Deformable Physiological Atlas-Based Programming of Deep Brain Stimulators: A Feasibility Study

Abstract

The postoperative neurological management of patients with deep brain stimulation (DBS) of the subthalamic nucleus (STN) for Parkinson’s disease is a complex and dynamic process that involves optimizing the stimulation parameters and decreasing the anti-parkinsonian medication while assessing the interactions of both treatment modalities. Neurologists who manage patients undergoing DBS therapy must have expert knowledge of the electro-anatomy of the subthalamic area and be familiar with the medical treatment of motor and non-motor symptoms. In clinical practice, finding the optimal programming parameters can be a challenging and time-consuming process. We have developed a computerized system to facilitate one of the bottlenecks of DBS therapy: the IPG (Internal Pulse Generator) programming. This system consists of a deformable physiological atlas built on more than 300 intra-operative macro-stimulations acquired from 30 Parkinson’s patients and of a non-rigid registration algorithm used to map these data into an atlas. By correlating the position of the quadripolar electrode implanted in the patient with the information contained in our atlas, we can determine which of four contacts has the highest probability to be the most clinically effective. Preliminary results presented in this study suggest that this approach facilitates the programming process by guiding the neurologist to the optimal contact. The system we propose was tested retrospectively on a total of 30 electrodes. In 19 of these cases, this system predicted the contact that was selected as the optimal one by the neurologist.