Study Rationale:
Deep brain stimulation (DBS) targets malfunctioning brain circuits. Commonly used to treat Parkinson’s disease (PD), this surgical therapy can produce striking clinical benefits when the appropriate electrical stimulation settings have been selected (i.e., programmed). However, DBS programming often requires multiple clinic visits to test the large number of possible stimulation parameters. PD DBS patients are thus in a position to benefit from a novel tool that improves on the current programming approach.
Hypothesis:
We will examine whether a brain imaging technique called functional Magnetic Resonance Imaging (fMRI) — a technique that maps brain activity — can help improve the current programming approach by making it easier, faster and more precise. Specific aims are to (1) detect the specific brain circuits engaged with DBS using fMRI and (2) assess fMRI as a tool to select optimal DBS settings.
Study Design:
First, patients who are already programmed at their best DBS settings will be scanned with fMRI. These images will help us understand which brain areas are activated by “optimal” settings. We will then build computer algorithms that identify these brain responses. Second, we will recruit patients who have not been programmed yet and split them into two groups: one group in which their DBS settings are conventionally chosen by their physician, and another group in which they will have fMRI and the computer algorithms to guide the selection of their settings. We will then compare the clinical benefits achieved with both programming methods.
Impact on Diagnosis/Treatment of Parkinson’s Disease:
To date, over 150,000 patients have been implanted with DBS for Parkinson’s disease. The process of programming DBS systems takes numerous clinic visits, resulting in a long, expensive and tiring process for patients. By predicting the best settings with a single MRI session, the process can be simplified and improved for patients and practitioners.
Next Steps for Development:
This new technology, when validated, could be shared with other DBS centers worldwide, improving the care of PD patients undergoing DBS surgery.