Imaging and neuromodulation in Parkinson's disease.

PURPOSE OF REVIEW: Imaging plays a key role in neuromodulation for Parkinson's disease, particularly for deep brain stimulation (DBS), which is the most frequently employed neuromodulatory treatment. Its role is rapidly expanding due to improving neuroradiological techniques.

RECENT FINDINGS: Imaging is crucial at each stage of DBS care: pre, intra-, and postoperative, with roles now going beyond the traditional surgical planning and lead localization. Imaging opens the door to patient selection informed by their unique preoperative features and individualized electrode placement due to the direct visualization of targets. Imaging also permits intra-operative localization of electrodes with widely accessible fluoroscopy and offers the possibility of visualizing the orientation of segmented contacts. Advanced imaging techniques have defined anatomical sweets spots and efficacious connectomes associated with best outcomes after DBS. They also offer opportunities to develop new biomarker of successful stimulation, which is critical to the future of DBS programming.

SUMMARY: Imaging should be thought as a powerful tool to push the neuromodulation field towards new boundaries focusing on personalized electrode implantation and stimulation titration. This will improve patient outcomes and inform alternative neuromodulation modalities, for which the data remain limited.