<scp>7 T MRI</scp> Connectivity‐Guided Reprogramming Improves Deep Brain Stimulation Motor Outcome in Parkinson's Disease

BACKGROUND: Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is an established treatment for Parkinson's disease (PD). Using 7-Tesla (7 T) MRI connectivity analysis to visualize the patient-specific STN motor subdivision, we hypothesize that reprogramming patients who are stimulated outside of this subdivision can improve their motor outcome substantially, without occurrence of adverse effects. OBJECTIVES: To determine whether connectivity-guided reprogramming improves motor outcome in PD patients treated with STN-DBS. METHODS: Patients who underwent STN-DBS with 7 T MRI probabilistic tractography (2022-2024) were evaluated after standardized follow-up. Their volume of tissue activated (VTA) was visualized with clinical guided programming. Patients were reprogrammed if their VTA did not overlap with the connectivity-defined STN motor subdivision. Follow-up outcome was assessed using the Movement Disorders Society Unified Parkinson's Disease Rating Scale motor part (MDS-UPDRS III; OFF medication, ON stimulation state) and hours OFF per day (MDS-UPDRS IV). RESULTS: Twelve patients were included, of whom nine were reprogrammed. Mean MDS-UPDRS III score after classic programming improved by 16 ± 27% compared to baseline (48 ± 14 to 40 ± 13), and improved significantly further to 42 ± 26% after connectivity-guided reprogramming (28 ± 8; p = 0.005). Furthermore, OFF time after classic programming decreased from 5 ± 3 h at baseline to 3 ± 2 h, and decreased further to 2 ± 2 h after reprogramming. No stimulation-induced adverse effects were reported after parameter adjustments. CONCLUSIONS: 7 T MRI connectivity-guided (re)programming of STN-DBS can provide substantial improvement in motor outcome in PD patients and reduce OFF time, without occurrence of side-effects. Furthermore, response rate to DBS increases, enhancing overall DBS effectiveness in PD.