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

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Abstract

BackgroundOptimisation of Deep Brain Stimulation (DBS) settings is a key aspect in achieving clinical efficacy in movement disorders, such as the Parkinsons 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. MethodsThe 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. ResultsBased on a sample of 177 implanted electrode reconstructions from 89 Parkinsons disease patients, we demonstrate that DBS parameter setting by our algorithm is more effective in covering the target structure (Wilcoxon p<6e-12, Hedges g>0.34) and minimising electric field leakage to neighbouring regions (p<2e-15, g>0.84) compared to expert parameter settings. ConclusionThe 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.

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