Patient-Specific and Interpretable Deep Brain Stimulation Optimisation Using MRI and Clinical Review Data

Background Optimisation of Deep Brain Stimulation (DBS) settings is a key aspect in achieving clinical efficacy in movement disorders, such as the Parkinson’s disease. Modern techniques attempt to solve the problem through data-intensive statistical and machine learning approaches, adding significant overhead to the existing clinical workflows. Here, we present an optimisation approach for DBS electrode contact and current selection, grounded in routinely collected MRI data, well-established tools (Lead-DBS) and, optionally, clinical review records.

The pipeline, packaged in a cross-platform tool, uses lead reconstruction data and simulation of volume of tissue activated to estimate the contacts in optimal position relative to the target structure, and suggest optimal stimulation current. The tool then allows further interactive user optimisation of the current settings. Existing electrode contact evaluations can be optionally included in the calculation process for further fine-tuning and adverse effect avoidance.

Based on a sample of 177 implanted electrode reconstructions from 89 Parkinson’s disease patients, we demonstrate that DBS parameter setting by our algorithm is more effective in covering the target structure (Wilcoxon p0.34) and minimising electric field leakage to neighbouring regions (p0.84) compared to expert parameter settings.

The proposed automated method, for optimisation of the DBS electrode contact and current selection shows promising results and is readily applicable to existing clinical workflows. We demonstrate that the algorithmically selected contacts perform better than manual selections according to electric field calculations, allowing for a comparable clinical outcome without the iterative optimisation procedure. Competing Interest Statement The authors have declared no competing interest. Funding Statement This study was funded by the Brain Dynamics, grant number, CZ.02.01.01/00/22_008/0004643. Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ethics Committee of the General University Hospital in Prague gave ethical approval for this work (case number 59/18). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data Availability All data produced in the present study are available upon reasonable request to the authors