scholarly journals Sweetspot mapping in deep brain stimulation: Strengths and limitations of current approaches

2020 ◽  
Author(s):  
Till A Dembek ◽  
Carlos Baldermann ◽  
Jan-Niklas Petry-Schmelzer ◽  
Hannah Jergas ◽  
Harald Treuer ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Clinical Data ◽  
Brain Stimulation ◽  
In Silico ◽  
Ground Truth ◽  
Ground Truth Data ◽  
Open Questions ◽  
Out Of Sample ◽  
Optimal Target ◽  
Deep Brain

Objective: Open questions remain regarding the optimal target, or sweetspot, for deep brain stimulation (DBS) in e.g. Parkinson's Disease. Previous studies introduced different methods of mapping DBS effects to determine sweetspots. While having a direct impact on surgical targeting and postoperative programming in DBS, these methods so far have not been investigated in ground truth data. Materials & Methods: This study investigated five previously published DBS mapping methods regarding their potential to correctly identify a ground truth sweetspot. Methods were investigated in silico in eight different use case scenarios, which incorporated different types of clinical data, noise, and differences in underlying neuroanatomy. Dice coefficients were calculated to determine the overlap between identified sweetspots and the ground truth. Additionally, out of sample predictive capabilities were assessed using the amount of explained variance R-squared. Results: The five investigated methods resulted in highly variable sweetspots. Methods based on voxel-wise statistics against average outcomes showed the best performance overall. While predictive capabilities were high, even in the best of cases Dice coefficients remained limited to values around 0.5, highlighting the overall limitations of sweetspot identification. Conclusions: This study highlights the strengths and limitations of current approaches to DBS sweetspot mapping. Those limitations need to be taken into account when considering the clinical implications. All future approaches should be investigated in silico before being applied to clinical data.

scholarly journals Normative vs. patient-specific brain connectivity in Deep Brain Stimulation

2020 ◽  
Author(s):  
Qiang Wang ◽  
Harith Akram ◽  
Muthuraman Muthuraman ◽  
Gabriel Gonzalez-Escamilla ◽  
Sameer A. Sheth ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Clinical Improvement ◽  
Brain Stimulation ◽  
Primary Motor Cortex ◽  
Supplementary Motor Area ◽  
Brain Connectivity ◽  
Motor Area ◽  
Patient Specific ◽  
Out Of Sample ◽  
Deep Brain

AbstractBrain connectivity profiles seeding from deep brain stimulation (DBS) electrodes have emerged as informative tools to estimate outcome variability across DBS patients. Given the limitations of acquiring and processing patient-specific diffusion-weighted imaging data, most studies have employed normative atlases of the human connectome. To date, it remains unclear whether patient-specific connectivity information would strengthen the accuracy of such analyses. Here, we compared similarities and differences between patient-specific, disease-matched and normative structural connectivity data and retrospective estimation of clinical improvement that they may generate.Data from 33 patients suffering from Parkinson’s Disease who underwent surgery at three different centers were retrospectively collected. Stimulation-dependent connectivity profiles seeding from active contacts were estimated using three modalities, namely either patient-specific diffusion-MRI data, disease-matched or normative group connectome data (acquired in healthy young subjects). Based on these profiles, models of optimal connectivity were constructed and used to retrospectively estimate the clinical improvement in out of sample data.All three modalities resulted in highly similar optimal connectivity profiles that could largely reproduce findings from prior research based on a novel multi-center cohort. Connectivity estimates seeding from electrodes when using either patient-specific or normative connectomes correlated significantly to primary motor cortex (R = 0.57, p = 0.001, R=0.73, p=0.001), supplementary motor area (R = 0.40, p = 0.005, R = 0.43, p = 0.003), pre-supplementary motor area (R = 0.33, p = 0.022, R = 0.33, p = 0.031), but not to more frontal regions such as the dorsomedial prefrontal cortex (R = 0.21, p = 0.17, R = 0.18, p = 0.17).However, in a data-driven approach that estimated optimal whole-brain connectivity profiles, out-of-sample estimation of clinical improvements were made and ranged within a similar magnitude when applying either of the three modalities (R = 0.43 at p = 0.001 for patient-specific connectivity; R = 0.25, p = 0.048 for the age- and disease-matched group connectome; R = 0.31 at p = 0.028 for healthy-/young connectome).ConclusionsThe use of patient-specific connectivity and normative connectomes lead to identical main conclusions about which brain areas are associated with clinical improvement. Still, although results were not significantly different, they hint at the fact that patient-specific connectivity may bear the potential of estimating slightly more variance when compared to group connectomes. Our findings further support the role of DBS electrode connectivity profiles as a promising method to guide surgical targeting and DBS programming.

Deep Brain Stimulation for Dystonia

2009 ◽  
Vol 4 (2) ◽  
pp. 79
Author(s):  
Dipankar Nandi ◽  
Sean O’Riordan ◽  
Peter G Bain ◽  
◽  
◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Surgical Treatment ◽  
General Anaesthesia ◽  
Motor Function ◽  
Brain Stimulation ◽  
Strong Evidence ◽  
Cervical Dystonia ◽  
Tardive Dystonia ◽  
Optimal Target ◽  
Deep Brain

There is now strong evidence demonstrating that bilateral globus pallidus internus (GPi) stimulation improves motor function and disability in patients with severe primary generalised, segmental or cervical dystonia. The improvement is gradual, typically occurring over a period of about six months, with pain and then phasic components dissipating before the tonic elements of dystonia. Controlled data indicate that the benefits of GPi stimulation are in the order of 40–60% and are sustained at three years. Further work is required to better understand variation in the extent of the response. The procedure is usually performed under general anaesthesia and is well tolerated, although minor and hardwarerelated complications are common. GPi stimulation can also provide useful benefit to selected patients with secondary dystonia, with encouraging results reported for tardive dystonia, myoclonic dystonia and pantothenate-kinase-associated neurodegeneration. Currently, it is not known whether the nucleus ventralis intermedius of the thalamus or GPi is the optimal target for the surgical treatment of writer’s cramp.

scholarly journals DIPS (Dystonia Image-based Programming of Stimulation: a prospective, randomized, double-blind crossover trial)

2021 ◽  
Vol 3 (1) ◽  
Author(s):  
Florian Lange ◽  
Jonas Roothans ◽  
Tim Wichmann ◽  
Götz Gelbrich ◽  
Christoph Röser ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Deep Brain Stimulation ◽  
Clinical Outcome ◽  
Primary Endpoint ◽  
Brain Stimulation ◽  
In Silico ◽  
Clinical Settings ◽  
Stimulation Parameters ◽  
Deep Brain

Abstract Introduction Deep brain stimulation of the internal globus pallidus is an effective treatment for dystonia. However, there is a large variability in clinical outcome with up to 25% non-responders even in highly selected primary dystonia patients. In a large cohort of patients we recently demonstrated that the variable clinical outcomes of pallidal DBS for dystonia may result to a large degree by the exact location and stimulation volume within the pallidal region. Here we test a novel approach of programing based on these insights: we first defined probabilistic maps of anti-dystonic effects by aggregating individual electrode locations and volumes of tissue activated of > 80 patients collected in a multicentre effort. We subsequently modified the algorithms to be able to test all possible stimulation settings of de novo patients in silico based on the expected clinical outcome and thus potentially predict the best possible stimulation parameters for the individual patients. Methods Within the framework of a BMBF-funded study, this concept of a computer-based prediction of optimal stimulation parameters for patients with dystonia will be tested in a randomized, controlled crossover study. The main parameter for clinical efficacy and primary endpoint is based on the blinded physician rating of dystonia severity reflected by Clinical Dystonia Rating Scales for both interventions (best clinical settings and model predicted settings) after 4 weeks of continuous stimulation. The primary endpoint is defined as “successful treatment with model predicted settings” (yes or no). The value is “yes” if the motor symptoms with model predicted settings are equal or better (tolerance 5% of absolute difference in percentages) to clinical settings. Secondary endpoints will include measures of quality of life, calculated energy consumption of the neurostimulation system and physician time for programming. Perspective We envision, that computer-guided deep brain stimulation programming in silico might provide optimal stimulation settings for patients with dystonia without the burden of months of programming sessions. The study protocol is designed to evaluate which programming method is more effective in controlling motor symptom severity and improving quality of life in dystonia (best clinical settings and model predicted settings). Trial registration Registered with ClinicalTrials.gov on Oct 27, 2021 (NCT05097001).

scholarly journals Anatomo-clinical atlases correlate clinical data and electrode contact coordinates: Application to subthalamic deep brain stimulation

2013 ◽  
Vol 212 (2) ◽  
pp. 297-307 ◽  
Author(s):  
Florent Lalys ◽  
Claire Haegelen ◽  
Maroua Mehri ◽  
Sophie Drapier ◽  
Marc Vérin ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Clinical Data ◽  
Brain Stimulation ◽  
Electrode Contact ◽  
Deep Brain

Selection of deep brain stimulation contacts using volume of tissue activated software following subthalamic nucleus stimulation

2020 ◽  
pp. 1-8
Author(s):  
Mathilde Devaluez ◽  
Melissa Tir ◽  
Pierre Krystkowiak ◽  
Mickael Aubignat ◽  
Michel Lefranc
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Deep Brain Stimulation ◽  
Subthalamic Nucleus ◽  
Clinical Data ◽  
Brain Stimulation ◽  
Therapeutic Window ◽  
Patient Specific ◽  
Subthalamic Nucleus Stimulation ◽  
Deep Brain

OBJECTIVEHigh-frequency deep brain stimulation (DBS) of the subthalamic nucleus (STN) is effective in the treatment of motor symptoms of Parkinson’s disease. Using a patient-specific lead and volume of tissue activated (VTA) software, it is possible to visualize contact positions in the context of the patient’s own anatomy. In this study, the authors’ aim was to demonstrate that VTA software can be used in clinical practice to help determine the clinical effectiveness of stimulation in patients with Parkinson’s disease undergoing DBS of the STN.METHODSBrain images of 26 patients undergoing STN DBS were analyzed using VTA software. Preoperative clinical and neuropsychological data were collected. Contacts were chosen by two experts in DBS blinded to the clinical data. A therapeutic window of amplitude was determined. These results were compared with the parameter settings for each patient. Data were obtained at 3 months and 1 year postsurgery.RESULTSIn 90.4% (95% CI 82%–98%) of the patients, the contacts identified by the VTA software were concordant with the clinically effective contacts or with an effective contact in contact-by-contact testing. The therapeutic window of amplitude selected virtually included 81.3% of the clinical amplitudes.CONCLUSIONSVTA software appears to present significant concordance with clinical data for selecting contacts and stimulation parameters that could help in postoperative follow-up and programming.

Deep brain stimulation of the subcallosal cingulate gyrus for depression: anatomical location of active contacts in clinical responders and a suggested guideline for targeting

2009 ◽  
Vol 111 (6) ◽  
pp. 1209-1215 ◽  
Author(s):  
Clement Hamani ◽  
Helen Mayberg ◽  
Brian Snyder ◽  
Peter Giacobbe ◽  
Sidney Kennedy ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Frontal Lobe ◽  
Brain Stimulation ◽  
Anatomical Location ◽  
Anatomical Landmarks ◽  
Cingulate Gyrus ◽  
Optimal Target ◽  
Anterior Posterior ◽  
Deep Brain

Object Deep brain stimulation (DBS) of the subcallosal cingulate gyrus (SCG), including Brodmann area 25, is currently being investigated for the treatment of major depressive disorder (MDD). As a potential emerging therapy, optimal target selection within the SCG has still to be determined. The authors compared the location of the electrode contacts in responders and nonresponders to DBS of the SCG and correlated the results with clinical outcome to help in identifying the optimal target within the region. Based on the location of the active contacts used for long-term stimulation in responders, the authors suggest a standardized method of targeting the SCG in patients with MDD. Methods Postoperative MR imaging studies of 20 patients with MDD treated with DBS of the SCG were analyzed. The authors assessed the location of the active contacts relative to the midcommissural point and in relation to anatomical landmarks within the medial aspect of the frontal lobe. For this, a grid with 2 main lines was designed, with 1 line in the anterior-posterior and 1 line in the dorsal-ventral axis. Each of these lines was divided into 100 units, and data were converted into percentages. The anterior-posterior line extended from the anterior commissure (AC) to the projection of the anterior aspect of the corpus callosum (CCa). The dorsal-ventral line extended from the inferior portion of the CC (CCi) to the most ventral aspect of the frontal lobe (abbreviated “Fr” for the formula). Results Because the surgical technique did not vary across patients, differences in stereotactic coordinates between responders and nonresponders did not exceed 1.5 mm in any axis (x, y, or z). In patients who responded to the procedure, contacts used for long-term stimulation were in close approximation within the SCG. In the anterior-posterior line, these contacts were located within a 73.2 ± 7.7 percentile distance from the AC (with the AC center being 0% and the line crossing the CCa being 100%). In the dorsal-ventral line, active contacts in responders were located within a 26.2 ± 13.8 percentile distance from the CCi (with the CCi edge being 0% and the Fr inferior limit being 100%). In the medial-lateral plane, most electrode tips were in the transition between the gray and white matter of SCG. Conclusions Active contacts in patients who responded to DBS were relatively clustered within the SCG. Because of the anatomical variability in the size and shape of the SCG, the authors developed a method to standardize the targeting of this region.

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