Imaging-based DBS programming help: Does it help?

Deep brain stimulation (DBS) is highly effective in treating motor complications of medical therapy in Parkinson's disease [ [1] Deuschl G. Schade-Brittinger C. Krack P. Volkmann J. Schafer H. Botzel K. Daniels C. Deutschlander A. Dillmann U. Eisner W. Gruber D. Hamel W. Herzog J. Hilker R. Klebe S. Kloss M. Koy J. Krause M. Kupsch A. Lorenz D. Lorenzl S. Mehdorn H.M. Moringlane J.R. Oertel W. Pinsker M.O. Reichmann H. Reuss A. Schneider G.H. Schnitzler A. Steude U. Sturm V. Timmermann L. Tronnier V. Trottenberg T. Wojtecki L. Wolf E. Poewe W. Voges J. A randomized trial of deep-brain stimulation for Parkinson's disease. N. Engl. J. Med. 2006; 355: 896-908 Crossref PubMed Scopus (2155) Google Scholar , [2] Weaver F.M. Follett K. Stern M. Hur K. Harris C. Marks Jr., W.J. Rothlind J. Sagher O. Reda D. Moy C.S. Pahwa R. Burchiel K. Hogarth P. Lai E.C. Duda J.E. Holloway K. Samii A. Horn S. Bronstein J. Stoner G. Heemskerk J. Huang G.D. Bilateral deep brain stimulation vs best medical therapy for patients with advanced Parkinson disease: a randomized controlled trial. JAMA, J. Am. Med. Assoc. 2009; 301: 63-73 Crossref PubMed Scopus (1179) Google Scholar ]. However, effective DBS therapy after surgical implantation can require substantial patient resources to facilitate multiple, prolonged clinic visits to optimize programming. Traditionally, programming is an iterative process based on the clinical response of target symptoms in the unmedicated state. Though neurophysiology- and imaging-based tools [ [3] Jimenez-Shahed J. Device profile of the percept PC deep brain stimulation system for the treatment of Parkinson's disease and related disorders. Expet Rev. Med. Dev. 2021; 18: 319-332 Crossref PubMed Scopus (33) Google Scholar , [4] Waldthaler J. Bopp M. Kühn N. Bacara B. Keuler M. Gjorgjevski M. Carl B. Timmermann L. Nimsky C. Pedrosa D.J. Imaging-based programming of subthalamic nucleus deep brain stimulation in Parkinson's disease. Brain Stimul. 2021; 14: 1109-1117 Abstract Full Text Full Text PDF PubMed Scopus (12) Google Scholar ] are now commercially available, comparative efficacy data is lacking on whether these actually affect healthcare value from DBS. Since disparities in access to DBS therapy exist among groups with lower average access to healthcare [ [5] Chan A.K. McGovern R.A. Brown L.T. Sheehy J.P. Zacharia B.E. Mikell C.B. Bruce S.S. Ford B. McKhann G.M. 2nd, Disparities in access to deep brain stimulation surgery for Parkinson disease: interaction between African American race and Medicaid use. JAMA Neurol. 2014; 71: 291-299 Crossref PubMed Scopus (76) Google Scholar , [6] Crispo J.A.G. Lam M. Le B. Richard L. Shariff S.Z. Ansell D.R. Squarzolo M. Marras C. Willis A.W. Seitz D. Disparities in deep brain stimulation use for Parkinson's disease in ontario, Canada, can. J. Neurol. Sci. 2020; 47: 642-655 Crossref Scopus (4) Google Scholar ] and lower socioeconomic status [ [7] Willis A.W. Schootman M. Kung N. Wang X.Y. Perlmutter J.S. Racette B.A. Disparities in deep brain stimulation surgery among insured elders with Parkinson disease. Neurology. 2014; 82: 163-171 Crossref PubMed Scopus (75) Google Scholar ], improving healthcare value might improve access to this powerful treatment.