Final Report Summary - IMPACT (Improving the lives of Parkinson’s Disease patients while reducing side-effects through tailored deep brain stimulation) Executive Summary:Deep Brain Stimulation (DBS) is an established treatment for essential tremor, Parkinson’s disease, and dystonia. DBS can be considered as a 'pacemaker for the brain'; mild electrical stimulation pusles are delivered to brain tissue via implanted probes. This stimulation suppresses unwanted activity and may restore desired neuronal functions. As a result of DBS in Parkinson’s, motor symptoms may be greatly reduced and quality of life restored. For Parkinson’s disease alone, over 50,000 patients are diagnosed each year in Europe. However, due to the lack of personalized treatment possibilities, around 15–30% of DBS patients suffer from stimulation-induced side-effects resulting from stimulation. IMPACT has answered this need by realizing a direct-feedback “Expert Tuning Tool” (ETT) to improve the positioning and programming of patient specific brain stimulation implants. The system is based on patient-specific images and visualizes information relevant to the therapy in the context of the patient’s individual anatomy. The intent is that multi-disciplinary DBS teams will be able to use ‘the image as a common language’ when optimizing therapy. To this end, the IMPACT system combines pre- and post-operative medical imaging, and 3D brain recordings of the individual patient with historical and statistical data derived from previous DBS therapy patients. This allows to delineate e.g. brain areas that provide optimal outcome or that are responsible for stimulation-induced side-effects. By integrating and analyzing all this information in an intuitive fashion into a single application, optimization of DBS therapy in the individual patient is supported.The IMPACT Expert Tuning Tool was realized through a concerted effort of academic and technology partners, clinical centers and industry. Clinical partners contributed large amounts of clinical data obtained on previously implanted patients (medical images, brain recordings, therapy settings, outcome scores, etc.) that formed the basis of the IMPACT “DBS Database”. This database allowed detailed (statistical) analyses on brain areas/recordings of interest in relation to therapy outcomes to be performed. Dedicated image processing algorithms, signal analysis methods and computational models that simulate the effects of brain stimulation in a patient-specific way have been realized by academic and technical partners. These computational methods are used to analyze and characterize the data contained in the DBS Database; forming the ”DBS Model”. A user can query the DBS model (e.g. to see optimal outcomes, or a particular side-effect, or a particular recording feature) and as an output get a visual representation of the analyzed data in the context of individual patient anatomy. Industry partners realized recording hardware and integrated the DBS database and model into a R&D prototype that allowed clinical evaluation of the concepts. In the final phase of the project, prototypes were validated in a clinical setting. Excellent research results on the usability and performance of the system have been obtained: the prototype was found to perform well in clinical practice and its outputs were capable of predicting optimal therapy settings in a majority of cases. Clinical and technical results have been published and disseminated via a variety of channels.In summary, the IMPACT consortium successfully realized its ambition: An integrated system combining brain images and brain recording has been developed that supports the efficient optimization of therapy in DBS patients by comparing patient-specific information to data extracted from a large structured database of prior DBS cases. Project Context and Objectives:See attached PDF (includes figures and tables)Project Results:See attached PDF (includes figures and tables)Potential Impact:See attached PDF (includes figures and tables)List of Websites:www.impact-fp7.eu
