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Vilkhu G, Goas C, Miller JA, Kelly SM, McDonald KJ, Tsai AJ, Dviwedi A, Dalm BD, Merola A. Clinician vs. imaging-based subthalamic nucleus deep brain stimulation programming. Parkinsonism Relat Disord 2023; 106:105241. [PMID: 36525899 DOI: 10.1016/j.parkreldis.2022.105241] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 11/29/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION We sought to explore whether electrode visualization tools (EVT) can accurately predict the selection of optimal Deep Brain Stimulation (DBS) electrode contacts. METHODS Twelve patients with Parkinson's disease (PD) undergoing STN-DBS at The Ohio State University were enrolled in a prospective analysis to evaluate the accuracy of EVT-based vs. standard DBS programming. EVTs were generated by the Surgical Information Sciences (SIS) system to develop a 3D model showing the implanted lead location relative to the STN. Then, imaging-based data were compared to the results of a standard monopolar review to evaluate concordance with clinical data and time spent selecting useable, non-useable, and borderline electrode contacts. RESULTS A total of 18 DBS leads (n = 68 electrode contacts) were analyzed. The concordance between EVT and standard clinical programming expressed as the kappa coefficient was 0.65 (82.35% raw agreement) for non-useable, 0.52 for useable (64.71% raw agreement), and 0.52 for borderline (58.82% raw agreement). The average time spent determining whether an electrode contact was useable, non-useable, or borderline was 1.46 ± 0.76 min with EVT vs. 61.25 ± 17.47 with standard monopolar review. Eight different categories of side effects were identified, with facial pulling and speech difficulties being observed with the most frequency. The type of side effect observed was accurately predicted using EVT 90% of the time. CONCLUSIONS This study demonstrates that next-generation EVT-based programming can be implemented into STN-DBS programming workflows with a considerable saving of time and effort spent in testing combinations of stimulation settings, particularly for the identification of non-useable electrode contacts.
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Affiliation(s)
- Gurleen Vilkhu
- Department of Neurology, Wexner Medical Center, Ohio State University, 395 W. 12th Ave. Columbus, OH, 43210, USA
| | - Clarisse Goas
- Department of Neurology, Wexner Medical Center, Ohio State University, 395 W. 12th Ave. Columbus, OH, 43210, USA
| | - Jacob A Miller
- Department of Neurology, Wexner Medical Center, Ohio State University, 395 W. 12th Ave. Columbus, OH, 43210, USA
| | - Scott M Kelly
- Department of Neurology, Wexner Medical Center, Ohio State University, 395 W. 12th Ave. Columbus, OH, 43210, USA
| | - Kelsey J McDonald
- Department of Neurology, Wexner Medical Center, Ohio State University, 395 W. 12th Ave. Columbus, OH, 43210, USA
| | - Anna J Tsai
- Department of Neurology, Wexner Medical Center, Ohio State University, 395 W. 12th Ave. Columbus, OH, 43210, USA
| | - Alok Dviwedi
- Department of Molecular and Translational Medicine, Division of Biostatistics and Epidemiology, Texas Tech University Health Sciences Center El Paso, 5001 El Paso Drive, Texas, 79905, USA
| | - Brian D Dalm
- Department of Neurology, Wexner Medical Center, Ohio State University, 395 W. 12th Ave. Columbus, OH, 43210, USA
| | - Aristide Merola
- Department of Neurology, Wexner Medical Center, Ohio State University, 395 W. 12th Ave. Columbus, OH, 43210, USA.
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Dilevicius I, Serdijn WA, Costa TL. Stent with Piezoelectric Transducers for High Spatial Resolution Ultrasound Neuromodulation- a Finite Element Analysis. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2022; 2022:4966-4969. [PMID: 36085863 DOI: 10.1109/embc48229.2022.9871956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Deep brain stimulation is currently the only technique used in the clinical setting to modulate the neural activity of deep brain nuclei. Recently, low-intensity transcranial focused ultrasound (LIFU) has been shown to reversibly modulate brain activity through a transcranial pathway. Transcranial LIFU requires a low-frequency ultrasound of around 0.5 MHz due to skull attenuation, thus providing poor axial and lateral resolution. This paper proposes a new conceptual device that would use a stent to place a high-frequency ultrasound array within the brain vasculature to achieve high axial and lateral spatial resolution. The first part of this work identified the most commonly treated deep brain nuclei and examined the human brain vasculature for stent placement. Next, a finite element analysis was carried out using a piezoelectric array that follows the blood vessels curvature, and its ability to focus ultrasound waves in clinically relevant brain nuclei was evaluated. The analytical solution provided promising results for deep brain stimulation via a stent with ultrasound transducers for high spatial resolution neuromodulation.
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Khaledi-Nasab A, Kromer JA, Tass PA. Long-Lasting Desynchronization Effects of Coordinated Reset Stimulation Improved by Random Jitters. Front Physiol 2021; 12:719680. [PMID: 34630142 PMCID: PMC8497886 DOI: 10.3389/fphys.2021.719680] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 08/12/2021] [Indexed: 12/30/2022] Open
Abstract
Abnormally strong synchronized activity is related to several neurological disorders, including essential tremor, epilepsy, and Parkinson's disease. Chronic high-frequency deep brain stimulation (HF DBS) is an established treatment for advanced Parkinson's disease. To reduce the delivered integral electrical current, novel theory-based stimulation techniques such as coordinated reset (CR) stimulation directly counteract the abnormal synchronous firing by delivering phase-shifted stimuli through multiple stimulation sites. In computational studies in neuronal networks with spike-timing-dependent plasticity (STDP), it was shown that CR stimulation down-regulates synaptic weights and drives the network into an attractor of a stable desynchronized state. This led to desynchronization effects that outlasted the stimulation. Corresponding long-lasting therapeutic effects were observed in preclinical and clinical studies. Computational studies suggest that long-lasting effects of CR stimulation depend on the adjustment of the stimulation frequency to the dominant synchronous rhythm. This may limit clinical applicability as different pathological rhythms may coexist. To increase the robustness of the long-lasting effects, we study randomized versions of CR stimulation in networks of leaky integrate-and-fire neurons with STDP. Randomization is obtained by adding random jitters to the stimulation times and by shuffling the sequence of stimulation site activations. We study the corresponding long-lasting effects using analytical calculations and computer simulations. We show that random jitters increase the robustness of long-lasting effects with respect to changes of the number of stimulation sites and the stimulation frequency. In contrast, shuffling does not increase parameter robustness of long-lasting effects. Studying the relation between acute, acute after-, and long-lasting effects of stimulation, we find that both acute after- and long-lasting effects are strongly determined by the stimulation-induced synaptic reshaping, whereas acute effects solely depend on the statistics of administered stimuli. We find that the stimulation duration is another important parameter, as effective stimulation only entails long-lasting effects after a sufficient stimulation duration. Our results show that long-lasting therapeutic effects of CR stimulation with random jitters are more robust than those of regular CR stimulation. This might reduce the parameter adjustment time in future clinical trials and make CR with random jitters more suitable for treating brain disorders with abnormal synchronization in multiple frequency bands.
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Affiliation(s)
- Ali Khaledi-Nasab
- Department of Neurosurgery, Stanford University, Stanford, CA, United States
| | - Justus A Kromer
- Department of Neurosurgery, Stanford University, Stanford, CA, United States
| | - Peter A Tass
- Department of Neurosurgery, Stanford University, Stanford, CA, United States
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Bhusal B, Stockmann J, Guerin B, Mareyam A, Kirsch J, Wald LL, Nolt MJ, Rosenow J, Lopez-Rosado R, Elahi B, Golestanirad L. Safety and image quality at 7T MRI for deep brain stimulation systems: Ex vivo study with lead-only and full-systems. PLoS One 2021; 16:e0257077. [PMID: 34492090 PMCID: PMC8423254 DOI: 10.1371/journal.pone.0257077] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 08/23/2021] [Indexed: 11/19/2022] Open
Abstract
Ultra-high field MRI at 7 T can produce much better visualization of sub-cortical structures compared to lower field, which can greatly help target verification as well as overall treatment monitoring for patients with deep brain stimulation (DBS) implants. However, use of 7 T MRI for such patients is currently contra-indicated by guidelines from the device manufacturers due to the safety issues. The aim of this study was to provide an assessment of safety and image quality of ultra-high field magnetic resonance imaging at 7 T in patients with deep brain stimulation implants. We performed experiments with both lead-only and complete DBS systems implanted in anthropomorphic phantoms. RF heating was measured for 43 unique patient-derived device configurations. Magnetic force measurements were performed according to ASTM F2052 test method, and device integrity was assessed before and after experiments. Finally, we assessed electrode artifact in a cadaveric brain implanted with an isolated DBS lead. RF heating remained below 2°C, similar to a fever, with the 95% confidence interval between 0.38°C-0.52°C. Magnetic forces were well below forces imposed by gravity, and thus not a source of concern. No device malfunctioning was observed due to interference from MRI fields. Electrode artifact was most noticeable on MPRAGE and T2*GRE sequences, while it was minimized on T2-TSE images. Our work provides the safety assessment of ultra-high field MRI at 7 T in patients with DBS implants. Our results suggest that 7 T MRI may be performed safely in patients with DBS implants for specific implant models and MRI hardware.
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Affiliation(s)
- Bhumi Bhusal
- Department of Radiology, Northwestern University, Chicago, IL, United States of America
| | - Jason Stockmann
- Department of Radiology, Harvard Medical School, Boston, MA, United States of America
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA, United States of America
| | - Bastien Guerin
- Department of Radiology, Harvard Medical School, Boston, MA, United States of America
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA, United States of America
| | - Azma Mareyam
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA, United States of America
| | - John Kirsch
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA, United States of America
| | - Lawrence L. Wald
- Department of Radiology, Harvard Medical School, Boston, MA, United States of America
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA, United States of America
| | - Mark J. Nolt
- Department of Neurosurgery, Northwestern University, Chicago, IL, United States of America
| | - Joshua Rosenow
- Department of Neurosurgery, Northwestern University, Chicago, IL, United States of America
| | - Roberto Lopez-Rosado
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, United States of America
| | - Behzad Elahi
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, United States of America
| | - Laleh Golestanirad
- Department of Radiology, Northwestern University, Chicago, IL, United States of America
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, United States of America
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Measuring Subthalamic Nucleus Volume of Parkinson's Patients and Evaluating Its Relationship with Clinical Scales at Pre- and Postdeep Brain Stimulation Treatment: A Magnetic Resonance Imaging Study. BIOMED RESEARCH INTERNATIONAL 2021; 2021:6646416. [PMID: 33708991 PMCID: PMC7932794 DOI: 10.1155/2021/6646416] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 02/09/2021] [Accepted: 02/19/2021] [Indexed: 11/17/2022]
Abstract
This study investigated potential imaging biomarkers for predicting the efficacy of deep brain stimulation (DBS) of the subthalamic nucleus (STN) in patients with Parkinson's disease (PD). A total of 59 PD patients and 50 healthy control subjects underwent high-resolution 3-dimensional T1-weighted brain magnetic resonance imaging. Bilateral STN volumes were compared between the 2 groups, and a correlation analysis was performed to assess the relationship between bilateral STN volumes or intracranial volume (ICV) and pre- or postoperative clinical scale scores. The results showed that the left STN volume differed significantly between PD patients and controls. In patients, the left STN volume was negatively correlated with pre- and postoperative quality of life scores and positively correlated with Mini-mental State Examination (MMSE) and Montreal Cognitive Assessment scores; ICV was also positively correlated with the MMSE score. These findings indicate that changes in the left STN volume are a useful biomarker for evaluating the clinical outcome of PD patients following DBS.
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6
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Al‐Ozzi TM, Botero-Posada LF, Lopez Rios AL, Hutchison WD. Single unit and beta oscillatory activities in subthalamic nucleus are modulated during visual choice preference. Eur J Neurosci 2020; 53:2220-2233. [DOI: 10.1111/ejn.14750] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 03/31/2020] [Accepted: 04/11/2020] [Indexed: 12/27/2022]
Affiliation(s)
- Tameem M. Al‐Ozzi
- Department of Physiology University of Toronto Toronto ON Canada
- Department of Surgery University of Toronto Toronto ON Canada
- Krembil Research Institute Toronto ON Canada
| | - Luis F. Botero-Posada
- Hospital Universitario y Centros Especializados de Saint Vicente Fundacion Rionegro/Medellin Colombia
| | - Adriana L. Lopez Rios
- Hospital Universitario y Centros Especializados de Saint Vicente Fundacion Rionegro/Medellin Colombia
| | - William D. Hutchison
- Department of Physiology University of Toronto Toronto ON Canada
- Department of Surgery University of Toronto Toronto ON Canada
- Krembil Research Institute Toronto ON Canada
- Hospital Universitario y Centros Especializados de Saint Vicente Fundacion Rionegro/Medellin Colombia
- Division of Neurosurgery Toronto Western Hospital – University Health Network Toronto ON Canada
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7
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Cury RG, Teixeira MJ, Galhardoni R, Silva V, Iglesio R, França C, Arnaut D, Fonoff ET, Barbosa ER, Ciampi de Andrade D. Connectivity Patterns of Subthalamic Stimulation Influence Pain Outcomes in Parkinson's Disease. Front Neurol 2020; 11:9. [PMID: 32116998 PMCID: PMC7028764 DOI: 10.3389/fneur.2020.00009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 01/07/2020] [Indexed: 12/27/2022] Open
Abstract
Background: Pain is highly prevalent in Parkinson's disease and is associated with significant reduction in health-related quality of life. Subthalamic deep brain stimulation can produce significant pain relief in a subset of patients after surgery. However, the mechanism by which deep brain stimulation modulates sensory function in Parkinson's disease remains uncertain. Objective: To describe the motor and pain outcomes of deep brain stimulation applied to a series of patients with Parkinson's disease and to determine whether the structural connectivity between the volume of tissue activated and different regions of the brain was associated with the changes of these outcomes after surgery. Methods: Data from a long-term prospective cohort of 32 Parkinson's disease patients with subthalamic stimulation were combined with available human connectome to identify connections consistently associated with clinical improvement (Unified Parkinson Disease Rating Scale), pain intensity, and experimental cold pain threshold after surgery. Results: The connectivity between the volume of tissue activated and a distributed network of sensory brain regions (prefrontal, insular and cingulate cortex, and postcentral gyrus) was inversely correlated with pain intensity improvement and reduced sensitivity to cold pain after surgery (p < 0.01). The connectivity strength with the supplementary motor area positively correlated with motor and pain threshold improvement (p < 0.05). Conclusions: These data suggest that the pattern of the connectivity between the region stimulated and specific brain cortical area might be responsible, in part, for the successful control of motor and pain symptoms by subthalamic deep brain stimulation in Parkinson's disease.
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Affiliation(s)
- Rubens Gisbert Cury
- Department of Neurology, Movement Disorders Center, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Manoel Jacobsen Teixeira
- Neurosurgery Division, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Ricardo Galhardoni
- Transcranial Magnetic Stimulation Laboratory, Psychiatry Institute, University of São Paulo, São Paulo, Brazil
| | - Valquiria Silva
- Transcranial Magnetic Stimulation Laboratory, Psychiatry Institute, University of São Paulo, São Paulo, Brazil.,Department of Neurology, Pain Center, LIM 62, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Ricardo Iglesio
- Neurosurgery Division, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Carina França
- Department of Neurology, Movement Disorders Center, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Débora Arnaut
- Department of Neurology, Pain Center, LIM 62, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Erich Talamoni Fonoff
- Neurosurgery Division, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Egberto Reis Barbosa
- Department of Neurology, Movement Disorders Center, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Daniel Ciampi de Andrade
- Department of Neurology, Pain Center, LIM 62, School of Medicine, University of São Paulo, São Paulo, Brazil.,Pain Center, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil
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8
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Wu C, Matias C. Commentary: Using Directional Deep Brain Stimulation to Co-activate the Subthalamic Nucleus and Zona Incerta for Overlapping Essential Tremor/Parkinson's Disease Symptoms. Front Neurol 2019; 10:854. [PMID: 31555192 PMCID: PMC6742774 DOI: 10.3389/fneur.2019.00854] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 07/23/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
- Chengyuan Wu
- Division of Epilepsy and Neuromodulation Neurosurgery, Department of Neurosurgery, Vickie and Jack Farber Institute for Neuroscience, Thomas Jefferson University, Philadelphia, PA, United States
- Department of Radiology, Jefferson Integrated Magnetic Resonance Imaging Center, Thomas Jefferson University, Philadelphia, PA, United States
- *Correspondence: Chengyuan Wu
| | - Caio Matias
- Division of Epilepsy and Neuromodulation Neurosurgery, Department of Neurosurgery, Vickie and Jack Farber Institute for Neuroscience, Thomas Jefferson University, Philadelphia, PA, United States
- Department of Radiology, Jefferson Integrated Magnetic Resonance Imaging Center, Thomas Jefferson University, Philadelphia, PA, United States
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9
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Samoudi MA, Van Renterghem T, Botteldooren D. Computational modeling of a single-element transcranial focused ultrasound transducer for subthalamic nucleus stimulation. J Neural Eng 2019; 16:026015. [DOI: 10.1088/1741-2552/aafa38] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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10
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Duchin Y, Shamir RR, Patriat R, Kim J, Vitek JL, Sapiro G, Harel N. Patient-specific anatomical model for deep brain stimulation based on 7 Tesla MRI. PLoS One 2018; 13:e0201469. [PMID: 30133472 PMCID: PMC6104927 DOI: 10.1371/journal.pone.0201469] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 07/15/2018] [Indexed: 01/16/2023] Open
Abstract
Objective Deep brain stimulation (DBS) requires accurate localization of the anatomical target structure, and the precise placement of the DBS electrode within it. Ultra-high field 7 Tesla (T) MR images can be utilized to create patient-specific anatomical 3D models of the subthalamic nuclei (STN) to enhance pre-surgical DBS targeting as well as post-surgical visualization of the DBS lead position and orientation. We validated the accuracy of the 7T imaging-based patient-specific model of the STN and measured the variability of the location and dimensions across movement disorder patients. Methods 72 patients who underwent DBS surgery were scanned preoperatively on 7T MRI. Segmentations and 3D volume rendering of the STN were generated for all patients. For 21 STN-DBS cases, microelectrode recording (MER) was used to validate the segmentation. For 12 cases, we computed the correlation between the overlap of the STN and volume of tissue activated (VTA) and the monopolar review for a further validation of the model’s accuracy and its clinical relevancy. Results We successfully reconstructed and visualized the STN in all patients. Significant variability was found across individuals regarding the location of the STN center of mass as well as its volume, length, depth and width. Significant correlations were found between MER and the 7T imaging-based model of the STN (r = 0.86) and VTA-STN overlap and the monopolar review outcome (r = 0.61). Conclusion The results suggest that an accurate visualization and localization of a patient-specific 3D model of the STN can be generated based on 7T MRI. The imaging-based 7T MRI STN model was validated using MER and patient’s clinical outcomes. The significant variability observed in the STN location and shape based on a large number of patients emphasizes the importance of an accurate direct visualization of the STN for DBS targeting. An accurate STN localization can facilitate postoperative stimulation parameters for optimized patient outcome.
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Affiliation(s)
- Yuval Duchin
- Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, MN, United States of America
- Surgical Information Sciences, Minneapolis, MN, United States of America
| | - Reuben R. Shamir
- Surgical Information Sciences, Minneapolis, MN, United States of America
| | - Remi Patriat
- Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, MN, United States of America
| | - Jinyoung Kim
- Surgical Information Sciences, Minneapolis, MN, United States of America
- Departments of Electrical & Computer Engineering, Computer Science, Biomedical Engineering and Math, Duke University, Durham, NC, United States of America
| | - Jerrold L. Vitek
- Department of Neurology, University of Minnesota, Minneapolis, MN, United States of America
| | - Guillermo Sapiro
- Departments of Electrical & Computer Engineering, Computer Science, Biomedical Engineering and Math, Duke University, Durham, NC, United States of America
| | - Noam Harel
- Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, MN, United States of America
- * E-mail:
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11
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van Wijk BCM, Pogosyan A, Hariz MI, Akram H, Foltynie T, Limousin P, Horn A, Ewert S, Brown P, Litvak V. Localization of beta and high-frequency oscillations within the subthalamic nucleus region. NEUROIMAGE-CLINICAL 2017; 16:175-183. [PMID: 28794978 PMCID: PMC5540829 DOI: 10.1016/j.nicl.2017.07.018] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 07/05/2017] [Accepted: 07/22/2017] [Indexed: 12/01/2022]
Abstract
Parkinsonian bradykinesia and rigidity are typically associated with excessive beta band oscillations in the subthalamic nucleus. Recently another spectral peak has been identified that might be implicated in the pathophysiology of the disease: high-frequency oscillations (HFO) within the 150–400 Hz range. Beta-HFO phase-amplitude coupling (PAC) has been found to correlate with severity of motor impairment. However, the neuronal origin of HFO and its usefulness as a potential target for deep brain stimulation remain to be established. For example, it is unclear whether HFO arise from the same neural populations as beta oscillations. We intraoperatively recorded local field potentials from the subthalamic nucleus while advancing DBS electrodes in 2 mm steps from 4 mm above the surgical target point until 2 mm below, resulting in 4 recording sites. Data from 26 nuclei from 14 patients were analysed. For each trajectory, we identified the recording site with the largest spectral peak in the beta range (13–30 Hz), and the largest peak in the HFO range separately. In addition, we identified the recording site with the largest beta-HFO PAC. Recording sites with largest beta power and largest HFO power coincided in 50% of cases. In the other 50%, HFO was more likely to be detected at a more superior recording site in the target area. PAC followed more closely the site with largest HFO (45%) than beta power (27%). HFO are likely to arise from spatially close, but slightly more superior neural populations than beta oscillations. Further work is necessary to determine whether the different activities can help fine-tune deep brain stimulation targeting. LFPs were recorded from multiple sites within and around the subthalamic nucleus. Sites with largest beta and high-frequency oscillations (HFO) were identified. HFO were located slightly more superior than beta oscillations. Phase-amplitude coupling more closely followed the site with largest HFO. This work hints at different neural generators for beta and HFO.
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Affiliation(s)
- B C M van Wijk
- Department of Neurology, Charité - University Medicine Berlin, Berlin, Germany.,Wellcome Trust Centre for Neuroimaging, UCL Institute of Neurology, London, United Kingdom
| | - A Pogosyan
- Nuffield Department of Clinical Neuroscience, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
| | - M I Hariz
- Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, London, United Kingdom.,Department of Clinical Neuroscience, Umeå University, Umeå, Sweden
| | - H Akram
- Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, London, United Kingdom.,Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - T Foltynie
- Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, London, United Kingdom
| | - P Limousin
- Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, London, United Kingdom
| | - A Horn
- Department of Neurology, Charité - University Medicine Berlin, Berlin, Germany.,Berenson-Allen Center for Non-Invasive Brain Stimulation and Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - S Ewert
- Department of Neurology, Charité - University Medicine Berlin, Berlin, Germany.,Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - P Brown
- Nuffield Department of Clinical Neuroscience, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom.,Medical Research Council Brain Network Dynamics Unit at the University of Oxford, Oxford, United Kingdom
| | - V Litvak
- Wellcome Trust Centre for Neuroimaging, UCL Institute of Neurology, London, United Kingdom
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12
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West T, Farmer S, Berthouze L, Jha A, Beudel M, Foltynie T, Limousin P, Zrinzo L, Brown P, Litvak V. The Parkinsonian Subthalamic Network: Measures of Power, Linear, and Non-linear Synchronization and their Relationship to L-DOPA Treatment and OFF State Motor Severity. Front Hum Neurosci 2016; 10:517. [PMID: 27826233 PMCID: PMC5078477 DOI: 10.3389/fnhum.2016.00517] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 09/29/2016] [Indexed: 11/13/2022] Open
Abstract
In this paper we investigated the dopaminergic modulation of neuronal interactions occurring in the subthalamic nucleus (STN) during Parkinson's disease (PD). We utilized linear measures of local and long range synchrony such as power and coherence, as well as Detrended Fluctuation Analysis for Phase Synchrony (DFA-PS)- a recently developed non-linear method that computes the extent of long tailed autocorrelations present in the phase interactions between two coupled signals. Through analysis of local field potentials (LFPs) taken from the STN we seek to determine changes in the neurodynamics that may underpin the pathophysiology of PD in a group of 12 patients who had undergone surgery for deep brain stimulation. We demonstrate up modulation of alpha-theta (5-12 Hz) band power in response to L-DOPA treatment, whilst low beta band power (15-20 Hz) band-power is suppressed. We also find evidence for significant local connectivity within the region surrounding STN although there was evidence for its modulation via administration of L-DOPA. Further to this we present evidence for a positive correlation between the phase ordering of bilateral STN interactions and the severity of bradykinetic and rigidity symptoms in PD. Although, the ability of non-linear measures to predict clinical state did not exceed standard measures such as beta power, these measures may help identify the connections which play a role in pathological dynamics.
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Affiliation(s)
- Timothy West
- Centre for Mathematics and Physics in the Life Sciences and Experimental Biology, UCLLondon, UK; Wellcome Trust Centre for Neuroimaging, UCL Institute of NeurologyLondon, UK
| | - Simon Farmer
- Department of Neurology, National Hospital for Neurology and NeurosurgeryLondon, UK; Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, UCLLondon, UK
| | - Luc Berthouze
- Centre for Computational Neuroscience and Robotics, University of SussexFalmer, UK; UCL Great Ormond Street Institute of Child Health, UCLLondon, UK
| | - Ashwani Jha
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, UCL London, UK
| | - Martijn Beudel
- Department of Neurology, University Medical Center Groningen, University of Groningen Groningen, Netherlands
| | - Thomas Foltynie
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, UCL London, UK
| | - Patricia Limousin
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, UCL London, UK
| | - Ludvic Zrinzo
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, UCL London, UK
| | - Peter Brown
- Nuffield Department of Clinical Neurosciences, John Radcliffe HospitalOxford, UK; Medical Research Council Brain Network Dynamics Unit, University of OxfordOxford, UK
| | - Vladimir Litvak
- Wellcome Trust Centre for Neuroimaging, UCL Institute of Neurology London, UK
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