Reprogramming guided by the fused images of MRI and CT in subthalamic nucleus stimulation in Parkinson disease.
OBJECTIVE
To evaluate the usefulness of the visual information about the location of the contacts in deep brain stimulation (DBS) programming, we compared the outcomes of subthalamic nucleus (STN) stimulation before and after reprogramming guided by the fused images of MRI and CT.


METHODS
Of the 65 patients with Parkinson's disease, who underwent bilateral STN-DBS surgery between March 2005 and September 2006 and had been managed for at least 6 months with conventional programming which was only based on the physiological responses from the patients, 54 patients were reprogrammed based on the 3D anatomical location of the contacts revealed by the fused images of pre-operative MRI and post-operative CT scans taken at 6 months after surgery. A total 51 patients completed the evaluation after reprogramming.


RESULTS
Reprogramming significantly improved the UPDRS part III scores during the on- and off-medication condition. The daily levodopa-equivalent dose was significantly reduced. Improvement in the UPDRS part III scores after reprogramming was greater in the patients with electrodes in the STN than the patients with electrodes off the STN.


CONCLUSIONS
CT-MR fusion images helped to reprogram stimulation parameters with ease and confidence in a time-saving manner and resulted in further clinical improvement. This method could complement the conventional method of adjusting stimulation parameters after bilateral STN-DBS.
Lee
Jee-Young
JY
Department of Neurology, Inje University Ilsan Paik Hospital, Republic of Korea.
Jeon
Beom S
BS
Paek
Sun Ha
SH
Lim
Yong Hoon
YH
Kim
Mi-Ryoung
MR
Kim
Cheolyoung
C
D000293:Adolescent; D000328:Adult; D000368:Aged; D000978:Antiparkinson Agents / Q000008:administration & dosage / Q000627:therapeutic use; D002675:Child, Preschool; D046690:Deep Brain Stimulation / Q000379:methods*; D004567:Electrodes, Implanted; D023381:Endpoint Determination; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D010300:Parkinson Disease / Q000628:therapy*; D020531:Subthalamic Nucleus / Q000033:anatomy & histology* / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
D000978:Antiparkinson Agents