Automated optimization of deep brain stimulation parameters for modulating neuroimaging-based targets

Objective Therapeutic efficacy of deep brain stimulation (DBS) in both established and emerging indications, is highly dependent on accurate lead placement and optimized clinical programming. The latter relies on clinicians’ experience to search among available sets of stimulation parameters and can be limited by the time constraints of clinical practice. Recent innovations in device technology have expanded the number of possible electrode configurations and parameter sets available to clinicians, amplifying the challenge of time constraints. We hypothesize that patient specific neuroimaging data which can effectively assist the clinical programming using automated algorithms. Approach This paper introduces the DBS Illumina 3D algorithm as a tool which uses patient-specific imaging to find stimulation settings that optimizes activating a target area while minimizing the stimulation of areas outside the target that could result in unknown or undesired side effects. This approach utilizes preoperative neuroimaging data paired with the postoperative reconstruction of lead trajectory to search the available stimulation space and identify optimized stimulation parameters. We describe the application of this algorithm in three patients with treatment-resistant depression who underwent bilateral implantation of DBS in subcallosal cingulate cortex (SCC) and ventral capsule/ventral striatum (VC/VS) using tractography optimized targeting with an imaging defined target previously described. Main results Compared to the stimulation settings selected by the clinicians (informed by anatomy), stimulation settings produced by the algorithm achieved similar or greater target coverage, while producing a significantly smaller stimulation area that spills outside the target (P=0.002). Significance The DBS Illumina 3D algorithm is seamlessly integrated with the clinician programmer software and effectively and rapidly assists clinicians with the analysis of image based anatomy, and provides a starting point for the clinicians to search the highly complex stimulation parameter space and arrive at the stimulation settings that optimize activating a target area. Clinical trial registration number: NCT 03437928