We describe utilization of newly available image-guided programming (IGP) software for use as a deep brain stimulation (DBS) planning tool during initial programming in Parkinson’s disease (PD).

Optimization of DBS therapy usually consists of a trial-and-error process involving contact selection and appraisal of various stimulation parameters  which can be inefficient, lengthy, and/or burdensome. Reliable visualization of DBS lead location and Volume of Tissue Activation (VTA) in relation to patient-specific anatomy is now possible. Implementation of IGP software may improve efficiency while achieving patient-specific therapy optimization.

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In a large, ongoing, prospective, multicenter outcomes study (NCT02071134), IGP software is used during initial programming after implantation of an MICC-based Directional DBS System (Vercise, Boston Scientific). The IGP software uses a pre-op MRI and a post-op CT to display lead localization and VTA. Using Brainlab Elements software, pre- and post-op images are fused, voxel-by-voxel segmented, and lead is located (performed automatically). During the study, time to reach effective stimulation settings upon conclusion of initial programming is collected.

To date, 59-patients (mean age 62.9-years, 75% male) with 10.5-years of disease were enrolled. Initial programming of bilateral directional leads, where IGP software was utilized, lasted a mean of 35.6 ± 4.3 minutes, and 62% of patients completed these sessions in ≤30 minutes (70% GPi, 61% STN).

Use of IGP software reduced the time required to achieve optimal therapeutic settings in daily clinical practice. IGP software may therefore allow for more rapid achievement of therapeutic and well-tolerated settings further optimizing use of directional DBS stimulation As such, shorter and more efficient DBS programming sessions may free-up time to address other patient needs and reduce programming times, thereby resulting in better resource utilization. In this regard, further studies with use of IGP are now needed.