MRI-based Programming Technology for Dystonia Patients with DBS

The Dystonia Medical Research Foundation is proud to announce our latest research grant focused on funding research that can lead to better clinical treatments for dystonia patients. Later this year, we will be awarding a research grant of $50,000.00 to Dr. Fasano and the Toronto Western Hospital.

The Movement Disorder Group at Toronto Western Hospital is developing a novel MRI-based programming technology for dystonia patients who underwent deep brain stimulation (DBS), which could significantly improve the clinical outcomes and ease the current burdensome post-operative programming process.

DBS modulates dysregulated brain circuits. Commonly used in movement disorders such as Parkinson’s disease and dystonia, this surgical treatment can produce striking clinical benefits when the stimulation is appropriately programmed. However, DBS programming often requires numerous clinic visits to test the large number of possible stimulation parameters. Lack of immediate clinical feedback in response to stimulation in dystonia patients makes DBS programming particularly challenging.

Hence, DBS needs a physiological marker that can rapidly and accurately predict clinical response to streamline post-operative care for dystonia patients with DBS.

This is a two-stage study: (1) identify a reproducible functional magnetic resonance imaging (fMRI) pattern of brain response when the optimal DBS settings are used, then use these brain response patterns to predict the optimal DBS settings using a machine learning (ML) algorithm; and (2) demonstrate the clinical utility of this model in prospective patients.

The research team will use fMRI to identify brain activity patterns that correlate with clinical benefits in 25 dystonia patients with a priori clinically optimized DBS programming, serving as an objective proxy for DBS efficacy. This is based on promising results obtained in patients with Parkinson’s disease with DBS, in which we could predict with fMRI which location along the electrode (i.e. contact) should be use for optimal clinical benefits. The feasibility of this experiment is unique to Toronto Western Hospital, given our published phantom safety data. This MRI-based programming requires less than an hour per patient.

Second, we will perform a prospective blind comparison of this novel programming technology and our previously published programming algorithms in 10 stimulation-naïve dystonia patients. We will compare the achieved dystonia improvement to our routine programming method as well as consider the number of visits and time to optimal programming. This study will begin in Fall 2019.