. Dr. Luca has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Signant Health. Dr. Luca has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Abbott.

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