Validation of the Guide XT software for patients with Parkinson’s Disease undergoing STN-DBS in Hospital Clínic of Barcelona

Abstract

Parkison’s Disease is the second most common neurodegenerative disorder worldwide and its prevalence is expected to grow as population ages. Deep brain stimulation is a well-established surgical treatment used as an alternative when medication is not effective. This neurosurgical procedure consists of the implantation of electrodes into specific targets within certain areas of the brain and on the electrical stimulation of these targets through the application of constant or intermittent electricity from an implantable pulse generator (IPG) to treat the movement disorders associated with Parkinson’s Disease. Stimulation parameters setting is highly important in this surgical treatment. Programming deep brain stimulation is a challenging and time-consuming process since there is a huge number of possible parameters combinations. Guide XT (Boston Scientific) is a 3-dimensional neuroanatomic visual software that automatically detects the position of the electrodes in the anatomy of the patient. It enables the visualization of the volume of tissue activated by simulating the stimulation field output. This can help to efficiently determine the most appropriate settings for each patient. The objective of this project is to compare the stimulation settings of the traditional trial-and-error method versus the Guide XT-assisted selection of parameters, to determine software reliability as a supporting tool in deep brain stimulation programming. For the study, data from 37 patients who underwent bilateral subthalamic nucleus deep brain stimulation was collected. Stimulation settings from the first programming session and from the one month after the surgery visit was obtained. All patients were implanted with the Vercise Cartesia directional leads and the comparison and statistical analysis with respect to the stimulation parameters selected with Guide XT was performed in a jupyter notebook. The highest value of the Cohen’s kappa coefficient used to assess inter-rater agreement for the left side contact selection for those patients who did not present side effects in the first programming session was k=0.26. Nevertheless, the percentage of correspondence between contacts selection for both electrodes in the two programming sessions and selection based on software simulations was over 50% in all cases. Thus, it was concluded that the software is a reliable tool to be used in the clinical practice, even though a further analysis testing results in patients would be of interest