The VU-DBS project: integrated and computer-assisted planning, intra-operative placement, and post-operative programming of deep-brain stimulators

摘要

Movement disorders affect over 5,000,000 people in the United States. Contemporary treatment of these diseases involves high-frequency stimulation through deep brain stimulation (DBS). This form of therapy is offered to patients who have begun to see failure with standard medical therapy and also to patients for which medical therapy is poorly effective. A DBS procedure involves the surgical placement, with millimetric accuracy, of an electrode in the proximity of functional areas referred to as targets. Following the surgical procedure, the implant, which is a multi-contact electrode is programmed to alleviate symptoms while minimizing side effects. Surgical placement of the electrode is difficult because targets of interest are poorly visible in current imaging modalities. Consequently, the process of implantation of a DBS electrode is an iterative procedure. An approximate target position is determined pre-operatively from the position of adjacent structures that are visible in MR images. With the patient awake, this position is then adjusted intra-operatively, which is a lengthy process. The post-surgical programming of the stimulator is an equally challenging and time consuming task, with parameter setting combinations exceeding 4000. This paper reports on the status of the Vanderbilt University DBS Project, which involves the development and clinical evaluation of a system designed to facilitate the entire process from the time of planning to the time of programming.