Reprogramming guided by the fused images of MRI and CT in subthalamic nucleus stimulation in Parkinson disease

• Published in: Clinical neurology and neurosurgery Vol. 112; no. 1; pp. 47 - 53
• Main Authors: Lee, Jee-Young, Jeon, Beom S, Paek, Sun Ha, Lim, Yong Hoon, Kim, Mi-Ryoung, Kim, Cheolyoung
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier B.V 01.01.2010; Elsevier; Elsevier Limited
• Subjects: Adjustment; Adolescent; Adult; Aged; Antiparkinson Agents - administration & dosage; Antiparkinson Agents - therapeutic use; Biological and medical sciences; Child, Preschool; Deep Brain Stimulation - methods; Electrodes; Electrodes, Implanted; Endpoint Determination; Female; Fused images; Hospitals; Humans; Image Processing, Computer-Assisted - methods; Magnetic Resonance Imaging - methods; Male; Medical imaging; Medical sciences; Middle Aged; Neurologic Examination; Neurology; Neurosurgery; Parkinson Disease - therapy; Parkinson's disease; Post-operative CT; Pre-operative MRI; Reprogramming; Subthalamic Nucleus - anatomy & histology; Subthalamic Nucleus - diagnostic imaging; Subthalamic nucleus deep brain stimulation; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Tomography, X-Ray Computed - methods; Treatment Outcome; Young Adult; Fused images; Reprogramming; Post-operative CT; Pre-operative MRI; Subthalamic nucleus deep brain stimulation; Nervous system diseases; Parkinson disease; Subthalamic nucleus deep brain; Nuclear magnetic resonance imaging; Cerebral disorder; Encephalon; Surgery; Central nervous system disease; Degenerative disease; Subthalamic nucleus; Computerized axial tomography; Extrapyramidal syndrome; stimulation
• ISSN: 0303-8467; 1872-6968
• DOI: 10.1016/j.clineuro.2009.10.008

Abstract 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.