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Vu J, Bhusal B, Rosenow JM, Pilitsis J, Golestanirad L. Effect of surgical modification of deep brain stimulation lead trajectories on radiofrequency heating during MRI at 3T: from phantom experiments to clinical implementation. J Neurosurg 2024; 140:1459-1470. [PMID: 37948679 PMCID: PMC11065613 DOI: 10.3171/2023.8.jns23580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 08/22/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE Radiofrequency (RF) tissue heating around deep brain stimulation (DBS) leads is a well-known safety risk during MRI, resulting in strict imaging guidelines and limited allowable protocols. The implanted lead's trajectory and orientation with respect to the MRI electric fields contribute to variations in the magnitude of RF heating across patients. Currently, there are no surgical requirements for implanting the extracranial portion of the DBS lead, resulting in substantial variations in clinical lead trajectories and consequently RF heating. Recent studies have shown that incorporating concentric loops in the extracranial lead trajectory can reduce RF heating. However, optimal positioning of the loops and the quantitative benefit of trajectory modification in terms of added safety margins during MRI remain unknown. In this study, the authors systematically evaluated the characteristics of DBS lead trajectories that minimize RF heating during 3T MRI to develop the best surgical practices for safe access to postoperative MRI, and they present the first surgical implementation of these modified trajectories. METHODS The authors performed experiments to assess the maximum temperature increase of 244 distinct lead trajectories. They investigated the effect of the position, number, and size of the concentric loops on the skull. Experiments were performed in an anthropomorphic phantom implanted with a commercial DBS system, and RF exposure was generated by applying a high specific absorption rate sequence (B1+rms = 2.7 µT). The authors conducted test-retest experiments to assess the reliability of measurements. Additionally, they evaluated the effect of imaging landmarks and perturbations to the DBS device configuration on the efficacy of low-heating trajectories. Finally, two neurosurgeons implanted the recommended modified trajectories in patients, and the authors characterized their RF heating in comparison with unmodified trajectories. RESULTS The maximum temperature increase ranged from 0.09°C to 7.34°C. The authors found that increasing the number of loops and positioning them closer to the surgical burr hole, particularly for the contralateral lead, substantially reduced RF heating. These trajectory modifications were easily incorporated during the surgical procedure and resulted in a threefold reduction in RF heating. CONCLUSIONS Surgically modifying the extracranial portion of the DBS lead trajectory can substantially reduce RF heating during 3T MRI. The authors' results indicate that simple adjustments to the lead's configuration, such as small, concentric loops near the burr hole, can be readily adopted during DBS lead implantation to improve patient safety during MRI.
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Affiliation(s)
- Jasmine Vu
- Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Illinois
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Bhumi Bhusal
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Joshua M. Rosenow
- Department of Neurosurgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Julie Pilitsis
- Department of Neurosciences and Experimental Therapeutics, Albany Medical College, Albany, New York
| | - Laleh Golestanirad
- Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Illinois
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Bezchlibnyk YB, Quiles R, Barber J, Osa B, Clifford K, Murtaugh R. Safety of intracranial electrodes in an MRI environment: a technical report. J Med Radiat Sci 2024. [PMID: 38468438 DOI: 10.1002/jmrs.775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 02/09/2024] [Indexed: 03/13/2024] Open
Abstract
INTRODUCTION Intracranial electroencephalography (iEEG) involves placing intracranial electrodes to localise seizures in patients with medically refractory epilepsy. While magnetic resonance imaging (MRI) enables visualisation of electrodes within patient-specific anatomy, the safety of these electrodes must be confirmed prior to routine clinical utilisation. Therefore, the purpose of this study was to evaluate the safety of iEEG electrodes from a particular manufacturer in a 3.0-Tesla (3.0T) MRI environment. METHODS Measurements of magnetically induced displacement force and torque were determined for each of the 10 test articles using standardised techniques. Test articles were subsequently evaluated for radiofrequency-induced heating using a Perspex phantom in both open and 'fault' conditions. Additionally, we assessed radiofrequency (RF)-induced heating with all test articles placed into the phantom simultaneously to simulate an implantation, again in both open and 'fault' conditions. Finally, each test article was evaluated for MRI artefacts. RESULTS The magnetically induced displacement force was found to be less than the force on the article due to gravity for all test articles. Similarly, the maximum magnetically induced torque was less than the worst-case torque due to gravity for all test articles apart from the 8-contact strip - for which it was 11% greater - and the depthalon cap. The maximum temperature change for any portion of any test article assessed individually was 1.7°C, or 1.2°C for any device component meant to be implanted intracranially. In the implantation configuration, the maximum recorded temperature change was 0.7°C. CONCLUSIONS MRI may be safely performed for localising iEEG electrodes at 3.0T under certain conditions.
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Affiliation(s)
- Yarema B Bezchlibnyk
- Department of Neurosurgery and Brain Repair, Morsani School of Medicine, University of South Florida, Tampa, Florida, USA
| | - Rolando Quiles
- Department of Radiology, Morsani School of Medicine, University of South Florida, Tampa, Florida, USA
- Department of Radiology, Tampa General Hospital, Tampa, Florida, USA
| | | | | | - Keven Clifford
- Department of Radiology, Morsani School of Medicine, University of South Florida, Tampa, Florida, USA
- Tower Radiology, Tampa, USA
| | - Ryan Murtaugh
- Department of Radiology, Morsani School of Medicine, University of South Florida, Tampa, Florida, USA
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Gao C, Wu X, Cheng X, Madsen KH, Chu C, Yang Z, Fan L. Individualized brain mapping for navigated neuromodulation. Chin Med J (Engl) 2024; 137:508-523. [PMID: 38269482 PMCID: PMC10932519 DOI: 10.1097/cm9.0000000000002979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Indexed: 01/26/2024] Open
Abstract
ABSTRACT The brain is a complex organ that requires precise mapping to understand its structure and function. Brain atlases provide a powerful tool for studying brain circuits, discovering biological markers for early diagnosis, and developing personalized treatments for neuropsychiatric disorders. Neuromodulation techniques, such as transcranial magnetic stimulation and deep brain stimulation, have revolutionized clinical therapies for neuropsychiatric disorders. However, the lack of fine-scale brain atlases limits the precision and effectiveness of these techniques. Advances in neuroimaging and machine learning techniques have led to the emergence of stereotactic-assisted neurosurgery and navigation systems. Still, the individual variability among patients and the diversity of brain diseases make it necessary to develop personalized solutions. The article provides an overview of recent advances in individualized brain mapping and navigated neuromodulation and discusses the methodological profiles, advantages, disadvantages, and future trends of these techniques. The article concludes by posing open questions about the future development of individualized brain mapping and navigated neuromodulation.
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Affiliation(s)
- Chaohong Gao
- Sino–Danish College, University of Chinese Academy of Sciences, Beijing 100190, China
| | - Xia Wu
- Brainnetome Center, National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences, Beijing 100190, China
| | - Xinle Cheng
- School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing 100190, China
| | - Kristoffer Hougaard Madsen
- Department of Applied Mathematics and Computer Science, Technical University of Denmark, Kongens Lyngby 2800, Denmark
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre 2650, Denmark
| | - Congying Chu
- Brainnetome Center, National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences, Beijing 100190, China
| | - Zhengyi Yang
- Brainnetome Center, National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences, Beijing 100190, China
| | - Lingzhong Fan
- Sino–Danish College, University of Chinese Academy of Sciences, Beijing 100190, China
- Brainnetome Center, National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences, Beijing 100190, China
- School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing 100190, China
- CAS Center for Excellence in Brain Science and Intelligence Technology, Institute of Automation, Chinese Academy of Sciences, Beijing 100190, China
- School of Health and Life Sciences, University of Health and Rehabilitation Sciences, Qingdao, Shandong 266000, China
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Ahn SH, Koh CS, Park M, Jun SB, Chang JW, Kim SJ, Jung HH, Jeong J. Liquid Crystal Polymer-Based Miniaturized Fully Implantable Deep Brain Stimulator. Polymers (Basel) 2023; 15:4439. [PMID: 38006163 PMCID: PMC10675735 DOI: 10.3390/polym15224439] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 10/22/2023] [Accepted: 10/27/2023] [Indexed: 11/26/2023] Open
Abstract
A significant challenge in improving the deep brain stimulation (DBS) system is the miniaturization of the device, aiming to integrate both the stimulator and the electrode into a compact unit with a wireless charging capability to reduce invasiveness. We present a miniaturized, fully implantable, and battery-free DBS system designed for rats, using a liquid crystal polymer (LCP), a biocompatible and long-term reliable material. The system integrates the simulator circuit, the receiver coil, and a 20 mm long depth-type microelectrode array in a dome-shaped LCP package that is 13 mm in diameter and 5 mm in height. Wireless powering and control via an inductive link enable device miniaturization, allowing for full implantation and, thus, the free behavior of untethered animals. The eight-channel stimulation electrode array was microfabricated on an LCP substrate to form a multilayered system substrate, which was monolithically encapsulated by a domed LCP lid using a specialized spot-welding process. The device functionality was validated via an in vivo animal experiment using a neuropathic pain model in rats. This experiment demonstrated an increase in the mechanical withdrawal threshold of the rats with microelectrical stimulation delivered using the fully implanted device, highlighting the effectiveness of the system.
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Affiliation(s)
- Seung-Hee Ahn
- Department of Electrical and Computer Engineering, College of Engineering, Seoul National University, Seoul 08826, Republic of Korea
| | - Chin Su Koh
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Minkyung Park
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Sang Beom Jun
- Department of Electronic and Electrical Engineering, Ewha Womans University, Seoul 03760, Republic of Korea
| | - Jin Woo Chang
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Sung June Kim
- Department of Electrical and Computer Engineering, College of Engineering, Seoul National University, Seoul 08826, Republic of Korea
| | - Hyun Ho Jung
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Joonsoo Jeong
- School of Biomedical Convergence Engineering, Pusan National University, Yangsan 50612, Republic of Korea
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Vu J, Bhusal B, Rosenow J, Pilitsis J, Golestanirad L. Optimizing the trajectory of deep brain stimulation leads reduces RF heating during MRI at 3 T: Characteristics and clinical translation. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2023; 2023:1-5. [PMID: 38083480 PMCID: PMC10838567 DOI: 10.1109/embc40787.2023.10340979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Radiofrequency (RF) induced tissue heating around deep brain stimulation (DBS) leads is a well-known safety risk during magnetic resonance imaging (MRI), hindering routine protocols for patients. Known factors that contribute to variations in the magnitude of RF heating across patients include the implanted lead's trajectory and its orientation with respect to the MRI electric fields. Currently, there are no consistent requirements for surgically implanting the extracranial portion of the DBS lead. Recent studies have shown that incorporating concentric loops in the extracranial trajectory of the lead can reduce RF heating, but the optimal positioning of the loop is unknown. In this study, we evaluated RF heating of 77 unique lead trajectories to determine how different characteristics of the trajectory affect RF heating during MRI at 3 T. We performed phantom experiments with commercial DBS systems from two manufacturers to determine how consistently modifying the lead trajectory mitigates RF heating. We also presented the first surgical implementation of these modified trajectories in patients. Low-heating trajectories included small concentric loops near the surgical burr hole which were readily implemented during the surgical procedure; these trajectories generated nearly a 2-fold reduction in RF heating compared to unmodified trajectories.Clinical Relevance- Surgically modifying the DBS lead trajectory can be a cost-effective strategy for reducing RF-induced heating during MRI at 3 T.
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Eraifej J, Cabral J, Fernandes HM, Kahan J, He S, Mancini L, Thornton J, White M, Yousry T, Zrinzo L, Akram H, Limousin P, Foltynie T, Aziz TZ, Deco G, Kringelbach M, Green AL. Modulation of limbic resting-state networks by subthalamic nucleus deep brain stimulation. Netw Neurosci 2023; 7:478-495. [PMID: 37397890 PMCID: PMC10312264 DOI: 10.1162/netn_a_00297] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 11/29/2022] [Indexed: 09/03/2023] Open
Abstract
Beyond the established effects of subthalamic nucleus deep brain stimulation (STN-DBS) in reducing motor symptoms in Parkinson's disease, recent evidence has highlighted the effect on non-motor symptoms. However, the impact of STN-DBS on disseminated networks remains unclear. This study aimed to perform a quantitative evaluation of network-specific modulation induced by STN-DBS using Leading Eigenvector Dynamics Analysis (LEiDA). We calculated the occupancy of resting-state networks (RSNs) in functional MRI data from 10 patients with Parkinson's disease implanted with STN-DBS and statistically compared between ON and OFF conditions. STN-DBS was found to specifically modulate the occupancy of networks overlapping with limbic RSNs. STN-DBS significantly increased the occupancy of an orbitofrontal limbic subsystem with respect to both DBS OFF (p = 0.0057) and 49 age-matched healthy controls (p = 0.0033). Occupancy of a diffuse limbic RSN was increased with STN-DBS OFF when compared with healthy controls (p = 0.021), but not when STN-DBS was ON, which indicates rebalancing of this network. These results highlight the modulatory effect of STN-DBS on components of the limbic system, particularly within the orbitofrontal cortex, a structure associated with reward processing. These results reinforce the value of quantitative biomarkers of RSN activity in evaluating the disseminated impact of brain stimulation techniques and the personalization of therapeutic strategies.
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Affiliation(s)
- John Eraifej
- Oxford Functional Neurosurgery Group, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - Joana Cabral
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- Centre for Eudaimonia and Human Flourishing, Linacre College, University of Oxford, Oxford, United Kingdom
- Center for Music in the Brain, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Henrique M. Fernandes
- Center for Music in the Brain, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Joshua Kahan
- Sobell Department for Motor Neurosciences and Movement Disorders, UCL Institute of Neurology, London, United Kingdom
| | - Shenghong He
- MRC Brain Network Dynamics Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Laura Mancini
- Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, University College London, London, United Kingdom
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, UCLH NHS Foundation Trust, London, United Kingdom
| | - John Thornton
- Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, University College London, London, United Kingdom
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, UCLH NHS Foundation Trust, London, United Kingdom
| | - Mark White
- Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, University College London, London, United Kingdom
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, UCLH NHS Foundation Trust, London, United Kingdom
| | - Tarek Yousry
- Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, University College London, London, United Kingdom
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, UCLH NHS Foundation Trust, London, United Kingdom
| | - Ludvic Zrinzo
- Sobell Department for Motor Neurosciences and Movement Disorders, UCL Institute of Neurology, London, United Kingdom
| | - Harith Akram
- Sobell Department for Motor Neurosciences and Movement Disorders, UCL Institute of Neurology, London, United Kingdom
| | - Patricia Limousin
- Sobell Department for Motor Neurosciences and Movement Disorders, UCL Institute of Neurology, London, United Kingdom
| | - Tom Foltynie
- Sobell Department for Motor Neurosciences and Movement Disorders, UCL Institute of Neurology, London, United Kingdom
| | - Tipu Z. Aziz
- Oxford Functional Neurosurgery Group, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - Gustavo Deco
- Center for Brain and Cognition, Computational Neuroscience Group, Universitat Pompeu Fabra, Barcelona, Spain
- Institució Catalana de la Recerca i Estudis Avançats, Barcelona, Spain
- Department of Neuropsychology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Morten Kringelbach
- Centre for Eudaimonia and Human Flourishing, Linacre College, University of Oxford, Oxford, United Kingdom
- Center for Music in the Brain, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Alexander L. Green
- Oxford Functional Neurosurgery Group, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
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Ma R, Yin Z, Chen Y, Yuan T, An Q, Gan Y, Xu Y, Jiang Y, Du T, Yang A, Meng F, Zhu G, Zhang J. Sleep outcomes and related factors in Parkinson's disease after subthalamic deep brain electrode implantation: a retrospective cohort study. Ther Adv Neurol Disord 2023; 16:17562864231161163. [PMID: 37200769 PMCID: PMC10185976 DOI: 10.1177/17562864231161163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 02/15/2023] [Indexed: 05/20/2023] Open
Abstract
Background Subthalamic nucleus deep brain stimulation (STN-DBS) improves sleep qualities in Parkinson's disease (PD) patients; however, it remains elusive whether STN-DBS improves sleep by directly influencing the sleep circuit or alleviates other cardinal symptoms such as motor functions, other confounding factors including stimulation intensity may also involve. Studying the effect of microlesion effect (MLE) on sleep after STN-DBS electrode implantation may address this issue. Objective To examine the influence of MLE on sleep quality and related factors in PD, as well as the effects of regional and lateral specific correlations with sleep outcomes after STN-DBS electrode implantation. Study Design Case-control study; Level of evidence, 3. Data Sources and Methods In 78 PD patients who underwent bilateral STN-DBS surgery in our center, we compared the sleep qualities, motor performances, anti-Parkinsonian drug dosage, and emotional conditions at preoperative baseline and postoperative 1-month follow-up. We determined the related factors of sleep outcomes and visualized the electrodes position, simulated the MLE-engendered volume of tissue lesioned (VTL), and investigated sleep-related sweet/sour spots and laterality in STN. Results MLE improves sleep quality with Pittsburgh Sleep Quality Index (PSQI) by 13.36% and Parkinson's Disease Sleep Scale-2 (PDSS-2) by 17.95%. Motor (P = 0.014) and emotional (P = 0.001) improvements were both positively correlated with sleep improvements. However, MLE in STN associative subregions, as an independent factor, may cause sleep deterioration (r = 0.348, P = 0.002), and only the left STN showed significance (r = 0.327, P = 0.004). Sweet spot analysis also indicated part of the left STN associative subregion is the sour spot indicative of sleep deterioration. Conclusion The MLE of STN-DBS can overall improve sleep quality in PD patients, with a positive correlation between motor and emotional improvements. However, independent of all other factors, the MLE in the STN associative subregion, particularly the left side, may cause sleep deterioration.
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Affiliation(s)
- Ruoyu Ma
- Department of Neurosurgery, Beijing Tiantan
Hospital, Capital Medical University, Beijing, China
| | - Zixiao Yin
- Department of Neurosurgery, Beijing Tiantan
Hospital, Capital Medical University, Beijing, China
| | - Yingchuan Chen
- Department of Neurosurgery, Beijing Tiantan
Hospital, Capital Medical University, Beijing, China
| | - Tianshuo Yuan
- Department of Neurosurgery, Beijing Tiantan
Hospital, Capital Medical University, Beijing, China
| | - Qi An
- Department of Neurosurgery, Beijing Tiantan
Hospital, Capital Medical University, Beijing, China
| | - Yifei Gan
- Department of Neurosurgery, Beijing Tiantan
Hospital, Capital Medical University, Beijing, China
| | - Yichen Xu
- Department of Neurosurgery, Beijing Tiantan
Hospital, Capital Medical University, Beijing, China
| | - Yin Jiang
- Department of Functional Neurosurgery, Beijing
Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Tingting Du
- Department of Functional Neurosurgery, Beijing
Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Anchao Yang
- Department of Neurosurgery, Beijing Tiantan
Hospital, Capital Medical University, Beijing, China
| | - Fangang Meng
- Department of Functional Neurosurgery, Beijing
Neurosurgical Institute, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Neurostimulation,
Beijing, China
| | - Guanyu Zhu
- Department of Neurosurgery, Beijing Tiantan
Hospital, Capital Medical University, No. 119 South 4th Ring West Road,
Fengtai District, Beijing 100070, China
| | - Jianguo Zhang
- Department of Neurosurgery, Beijing Tiantan
Hospital, Capital Medical University, No. 119 South 4th Ring West Road,
Fengtai District, Beijing 100070, China
- Department of Functional Neurosurgery, Beijing
Neurosurgical Institute, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Neurostimulation,
Beijing, China
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Kosten L, Emmi SA, Missault S, Keliris GA. Combining magnetic resonance imaging with readout and/or perturbation of neural activity in animal models: Advantages and pitfalls. Front Neurosci 2022; 16:938665. [PMID: 35911983 PMCID: PMC9334914 DOI: 10.3389/fnins.2022.938665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 06/28/2022] [Indexed: 11/13/2022] Open
Abstract
One of the main challenges in brain research is to link all aspects of brain function: on a cellular, systemic, and functional level. Multimodal neuroimaging methodology provides a continuously evolving platform. Being able to combine calcium imaging, optogenetics, electrophysiology, chemogenetics, and functional magnetic resonance imaging (fMRI) as part of the numerous efforts on brain functional mapping, we have a unique opportunity to better understand brain function. This review will focus on the developments in application of these tools within fMRI studies and highlight the challenges and choices neurosciences face when designing multimodal experiments.
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Affiliation(s)
- Lauren Kosten
- Bio-Imaging Lab, Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium
| | - Serena Alexa Emmi
- Bio-Imaging Lab, Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium
| | - Stephan Missault
- Bio-Imaging Lab, Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium
| | - Georgios A. Keliris
- Bio-Imaging Lab, Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium
- Foundation for Research & Technology – Hellas, Heraklion, Greece
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Bhusal B, Bhattacharyya P, Baig T, Jones S, Martens M. Effect of inter-electrode RF coupling on heating patterns of wire-like conducting implants in MRI. Magn Reson Med 2022; 87:2933-2946. [PMID: 35092097 DOI: 10.1002/mrm.29177] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 12/16/2021] [Accepted: 01/09/2022] [Indexed: 11/05/2022]
Abstract
PURPOSE In this study, the effects of RF coupling on the magnitude and spatial patterns of RF-induced heating near multiple wire-like conducting implants (such as simultaneous electrical stimulation of stereoelectroencephalography electrodes) during MRI were assessed. METHODS Simulations and experimental measurements of RF-induced temperature increases near partially immersed wire-like conductors were performed using a phantom with a transmit/receive head coil on a 3T MRI system. The conductors consisted of either a pair of wires or a single simultaneous electrical stimulation of stereoelectroencephalography electrode with multiple contacts, and the locations and lengths of the conductors were varied to study the effect of electromagnetic coupling on RF-induced heating. RESULTS The temperature increase near a wire within the phantom was dependent not only on its own location and length, but also on the locations and lengths of the other partially immersed wires. In the configurations that were studied, the presence of a second implant could increase the heating near the tip of the conductor by as much as 95%. CONCLUSION The level of RF-induced heating during an MR scan is affected significantly by RF coupling when more than one wire-like implant is present. In some of the configurations studied, the heating was increased by the presence of a second conductor partially immersed in the phantom. Thus, RF coupling is an important factor to consider in the assessment of safety issues for MRI when multiple implants are present.
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Affiliation(s)
- Bhumi Bhusal
- Department of Radiology, Northwestern University, Chicago, Illinois, USA
| | | | - Tanvir Baig
- Department of Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Stephen Jones
- Imaging Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Michael Martens
- Department of Physics, Case Western Reserve University, Cleveland, Ohio, USA
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Thielen B, Meng E. A comparison of insertion methods for surgical placement of penetrating neural interfaces. J Neural Eng 2021; 18:10.1088/1741-2552/abf6f2. [PMID: 33845469 PMCID: PMC8600966 DOI: 10.1088/1741-2552/abf6f2] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 04/12/2021] [Indexed: 02/07/2023]
Abstract
Many implantable electrode arrays exist for the purpose of stimulating or recording electrical activity in brain, spinal, or peripheral nerve tissue, however most of these devices are constructed from materials that are mechanically rigid. A growing body of evidence suggests that the chronic presence of these rigid probes in the neural tissue causes a significant immune response and glial encapsulation of the probes, which in turn leads to gradual increase in distance between the electrodes and surrounding neurons. In recording electrodes, the consequence is the loss of signal quality and, therefore, the inability to collect electrophysiological recordings long term. In stimulation electrodes, higher current injection is required to achieve a comparable response which can lead to tissue and electrode damage. To minimize the impact of the immune response, flexible neural probes constructed with softer materials have been developed. These flexible probes, however, are often not strong enough to be inserted on their own into the tissue, and instead fail via mechanical buckling of the shank under the force of insertion. Several strategies have been developed to allow the insertion of flexible probes while minimizing tissue damage. It is critical to keep these strategies in mind during probe design in order to ensure successful surgical placement. In this review, existing insertion strategies will be presented and evaluated with respect to surgical difficulty, immune response, ability to reach the target tissue, and overall limitations of the technique. Overall, the majority of these insertion techniques have only been evaluated for the insertion of a single probe and do not quantify the accuracy of probe placement. More work needs to be performed to evaluate and optimize insertion methods for accurate placement of devices and for devices with multiple probes.
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Affiliation(s)
- Brianna Thielen
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, United States of America
| | - Ellis Meng
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, United States of America
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Gonzalez-Escamilla G, Muthuraman M, Ciolac D, Coenen VA, Schnitzler A, Groppa S. Neuroimaging and electrophysiology meet invasive neurostimulation for causal interrogations and modulations of brain states. Neuroimage 2020; 220:117144. [DOI: 10.1016/j.neuroimage.2020.117144] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 06/22/2020] [Accepted: 07/02/2020] [Indexed: 12/13/2022] Open
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Li SJ, Lo YC, Lai HY, Lin SH, Lin HC, Lin TC, Chang CW, Chen TC, Chin-Jung Hsieh C, Yang SH, Chiu FM, Kuo CH, Chen YY. Uncovering the Modulatory Interactions of Brain Networks in Cognition with Central Thalamic Deep Brain Stimulation Using Functional Magnetic Resonance Imaging. Neuroscience 2020; 440:65-84. [DOI: 10.1016/j.neuroscience.2020.05.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 05/05/2020] [Accepted: 05/12/2020] [Indexed: 01/04/2023]
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Boutet A, Chow CT, Narang K, Elias GJB, Neudorfer C, Germann J, Ranjan M, Loh A, Martin AJ, Kucharczyk W, Steele CJ, Hancu I, Rezai AR, Lozano AM. Improving Safety of MRI in Patients with Deep Brain Stimulation Devices. Radiology 2020; 296:250-262. [PMID: 32573388 DOI: 10.1148/radiol.2020192291] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
MRI is a valuable clinical and research tool for patients undergoing deep brain stimulation (DBS). However, risks associated with imaging DBS devices have led to stringent regulations, limiting the clinical and research utility of MRI in these patients. The main risks in patients with DBS devices undergoing MRI are heating at the electrode tips, induced currents, implantable pulse generator dysfunction, and mechanical forces. Phantom model studies indicate that electrode tip heating remains the most serious risk for modern DBS devices. The absence of adverse events in patients imaged under DBS vendor guidelines for MRI demonstrates the general safety of MRI for patients with DBS devices. Moreover, recent work indicates that-given adequate safety data-patients may be imaged outside these guidelines. At present, investigators are primarily focused on improving DBS device and MRI safety through the development of tools, including safety simulation models. Existing guidelines provide a standardized framework for performing safe MRI in patients with DBS devices. It also highlights the possibility of expanding MRI as a tool for research and clinical care in these patients going forward.
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Affiliation(s)
- Alexandre Boutet
- From the University Health Network, Toronto, Canada (A.B., C.T.C., K.N., G.J.B.E., C.N., J.G., A.L., W.K., A.M.L.); Joint Department of Medical Imaging, University of Toronto, Toronto, Canada (A.B., W.K.); Department of Neurosurgery, West Virginia University, Morgantown, WVa (M.R., A.R.R.); Department of Neurosurgery, Rockefeller Neuroscience Institute, Morgantown, WVa (M.R., A.R.R.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (A.J.M.); Department of Psychology, Concordia University, Montreal, Canada (C.J.S.); Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (C.J.S.); Center for Scientific Review, National Institutes of Health, Bethesda, Md (I.H.); and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital and University of Toronto, 399 Bathurst St, WW 4-437, Toronto, ON, Canada M5T 2S8 (A.M.L.)
| | - Clement T Chow
- From the University Health Network, Toronto, Canada (A.B., C.T.C., K.N., G.J.B.E., C.N., J.G., A.L., W.K., A.M.L.); Joint Department of Medical Imaging, University of Toronto, Toronto, Canada (A.B., W.K.); Department of Neurosurgery, West Virginia University, Morgantown, WVa (M.R., A.R.R.); Department of Neurosurgery, Rockefeller Neuroscience Institute, Morgantown, WVa (M.R., A.R.R.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (A.J.M.); Department of Psychology, Concordia University, Montreal, Canada (C.J.S.); Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (C.J.S.); Center for Scientific Review, National Institutes of Health, Bethesda, Md (I.H.); and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital and University of Toronto, 399 Bathurst St, WW 4-437, Toronto, ON, Canada M5T 2S8 (A.M.L.)
| | - Keshav Narang
- From the University Health Network, Toronto, Canada (A.B., C.T.C., K.N., G.J.B.E., C.N., J.G., A.L., W.K., A.M.L.); Joint Department of Medical Imaging, University of Toronto, Toronto, Canada (A.B., W.K.); Department of Neurosurgery, West Virginia University, Morgantown, WVa (M.R., A.R.R.); Department of Neurosurgery, Rockefeller Neuroscience Institute, Morgantown, WVa (M.R., A.R.R.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (A.J.M.); Department of Psychology, Concordia University, Montreal, Canada (C.J.S.); Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (C.J.S.); Center for Scientific Review, National Institutes of Health, Bethesda, Md (I.H.); and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital and University of Toronto, 399 Bathurst St, WW 4-437, Toronto, ON, Canada M5T 2S8 (A.M.L.)
| | - Gavin J B Elias
- From the University Health Network, Toronto, Canada (A.B., C.T.C., K.N., G.J.B.E., C.N., J.G., A.L., W.K., A.M.L.); Joint Department of Medical Imaging, University of Toronto, Toronto, Canada (A.B., W.K.); Department of Neurosurgery, West Virginia University, Morgantown, WVa (M.R., A.R.R.); Department of Neurosurgery, Rockefeller Neuroscience Institute, Morgantown, WVa (M.R., A.R.R.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (A.J.M.); Department of Psychology, Concordia University, Montreal, Canada (C.J.S.); Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (C.J.S.); Center for Scientific Review, National Institutes of Health, Bethesda, Md (I.H.); and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital and University of Toronto, 399 Bathurst St, WW 4-437, Toronto, ON, Canada M5T 2S8 (A.M.L.)
| | - Clemens Neudorfer
- From the University Health Network, Toronto, Canada (A.B., C.T.C., K.N., G.J.B.E., C.N., J.G., A.L., W.K., A.M.L.); Joint Department of Medical Imaging, University of Toronto, Toronto, Canada (A.B., W.K.); Department of Neurosurgery, West Virginia University, Morgantown, WVa (M.R., A.R.R.); Department of Neurosurgery, Rockefeller Neuroscience Institute, Morgantown, WVa (M.R., A.R.R.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (A.J.M.); Department of Psychology, Concordia University, Montreal, Canada (C.J.S.); Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (C.J.S.); Center for Scientific Review, National Institutes of Health, Bethesda, Md (I.H.); and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital and University of Toronto, 399 Bathurst St, WW 4-437, Toronto, ON, Canada M5T 2S8 (A.M.L.)
| | - Jürgen Germann
- From the University Health Network, Toronto, Canada (A.B., C.T.C., K.N., G.J.B.E., C.N., J.G., A.L., W.K., A.M.L.); Joint Department of Medical Imaging, University of Toronto, Toronto, Canada (A.B., W.K.); Department of Neurosurgery, West Virginia University, Morgantown, WVa (M.R., A.R.R.); Department of Neurosurgery, Rockefeller Neuroscience Institute, Morgantown, WVa (M.R., A.R.R.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (A.J.M.); Department of Psychology, Concordia University, Montreal, Canada (C.J.S.); Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (C.J.S.); Center for Scientific Review, National Institutes of Health, Bethesda, Md (I.H.); and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital and University of Toronto, 399 Bathurst St, WW 4-437, Toronto, ON, Canada M5T 2S8 (A.M.L.)
| | - Manish Ranjan
- From the University Health Network, Toronto, Canada (A.B., C.T.C., K.N., G.J.B.E., C.N., J.G., A.L., W.K., A.M.L.); Joint Department of Medical Imaging, University of Toronto, Toronto, Canada (A.B., W.K.); Department of Neurosurgery, West Virginia University, Morgantown, WVa (M.R., A.R.R.); Department of Neurosurgery, Rockefeller Neuroscience Institute, Morgantown, WVa (M.R., A.R.R.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (A.J.M.); Department of Psychology, Concordia University, Montreal, Canada (C.J.S.); Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (C.J.S.); Center for Scientific Review, National Institutes of Health, Bethesda, Md (I.H.); and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital and University of Toronto, 399 Bathurst St, WW 4-437, Toronto, ON, Canada M5T 2S8 (A.M.L.)
| | - Aaron Loh
- From the University Health Network, Toronto, Canada (A.B., C.T.C., K.N., G.J.B.E., C.N., J.G., A.L., W.K., A.M.L.); Joint Department of Medical Imaging, University of Toronto, Toronto, Canada (A.B., W.K.); Department of Neurosurgery, West Virginia University, Morgantown, WVa (M.R., A.R.R.); Department of Neurosurgery, Rockefeller Neuroscience Institute, Morgantown, WVa (M.R., A.R.R.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (A.J.M.); Department of Psychology, Concordia University, Montreal, Canada (C.J.S.); Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (C.J.S.); Center for Scientific Review, National Institutes of Health, Bethesda, Md (I.H.); and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital and University of Toronto, 399 Bathurst St, WW 4-437, Toronto, ON, Canada M5T 2S8 (A.M.L.)
| | - Alastair J Martin
- From the University Health Network, Toronto, Canada (A.B., C.T.C., K.N., G.J.B.E., C.N., J.G., A.L., W.K., A.M.L.); Joint Department of Medical Imaging, University of Toronto, Toronto, Canada (A.B., W.K.); Department of Neurosurgery, West Virginia University, Morgantown, WVa (M.R., A.R.R.); Department of Neurosurgery, Rockefeller Neuroscience Institute, Morgantown, WVa (M.R., A.R.R.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (A.J.M.); Department of Psychology, Concordia University, Montreal, Canada (C.J.S.); Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (C.J.S.); Center for Scientific Review, National Institutes of Health, Bethesda, Md (I.H.); and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital and University of Toronto, 399 Bathurst St, WW 4-437, Toronto, ON, Canada M5T 2S8 (A.M.L.)
| | - Walter Kucharczyk
- From the University Health Network, Toronto, Canada (A.B., C.T.C., K.N., G.J.B.E., C.N., J.G., A.L., W.K., A.M.L.); Joint Department of Medical Imaging, University of Toronto, Toronto, Canada (A.B., W.K.); Department of Neurosurgery, West Virginia University, Morgantown, WVa (M.R., A.R.R.); Department of Neurosurgery, Rockefeller Neuroscience Institute, Morgantown, WVa (M.R., A.R.R.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (A.J.M.); Department of Psychology, Concordia University, Montreal, Canada (C.J.S.); Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (C.J.S.); Center for Scientific Review, National Institutes of Health, Bethesda, Md (I.H.); and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital and University of Toronto, 399 Bathurst St, WW 4-437, Toronto, ON, Canada M5T 2S8 (A.M.L.)
| | - Christopher J Steele
- From the University Health Network, Toronto, Canada (A.B., C.T.C., K.N., G.J.B.E., C.N., J.G., A.L., W.K., A.M.L.); Joint Department of Medical Imaging, University of Toronto, Toronto, Canada (A.B., W.K.); Department of Neurosurgery, West Virginia University, Morgantown, WVa (M.R., A.R.R.); Department of Neurosurgery, Rockefeller Neuroscience Institute, Morgantown, WVa (M.R., A.R.R.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (A.J.M.); Department of Psychology, Concordia University, Montreal, Canada (C.J.S.); Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (C.J.S.); Center for Scientific Review, National Institutes of Health, Bethesda, Md (I.H.); and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital and University of Toronto, 399 Bathurst St, WW 4-437, Toronto, ON, Canada M5T 2S8 (A.M.L.)
| | - Ileana Hancu
- From the University Health Network, Toronto, Canada (A.B., C.T.C., K.N., G.J.B.E., C.N., J.G., A.L., W.K., A.M.L.); Joint Department of Medical Imaging, University of Toronto, Toronto, Canada (A.B., W.K.); Department of Neurosurgery, West Virginia University, Morgantown, WVa (M.R., A.R.R.); Department of Neurosurgery, Rockefeller Neuroscience Institute, Morgantown, WVa (M.R., A.R.R.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (A.J.M.); Department of Psychology, Concordia University, Montreal, Canada (C.J.S.); Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (C.J.S.); Center for Scientific Review, National Institutes of Health, Bethesda, Md (I.H.); and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital and University of Toronto, 399 Bathurst St, WW 4-437, Toronto, ON, Canada M5T 2S8 (A.M.L.)
| | - Ali R Rezai
- From the University Health Network, Toronto, Canada (A.B., C.T.C., K.N., G.J.B.E., C.N., J.G., A.L., W.K., A.M.L.); Joint Department of Medical Imaging, University of Toronto, Toronto, Canada (A.B., W.K.); Department of Neurosurgery, West Virginia University, Morgantown, WVa (M.R., A.R.R.); Department of Neurosurgery, Rockefeller Neuroscience Institute, Morgantown, WVa (M.R., A.R.R.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (A.J.M.); Department of Psychology, Concordia University, Montreal, Canada (C.J.S.); Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (C.J.S.); Center for Scientific Review, National Institutes of Health, Bethesda, Md (I.H.); and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital and University of Toronto, 399 Bathurst St, WW 4-437, Toronto, ON, Canada M5T 2S8 (A.M.L.)
| | - Andres M Lozano
- From the University Health Network, Toronto, Canada (A.B., C.T.C., K.N., G.J.B.E., C.N., J.G., A.L., W.K., A.M.L.); Joint Department of Medical Imaging, University of Toronto, Toronto, Canada (A.B., W.K.); Department of Neurosurgery, West Virginia University, Morgantown, WVa (M.R., A.R.R.); Department of Neurosurgery, Rockefeller Neuroscience Institute, Morgantown, WVa (M.R., A.R.R.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (A.J.M.); Department of Psychology, Concordia University, Montreal, Canada (C.J.S.); Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (C.J.S.); Center for Scientific Review, National Institutes of Health, Bethesda, Md (I.H.); and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital and University of Toronto, 399 Bathurst St, WW 4-437, Toronto, ON, Canada M5T 2S8 (A.M.L.)
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14
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Kahan J, Mancini L, Flandin G, White M, Papadaki A, Thornton J, Yousry T, Zrinzo L, Hariz M, Limousin P, Friston K, Foltynie T. Deep brain stimulation has state-dependent effects on motor connectivity in Parkinson's disease. Brain 2020; 142:2417-2431. [PMID: 31219504 DOI: 10.1093/brain/awz164] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 03/12/2019] [Accepted: 04/18/2019] [Indexed: 12/17/2022] Open
Abstract
Subthalamic nucleus deep brain stimulation is an effective treatment for advanced Parkinson's disease; however, its therapeutic mechanism is unclear. Previous modelling of functional MRI data has suggested that deep brain stimulation has modulatory effects on a number of basal ganglia pathways. This work uses an enhanced data collection protocol to collect rare functional MRI data in patients with subthalamic nucleus deep brain stimulation. Eleven patients with Parkinson's disease and subthalamic nucleus deep brain stimulation underwent functional MRI at rest and during a movement task; once with active deep brain stimulation, and once with deep brain stimulation switched off. Dynamic causal modelling and Bayesian model selection were first used to compare a series of plausible biophysical models of the cortico-basal ganglia circuit that could explain the functional MRI activity at rest in an attempt to reproduce and extend the findings from our previous work. General linear modelling of the movement task functional MRI data revealed deep brain stimulation-associated signal increases in the primary motor and cerebellar cortices. Given the significance of the cerebellum in voluntary movement, we then built a more complete model of the motor system by including cerebellar-basal ganglia interactions, and compared the modulatory effects deep brain stimulation had on different circuit components during the movement task and again using the resting state data. Consistent with previous results from our independent cohort, model comparison found that the rest data were best explained by deep brain stimulation-induced increased (effective) connectivity of the cortico-striatal, thalamo-cortical and direct pathway and reduced coupling of subthalamic nucleus afferent and efferent connections. No changes in cerebellar connectivity were identified at rest. In contrast, during the movement task, there was functional recruitment of subcortical-cerebellar pathways, which were additionally modulated by deep brain stimulation, as well as modulation of local (intrinsic) cortical and cerebellar circuits. This work provides in vivo evidence for the modulatory effects of subthalamic nucleus deep brain stimulation on effective connectivity within the cortico-basal ganglia loops at rest, as well as further modulations in the cortico-cerebellar motor system during voluntary movement. We propose that deep brain stimulation has both behaviour-independent effects on basal ganglia connectivity, as well as behaviour-dependent modulatory effects.
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Affiliation(s)
- Joshua Kahan
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK
| | - Laura Mancini
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, UCLH NHS Foundation Trust, London, WC1N 3BG, UK.,Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK
| | - Guillaume Flandin
- The Wellcome Centre for Human Neuroimaging, UCL, London, WC1N 3AR, UK
| | - Mark White
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, UCLH NHS Foundation Trust, London, WC1N 3BG, UK.,Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK
| | - Anastasia Papadaki
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, UCLH NHS Foundation Trust, London, WC1N 3BG, UK.,Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK
| | - John Thornton
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, UCLH NHS Foundation Trust, London, WC1N 3BG, UK.,Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK
| | - Tarek Yousry
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, UCLH NHS Foundation Trust, London, WC1N 3BG, UK.,Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK
| | - Ludvic Zrinzo
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK
| | - Marwan Hariz
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK
| | - Patricia Limousin
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK
| | - Karl Friston
- The Wellcome Centre for Human Neuroimaging, UCL, London, WC1N 3AR, UK
| | - Tom Foltynie
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK
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Yang B, Tam F, Davidson B, Wei PS, Hamani C, Lipsman N, Chen CH, Graham SJ. Technical Note: An anthropomorphic phantom with implanted neurostimulator for investigation of MRI safety. Med Phys 2020; 47:3745-3751. [PMID: 32350868 DOI: 10.1002/mp.14214] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 04/03/2020] [Accepted: 04/20/2020] [Indexed: 12/18/2022] Open
Abstract
PURPOSE The objective of this work was to design and construct an improved anthropomorphic phantom for use in studying magnetic resonance imaging (MRI) radiofrequency (RF) safety at 3 T related to deep brain stimulation (DBS), and especially the role of DBS lead trajectories. METHOD Based on a computer-aided design including reasonable representation of human features, the phantom was fabricated by three-dimensional (3D) printing and then fully assembled with a human skull, a commercial DBS device implanted using the surgical standard at our institution, and fiber-optic temperature sensors embedded in two tissue mimicking solutions (e.g., the heterogeneous setup). Preliminary MRI safety experiments were conducted using turbo spin-echo (TSE) imaging with the device powered on and powered off. These results were then compared to analogous results for a homogeneous phantom setup that filled the structure with a standard body average solution. RESULT Both phantom setups produced temperature increases of ~1.0°C, with a maximum increase of 1.1 ± 0.2°C recorded during imaging of the heterogeneous phantom setup. The preliminary experimental results suggest that improved phantom structures capable of replicating actual DBS lead trajectories may be advisable when conducting DBS-related MRI safety studies. CONCLUSION An anthropomorphic phantom was constructed with promising initial results indicating different DBS lead trajectories and phantom setups may impact temperature elevations along an implanted DBS lead. Although additional work will be necessary to validate its efficacy over conventional phantoms, the anthropomorphic phantom can likely be used in the future to assess different procedures for DBS lead placement, the RF power deposition of MRI protocols applicable to DBS patients, and to validate novel methods to reduce localized heating effects associated with DBS devices, such as parallel RF transmission.
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Affiliation(s)
- Benson Yang
- Physical Sciences Platform, Sunnybrook Research Institute, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada.,Department of Electrical and Computer Engineering, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada
| | - Fred Tam
- Physical Sciences Platform, Sunnybrook Research Institute, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada
| | - Benjamin Davidson
- Division of Neurosurgery, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada
| | - Pei-Shan Wei
- Physical Sciences Platform, Sunnybrook Research Institute, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada
| | - Clement Hamani
- Division of Neurosurgery, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada.,Harquail Centre for Neuromodulation, Sunnybrook Research Institute, Hurvitz Brain Sciences Program, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada
| | - Nir Lipsman
- Physical Sciences Platform, Sunnybrook Research Institute, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada.,Division of Neurosurgery, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada.,Harquail Centre for Neuromodulation, Sunnybrook Research Institute, Hurvitz Brain Sciences Program, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada
| | - Chih-Hung Chen
- Department of Electrical and Computer Engineering, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada
| | - Simon J Graham
- Physical Sciences Platform, Sunnybrook Research Institute, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada.,Department of Medical Biophysics, University of Toronto, 101 College St Suite 15-701, Toronto, ON, M5G 1L7, Canada
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16
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Ashok Kumar N, Chauhan M, Kandala SK, Sohn SM, Sadleir RJ. Development and testing of implanted carbon electrodes for electromagnetic field mapping during neuromodulation. Magn Reson Med 2020; 84:2103-2116. [PMID: 32301176 DOI: 10.1002/mrm.28273] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 03/01/2020] [Accepted: 03/11/2020] [Indexed: 02/05/2023]
Abstract
PURPOSE Deep brain stimulation electrodes composed of carbon fibers were tested as a means of administering and imaging magnetic resonance electrical impedance tomography (MREIT) currents. Artifacts and heating properties of custom carbon-fiber deep brain stimulation (DBS) electrodes were compared with those produced with standard DBS electrodes. METHODS Electrodes were constructed from multiple strands of 7-μm carbon-fiber stock. The insulated carbon electrodes were matched to DBS electrode diameter and contact areas. Images of DBS and carbon electrodes were collected with and without current flow and were compared in terms of artifact and thermal effects in phantoms or tissue samples in 7T imaging conditions. Effects on magnetic flux density and current density distributions were also assessed. RESULTS Carbon electrodes produced magnitude artifacts with smaller FWHM values compared to the magnitude artifacts around DBS electrodes in spin echo and gradient echo imaging protocols. DBS electrodes appeared 269% larger than actual size in gradient echo images, in sharp contrast to the negligible artifact observed in diameter-matched carbon electrodes. As expected, larger temperature changes were observed near DBS electrodes during extended RF excitations compared with carbon electrodes in the same phantom. Magnitudes and distribution of magnetic flux density and current density reconstructions were comparable for carbon and DBS electrodes. CONCLUSION Carbon electrodes may offer a safer, MR-compatible method for administering neuromodulation currents. Use of carbon-fiber electrodes should allow imaging of structures close to electrodes, potentially allowing better targeting, electrode position revision, and the facilitation of functional imaging near electrodes during neuromodulation.
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Affiliation(s)
- Neeta Ashok Kumar
- School of Biological and Health Systems Engineering, Arizona State University, Tempe, Arizona, USA
| | - Munish Chauhan
- School of Biological and Health Systems Engineering, Arizona State University, Tempe, Arizona, USA
| | - Sri Kirthi Kandala
- School of Biological and Health Systems Engineering, Arizona State University, Tempe, Arizona, USA
| | - Sung-Min Sohn
- School of Biological and Health Systems Engineering, Arizona State University, Tempe, Arizona, USA
| | - Rosalind J Sadleir
- School of Biological and Health Systems Engineering, Arizona State University, Tempe, Arizona, USA
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17
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Fallegger F, Schiavone G, Lacour SP. Conformable Hybrid Systems for Implantable Bioelectronic Interfaces. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2020; 32:e1903904. [PMID: 31608508 DOI: 10.1002/adma.201903904] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 08/20/2019] [Indexed: 05/27/2023]
Abstract
Conformable bioelectronic systems are promising tools that may aid the understanding of diseases, alleviate pathological symptoms such as chronic pain, heart arrhythmia, and dysfunctions, and assist in reversing conditions such as deafness, blindness, and paralysis. Combining reduced invasiveness with advanced electronic functions, hybrid bioelectronic systems have evolved tremendously in the last decade, pushed by progress in materials science, micro- and nanofabrication, system assembly and packaging, and biomedical engineering. Hybrid integration refers here to a technological approach to embed within mechanically compliant carrier substrates electronic components and circuits prepared with traditional electronic materials. This combination leverages mechanical and electronic performance of polymer substrates and device materials, respectively, and offers many opportunities for man-made systems to communicate with the body with unmet precision. However, trade-offs between materials selection, manufacturing processes, resolution, electrical function, mechanical integrity, biointegration, and reliability should be considered. Herein, prominent trends in manufacturing conformable hybrid systems are analyzed and key design, function, and validation principles are outlined together with the remaining challenges to produce reliable conformable, hybrid bioelectronic systems.
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Affiliation(s)
- Florian Fallegger
- Bertarelli Foundation Chair in Neuroprosthetic Technology, Laboratory for Soft Bioelectronic Interfaces, Institute of Microengineering, Institute of Bioengineering, Center for Neuroprosthetics, Ecole Polytechnique Fédérale de Lausanne, 1202, Geneva, Switzerland
| | - Giuseppe Schiavone
- Bertarelli Foundation Chair in Neuroprosthetic Technology, Laboratory for Soft Bioelectronic Interfaces, Institute of Microengineering, Institute of Bioengineering, Center for Neuroprosthetics, Ecole Polytechnique Fédérale de Lausanne, 1202, Geneva, Switzerland
| | - Stéphanie P Lacour
- Bertarelli Foundation Chair in Neuroprosthetic Technology, Laboratory for Soft Bioelectronic Interfaces, Institute of Microengineering, Institute of Bioengineering, Center for Neuroprosthetics, Ecole Polytechnique Fédérale de Lausanne, 1202, Geneva, Switzerland
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18
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Boutet A, Elias GJB, Gramer R, Neudorfer C, Germann J, Naheed A, Bennett N, Li B, Gwun D, Chow CT, Maciel R, Valencia A, Fasano A, Munhoz RP, Foltz W, Mikulis D, Hancu I, Kalia SK, Hodaie M, Kucharczyk W, Lozano AM. Safety assessment of spine MRI in deep brain stimulation patients. J Neurosurg Spine 2020; 32:973-983. [PMID: 32059193 DOI: 10.3171/2019.12.spine191241] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 12/06/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Many centers are hesitant to perform clinically indicated MRI in patients who have undergone deep brain stimulation (DBS). Highly restrictive guidelines prohibit the use of most routine clinical MRI protocols in these patients. The authors' goals were to assess the safety of spine MRI in patients with implanted DBS devices, first through phantom model testing and subsequently through validation in a DBS patient cohort. METHODS A phantom was used to assess DBS device heating during 1.5-T spine MRI. To establish a safe spine protocol, routinely used clinical sequences deemed unsafe (a rise in temperature > 2°C) were modified to decrease the rise in temperature. This safe phantom-based protocol was then used to prospectively run 67 spine MRI sequences in 9 DBS participants requiring clinical imaging. The primary outcome was acute adverse effects; secondary outcomes included long-term adverse clinical effects, acute findings on brain MRI, and device impedance stability. RESULTS The increases in temperature were highest when scanning the cervical spine and lowest when scanning the lumbar spine. A temperature rise < 2°C was achieved when 3D sequences were modified to 2D and when the number of slices was decreased by the minimum amount compared to routine spine MRI protocols (but there were still more slices than allowed by vendor guidelines). Following spine MRI, no acute or long-term adverse effects or acute findings on brain MR images were detected. Device impedances remained stable. CONCLUSIONS Patients with DBS devices may safely undergo spine MRI with a fewer number of slices compared to those used in routine clinical protocols. Safety data acquisition may allow protocols outside vendor guidelines with a maximized number of slices, reducing the need for radiologist supervision.Clinical trial registration no.: NCT03753945 (ClinicalTrials.gov).
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Affiliation(s)
- Alexandre Boutet
- 1Joint Department of Medical Imaging, University of Toronto
- 2University Health Network, Toronto
| | | | | | | | | | - Asma Naheed
- 1Joint Department of Medical Imaging, University of Toronto
| | - Nicole Bennett
- 1Joint Department of Medical Imaging, University of Toronto
| | - Bryan Li
- 2University Health Network, Toronto
| | | | | | - Ricardo Maciel
- 2University Health Network, Toronto
- 3Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, Division of Neurology, University of Toronto
| | | | - Alfonso Fasano
- 3Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, Division of Neurology, University of Toronto
- 4Krembil Brain Institute, Toronto
| | - Renato P Munhoz
- 3Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, Division of Neurology, University of Toronto
- 4Krembil Brain Institute, Toronto
| | - Warren Foltz
- 5Department of Radiation Oncology, STTARR Innovation Centre, University Health Network, Toronto, Ontario, Canada; and
| | - David Mikulis
- 1Joint Department of Medical Imaging, University of Toronto
- 2University Health Network, Toronto
- 4Krembil Brain Institute, Toronto
| | - Ileana Hancu
- 6National Institutes of Health, Center for Scientific Review, Bethesda, Maryland
| | | | | | - Walter Kucharczyk
- 1Joint Department of Medical Imaging, University of Toronto
- 2University Health Network, Toronto
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19
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Boutet A, Hancu I, Saha U, Crawley A, Xu DS, Ranjan M, Hlasny E, Chen R, Foltz W, Sammartino F, Coblentz A, Kucharczyk W, Lozano AM. 3-Tesla MRI of deep brain stimulation patients: safety assessment of coils and pulse sequences. J Neurosurg 2020; 132:586-594. [DOI: 10.3171/2018.11.jns181338] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 11/05/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVEPhysicians are more frequently encountering patients who are treated with deep brain stimulation (DBS), yet many MRI centers do not routinely perform MRI in this population. This warrants a safety assessment to improve DBS patients’ accessibility to MRI, thereby improving their care while simultaneously providing a new tool for neuromodulation research.METHODSA phantom simulating a patient with a DBS neuromodulation device (DBS lead model 3387 and IPG Activa PC model 37601) was constructed and used. Temperature changes at the most ventral DBS electrode contacts, implantable pulse generator (IPG) voltages, specific absorption rate (SAR), and B1+rms were recorded during 3-T MRI scanning. Safety data were acquired with a transmit body multi-array receive and quadrature transmit-receive head coil during various pulse sequences, using numerous DBS configurations from “the worst” to “the most common.”In addition, 3-T MRI scanning (T1 and fMRI) was performed on 41 patients with fully internalized and active DBS using a quadrature transmit-receive head coil. MR images, neurological examination findings, and stability of the IPG impedances were assessed.RESULTSIn the phantom study, temperature rises at the DBS electrodes were less than 2°C for both coils during 3D SPGR, EPI, DTI, and SWI. Sequences with intense radiofrequency pulses such as T2-weighted sequences may cause higher heating (due to their higher SAR). The IPG did not power off and kept a constant firing rate, and its average voltage output was unchanged. The 41 DBS patients underwent 3-T MRI with no adverse event.CONCLUSIONSUnder the experimental conditions used in this study, 3-T MRI scanning of DBS patients with selected pulse sequences appears to be safe. Generally, T2-weighted sequences (using routine protocols) should be avoided in DBS patients. Complementary 3-T MRI phantom safety data suggest that imaging conditions that are less restrictive than those used in the patients in this study, such as using transmit body multi-array receive coils, may also be safe. Given the interplay between the implanted DBS neuromodulation device and the MRI system, these findings are specific to the experimental conditions in this study.
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Affiliation(s)
- Alexandre Boutet
- 1Joint Department of Medical Imaging, and
- 2University Health Network; and
| | - Ileana Hancu
- 3GE Global Research Center, Niskayuna, New York; and
| | - Utpal Saha
- 4Krembil Research Institute, Toronto, Ontario, Canada
| | - Adrian Crawley
- 1Joint Department of Medical Imaging, and
- 2University Health Network; and
| | | | | | | | - Robert Chen
- 2University Health Network; and
- 5Division of Neurology, Department of Medicine, University of Toronto
| | - Warren Foltz
- 6STTARR Innovation Centre, Department of Radiation Oncology,
| | | | - Ailish Coblentz
- 1Joint Department of Medical Imaging, and
- 2University Health Network; and
| | - Walter Kucharczyk
- 1Joint Department of Medical Imaging, and
- 2University Health Network; and
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20
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Martinez JA, Moulin K, Yoo B, Shi Y, Kim HJ, Villablanca PJ, Ennis DB. Evaluation of a Workflow to Define Low Specific Absorption Rate MRI Protocols for Patients With Active Implantable Medical Devices. J Magn Reson Imaging 2020; 52:91-102. [PMID: 31922311 DOI: 10.1002/jmri.27044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 12/16/2019] [Accepted: 12/18/2019] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND MRI exams for patients with MR-conditional active implantable medical devices (AIMDs) are contraindicated unless specific conditions are met. This limits the maximum specific absorption rate (SAR, W/kg). Currently, there is no general framework to guide meeting a lower SAR limit. PURPOSE To design and evaluate a workflow for modifying MRI protocols to whole-body SAR (WB-SAR ≤0.1 W/kg) and local-head SAR (LH-SAR ≤0.3 W/kg) limits while mitigating the impact on image quality and exam time. STUDY TYPE Prospective. POPULATION Twenty healthy volunteers on head (n = 5), C-spine (n = 5), T-spine (n = 5), and L-spine (n = 5) with IRB consent. ASSESSMENT Vendor-provided head, C-spine, T-spine, and L-spine protocols (SARRT ) were modified to meet both low SAR targets (SARLOW ) using the proposed workflow. in vitro SNR and CNR were evaluated with a T1 -T2 phantom. in vivo image quality and clinical acceptability were scored using a 5-point Likert scale for two blinded readers. FIELD STRENGTH/SEQUENCES 1.5T/spin-echoes, gradient-echoes. STATISTICAL ANALYSIS In vitro SNR and CNR values were evaluated with a repeated measures general linear model. in vivo image quality and clinical acceptability were evaluated using a generalized estimating equation analysis (GEE). The two reader's level of agreement was analyzed using Cohen's kappa statistical analysis. RESULTS Using the workflow, SAR limits were met. LH-SAR 0.12 ± 0.02 W/kg, median (SD) values for LH-SAR were 0.12 (0.02) W/kg and WB-SAR: 0.09 (0.01) W/kg. Examination time did not increase ≤2x the initial time. SARRT SNR values were higher and significantly different than SARLOW (P < 0.05). However, no significant difference was observed between the CNR values (value = 0.21). Median (IQR) CNR values were 14.2 (25.0) vs. 15.1 (9.2) for head, 12.1 (16.9) vs. 25.3 (14.2) for C-spine, 81.6 (70.1) vs. 71.0 (26.6) for T-spine, and 51.4 (52.6) vs. 37.7 (27.3) for L-spine. Image quality scores were not significantly different between SARRT and SARLOW (median [SD] scores were 4.0 [0.01] vs. 4.3 [0.2], P > 0.05). DATA CONCLUSION The proposed workflow provides guidance for modifying routine MRI exams to achieve low SAR limits. This can benefit patients referred for an MRI exam with low SAR MR-conditional AIMDs. LEVEL OF EVIDENCE 1 Technical Efficacy Stage: 5 J. Magn. Reson. Imaging 2020;52:91-102.
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Affiliation(s)
- Jessica A Martinez
- Department of Bioengineering, University of California, Los Angeles, California, USA.,Department of Radiological Sciences, University of California, Los Angeles, California, USA
| | - Kévin Moulin
- Department of Radiology, Stanford University, Stanford, California, USA
| | - Bryan Yoo
- Department of Radiological Sciences, University of California, Los Angeles, California, USA
| | - Yu Shi
- Department of Radiological Sciences, University of California, Los Angeles, California, USA
| | - Hyun J Kim
- Department of Radiological Sciences, University of California, Los Angeles, California, USA
| | - Pablo J Villablanca
- Department of Radiological Sciences, University of California, Los Angeles, California, USA
| | - Daniel B Ennis
- Department of Radiology, Stanford University, Stanford, California, USA
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21
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Boutet A, Rashid T, Hancu I, Elias GJB, Gramer RM, Germann J, Dimarzio M, Li B, Paramanandam V, Prasad S, Ranjan M, Coblentz A, Gwun D, Chow CT, Maciel R, Soh D, Fiveland E, Hodaie M, Kalia SK, Fasano A, Kucharczyk W, Pilitsis J, Lozano AM. Functional MRI Safety and Artifacts during Deep Brain Stimulation: Experience in 102 Patients. Radiology 2019; 293:174-183. [PMID: 31385756 DOI: 10.1148/radiol.2019190546] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BackgroundWith growing numbers of patients receiving deep brain stimulation (DBS), radiologists are encountering these neuromodulation devices at an increasing rate. Current MRI safety guidelines, however, limit MRI access in these patients.PurposeTo describe an MRI (1.5 T and 3 T) experience and safety profile in a large cohort of participants with active DBS systems and characterize the hardware-related artifacts on images from functional MRI.Materials and MethodsIn this prospective study, study participants receiving active DBS underwent 1.5- or 3-T MRI (T1-weighted imaging and gradient-recalled echo [GRE]-echo-planar imaging [EPI]) between June 2017 and October 2018. Short- and long-term adverse events were tracked. The authors quantified DBS hardware-related artifacts on images from GRE-EPI (functional MRI) at the cranial coil wire and electrode contacts. Segmented artifacts were then transformed into standard space to define the brain areas affected by signal loss. Two-sample t tests were used to assess the difference in artifact size between 1.5- and 3-T MRI.ResultsA total of 102 participants (mean age ± standard deviation, 60 years ± 11; 65 men) were evaluated. No MRI-related short- and long-term adverse events or acute changes were observed. DBS artifacts were most prominent near the electrode contacts and over the frontoparietal cortical area where the redundancy of the extension wire is placed subcutaneously. The mean electrode contact artifact diameter was 9.3 mm ± 1.6, and 1.9% ± 0.8 of the brain was obscured by the coil artifact. The coil artifacts were larger at 3 T than at 1.5 T, obscuring 2.1% ± 0.7 and 1.4% ± 0.7 of intracranial volume, respectively (P < .001). The superficial frontoparietal cortex and deep structures neighboring the electrode contacts were most commonly obscured.ConclusionWith a priori local safety testing, patients receiving deep brain stimulation may safely undergo 1.5- and 3-T MRI. Deep brain stimulation hardware-related artifacts only affect a small proportion of the brain.© RSNA, 2019Online supplemental material is available for this article.See also the editorial by Martin in this issue.
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Affiliation(s)
- Alexandre Boutet
- From the Joint Department of Medical Imaging, University of Toronto, Toronto, Canada (A.B., A.C., W.K.); Division of Neurosurgery, Toronto Western Hospital, University Health Network, 399 Bathurst St, WW 4-437, Toronto, ON, Canada M5T 2S8 (A.B., G.J.B.E., R.M.G., J.G., B.L., V.P., S.P., M.R., A.C., D.G., C.T.C., R.M., D.S., M.H., S.K.K., A.F., W.K., A.M.L.); Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY (T.R., M.D., J.P.); Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Division of Neurology, University of Toronto, Toronto, Ontario, Canada (I.H., V.P., S.P., R.M., D.S., A.F.); GE Global Research Center, Niskayuna, NY (E.F.); Krembil Brain Institute, Toronto, Canada (A.F.); and Department of Neurosurgery, Albany Medical Center, Albany, NY (J.P.)
| | - Tanweer Rashid
- From the Joint Department of Medical Imaging, University of Toronto, Toronto, Canada (A.B., A.C., W.K.); Division of Neurosurgery, Toronto Western Hospital, University Health Network, 399 Bathurst St, WW 4-437, Toronto, ON, Canada M5T 2S8 (A.B., G.J.B.E., R.M.G., J.G., B.L., V.P., S.P., M.R., A.C., D.G., C.T.C., R.M., D.S., M.H., S.K.K., A.F., W.K., A.M.L.); Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY (T.R., M.D., J.P.); Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Division of Neurology, University of Toronto, Toronto, Ontario, Canada (I.H., V.P., S.P., R.M., D.S., A.F.); GE Global Research Center, Niskayuna, NY (E.F.); Krembil Brain Institute, Toronto, Canada (A.F.); and Department of Neurosurgery, Albany Medical Center, Albany, NY (J.P.)
| | - Ileana Hancu
- From the Joint Department of Medical Imaging, University of Toronto, Toronto, Canada (A.B., A.C., W.K.); Division of Neurosurgery, Toronto Western Hospital, University Health Network, 399 Bathurst St, WW 4-437, Toronto, ON, Canada M5T 2S8 (A.B., G.J.B.E., R.M.G., J.G., B.L., V.P., S.P., M.R., A.C., D.G., C.T.C., R.M., D.S., M.H., S.K.K., A.F., W.K., A.M.L.); Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY (T.R., M.D., J.P.); Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Division of Neurology, University of Toronto, Toronto, Ontario, Canada (I.H., V.P., S.P., R.M., D.S., A.F.); GE Global Research Center, Niskayuna, NY (E.F.); Krembil Brain Institute, Toronto, Canada (A.F.); and Department of Neurosurgery, Albany Medical Center, Albany, NY (J.P.)
| | - Gavin J B Elias
- From the Joint Department of Medical Imaging, University of Toronto, Toronto, Canada (A.B., A.C., W.K.); Division of Neurosurgery, Toronto Western Hospital, University Health Network, 399 Bathurst St, WW 4-437, Toronto, ON, Canada M5T 2S8 (A.B., G.J.B.E., R.M.G., J.G., B.L., V.P., S.P., M.R., A.C., D.G., C.T.C., R.M., D.S., M.H., S.K.K., A.F., W.K., A.M.L.); Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY (T.R., M.D., J.P.); Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Division of Neurology, University of Toronto, Toronto, Ontario, Canada (I.H., V.P., S.P., R.M., D.S., A.F.); GE Global Research Center, Niskayuna, NY (E.F.); Krembil Brain Institute, Toronto, Canada (A.F.); and Department of Neurosurgery, Albany Medical Center, Albany, NY (J.P.)
| | - Robert M Gramer
- From the Joint Department of Medical Imaging, University of Toronto, Toronto, Canada (A.B., A.C., W.K.); Division of Neurosurgery, Toronto Western Hospital, University Health Network, 399 Bathurst St, WW 4-437, Toronto, ON, Canada M5T 2S8 (A.B., G.J.B.E., R.M.G., J.G., B.L., V.P., S.P., M.R., A.C., D.G., C.T.C., R.M., D.S., M.H., S.K.K., A.F., W.K., A.M.L.); Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY (T.R., M.D., J.P.); Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Division of Neurology, University of Toronto, Toronto, Ontario, Canada (I.H., V.P., S.P., R.M., D.S., A.F.); GE Global Research Center, Niskayuna, NY (E.F.); Krembil Brain Institute, Toronto, Canada (A.F.); and Department of Neurosurgery, Albany Medical Center, Albany, NY (J.P.)
| | - Jürgen Germann
- From the Joint Department of Medical Imaging, University of Toronto, Toronto, Canada (A.B., A.C., W.K.); Division of Neurosurgery, Toronto Western Hospital, University Health Network, 399 Bathurst St, WW 4-437, Toronto, ON, Canada M5T 2S8 (A.B., G.J.B.E., R.M.G., J.G., B.L., V.P., S.P., M.R., A.C., D.G., C.T.C., R.M., D.S., M.H., S.K.K., A.F., W.K., A.M.L.); Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY (T.R., M.D., J.P.); Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Division of Neurology, University of Toronto, Toronto, Ontario, Canada (I.H., V.P., S.P., R.M., D.S., A.F.); GE Global Research Center, Niskayuna, NY (E.F.); Krembil Brain Institute, Toronto, Canada (A.F.); and Department of Neurosurgery, Albany Medical Center, Albany, NY (J.P.)
| | - Marisa Dimarzio
- From the Joint Department of Medical Imaging, University of Toronto, Toronto, Canada (A.B., A.C., W.K.); Division of Neurosurgery, Toronto Western Hospital, University Health Network, 399 Bathurst St, WW 4-437, Toronto, ON, Canada M5T 2S8 (A.B., G.J.B.E., R.M.G., J.G., B.L., V.P., S.P., M.R., A.C., D.G., C.T.C., R.M., D.S., M.H., S.K.K., A.F., W.K., A.M.L.); Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY (T.R., M.D., J.P.); Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Division of Neurology, University of Toronto, Toronto, Ontario, Canada (I.H., V.P., S.P., R.M., D.S., A.F.); GE Global Research Center, Niskayuna, NY (E.F.); Krembil Brain Institute, Toronto, Canada (A.F.); and Department of Neurosurgery, Albany Medical Center, Albany, NY (J.P.)
| | - Bryan Li
- From the Joint Department of Medical Imaging, University of Toronto, Toronto, Canada (A.B., A.C., W.K.); Division of Neurosurgery, Toronto Western Hospital, University Health Network, 399 Bathurst St, WW 4-437, Toronto, ON, Canada M5T 2S8 (A.B., G.J.B.E., R.M.G., J.G., B.L., V.P., S.P., M.R., A.C., D.G., C.T.C., R.M., D.S., M.H., S.K.K., A.F., W.K., A.M.L.); Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY (T.R., M.D., J.P.); Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Division of Neurology, University of Toronto, Toronto, Ontario, Canada (I.H., V.P., S.P., R.M., D.S., A.F.); GE Global Research Center, Niskayuna, NY (E.F.); Krembil Brain Institute, Toronto, Canada (A.F.); and Department of Neurosurgery, Albany Medical Center, Albany, NY (J.P.)
| | - Vijayashankar Paramanandam
- From the Joint Department of Medical Imaging, University of Toronto, Toronto, Canada (A.B., A.C., W.K.); Division of Neurosurgery, Toronto Western Hospital, University Health Network, 399 Bathurst St, WW 4-437, Toronto, ON, Canada M5T 2S8 (A.B., G.J.B.E., R.M.G., J.G., B.L., V.P., S.P., M.R., A.C., D.G., C.T.C., R.M., D.S., M.H., S.K.K., A.F., W.K., A.M.L.); Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY (T.R., M.D., J.P.); Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Division of Neurology, University of Toronto, Toronto, Ontario, Canada (I.H., V.P., S.P., R.M., D.S., A.F.); GE Global Research Center, Niskayuna, NY (E.F.); Krembil Brain Institute, Toronto, Canada (A.F.); and Department of Neurosurgery, Albany Medical Center, Albany, NY (J.P.)
| | - Sreeram Prasad
- From the Joint Department of Medical Imaging, University of Toronto, Toronto, Canada (A.B., A.C., W.K.); Division of Neurosurgery, Toronto Western Hospital, University Health Network, 399 Bathurst St, WW 4-437, Toronto, ON, Canada M5T 2S8 (A.B., G.J.B.E., R.M.G., J.G., B.L., V.P., S.P., M.R., A.C., D.G., C.T.C., R.M., D.S., M.H., S.K.K., A.F., W.K., A.M.L.); Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY (T.R., M.D., J.P.); Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Division of Neurology, University of Toronto, Toronto, Ontario, Canada (I.H., V.P., S.P., R.M., D.S., A.F.); GE Global Research Center, Niskayuna, NY (E.F.); Krembil Brain Institute, Toronto, Canada (A.F.); and Department of Neurosurgery, Albany Medical Center, Albany, NY (J.P.)
| | - Manish Ranjan
- From the Joint Department of Medical Imaging, University of Toronto, Toronto, Canada (A.B., A.C., W.K.); Division of Neurosurgery, Toronto Western Hospital, University Health Network, 399 Bathurst St, WW 4-437, Toronto, ON, Canada M5T 2S8 (A.B., G.J.B.E., R.M.G., J.G., B.L., V.P., S.P., M.R., A.C., D.G., C.T.C., R.M., D.S., M.H., S.K.K., A.F., W.K., A.M.L.); Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY (T.R., M.D., J.P.); Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Division of Neurology, University of Toronto, Toronto, Ontario, Canada (I.H., V.P., S.P., R.M., D.S., A.F.); GE Global Research Center, Niskayuna, NY (E.F.); Krembil Brain Institute, Toronto, Canada (A.F.); and Department of Neurosurgery, Albany Medical Center, Albany, NY (J.P.)
| | - Ailish Coblentz
- From the Joint Department of Medical Imaging, University of Toronto, Toronto, Canada (A.B., A.C., W.K.); Division of Neurosurgery, Toronto Western Hospital, University Health Network, 399 Bathurst St, WW 4-437, Toronto, ON, Canada M5T 2S8 (A.B., G.J.B.E., R.M.G., J.G., B.L., V.P., S.P., M.R., A.C., D.G., C.T.C., R.M., D.S., M.H., S.K.K., A.F., W.K., A.M.L.); Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY (T.R., M.D., J.P.); Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Division of Neurology, University of Toronto, Toronto, Ontario, Canada (I.H., V.P., S.P., R.M., D.S., A.F.); GE Global Research Center, Niskayuna, NY (E.F.); Krembil Brain Institute, Toronto, Canada (A.F.); and Department of Neurosurgery, Albany Medical Center, Albany, NY (J.P.)
| | - Dave Gwun
- From the Joint Department of Medical Imaging, University of Toronto, Toronto, Canada (A.B., A.C., W.K.); Division of Neurosurgery, Toronto Western Hospital, University Health Network, 399 Bathurst St, WW 4-437, Toronto, ON, Canada M5T 2S8 (A.B., G.J.B.E., R.M.G., J.G., B.L., V.P., S.P., M.R., A.C., D.G., C.T.C., R.M., D.S., M.H., S.K.K., A.F., W.K., A.M.L.); Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY (T.R., M.D., J.P.); Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Division of Neurology, University of Toronto, Toronto, Ontario, Canada (I.H., V.P., S.P., R.M., D.S., A.F.); GE Global Research Center, Niskayuna, NY (E.F.); Krembil Brain Institute, Toronto, Canada (A.F.); and Department of Neurosurgery, Albany Medical Center, Albany, NY (J.P.)
| | - Clement T Chow
- From the Joint Department of Medical Imaging, University of Toronto, Toronto, Canada (A.B., A.C., W.K.); Division of Neurosurgery, Toronto Western Hospital, University Health Network, 399 Bathurst St, WW 4-437, Toronto, ON, Canada M5T 2S8 (A.B., G.J.B.E., R.M.G., J.G., B.L., V.P., S.P., M.R., A.C., D.G., C.T.C., R.M., D.S., M.H., S.K.K., A.F., W.K., A.M.L.); Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY (T.R., M.D., J.P.); Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Division of Neurology, University of Toronto, Toronto, Ontario, Canada (I.H., V.P., S.P., R.M., D.S., A.F.); GE Global Research Center, Niskayuna, NY (E.F.); Krembil Brain Institute, Toronto, Canada (A.F.); and Department of Neurosurgery, Albany Medical Center, Albany, NY (J.P.)
| | - Ricardo Maciel
- From the Joint Department of Medical Imaging, University of Toronto, Toronto, Canada (A.B., A.C., W.K.); Division of Neurosurgery, Toronto Western Hospital, University Health Network, 399 Bathurst St, WW 4-437, Toronto, ON, Canada M5T 2S8 (A.B., G.J.B.E., R.M.G., J.G., B.L., V.P., S.P., M.R., A.C., D.G., C.T.C., R.M., D.S., M.H., S.K.K., A.F., W.K., A.M.L.); Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY (T.R., M.D., J.P.); Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Division of Neurology, University of Toronto, Toronto, Ontario, Canada (I.H., V.P., S.P., R.M., D.S., A.F.); GE Global Research Center, Niskayuna, NY (E.F.); Krembil Brain Institute, Toronto, Canada (A.F.); and Department of Neurosurgery, Albany Medical Center, Albany, NY (J.P.)
| | - Derrick Soh
- From the Joint Department of Medical Imaging, University of Toronto, Toronto, Canada (A.B., A.C., W.K.); Division of Neurosurgery, Toronto Western Hospital, University Health Network, 399 Bathurst St, WW 4-437, Toronto, ON, Canada M5T 2S8 (A.B., G.J.B.E., R.M.G., J.G., B.L., V.P., S.P., M.R., A.C., D.G., C.T.C., R.M., D.S., M.H., S.K.K., A.F., W.K., A.M.L.); Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY (T.R., M.D., J.P.); Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Division of Neurology, University of Toronto, Toronto, Ontario, Canada (I.H., V.P., S.P., R.M., D.S., A.F.); GE Global Research Center, Niskayuna, NY (E.F.); Krembil Brain Institute, Toronto, Canada (A.F.); and Department of Neurosurgery, Albany Medical Center, Albany, NY (J.P.)
| | - Eric Fiveland
- From the Joint Department of Medical Imaging, University of Toronto, Toronto, Canada (A.B., A.C., W.K.); Division of Neurosurgery, Toronto Western Hospital, University Health Network, 399 Bathurst St, WW 4-437, Toronto, ON, Canada M5T 2S8 (A.B., G.J.B.E., R.M.G., J.G., B.L., V.P., S.P., M.R., A.C., D.G., C.T.C., R.M., D.S., M.H., S.K.K., A.F., W.K., A.M.L.); Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY (T.R., M.D., J.P.); Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Division of Neurology, University of Toronto, Toronto, Ontario, Canada (I.H., V.P., S.P., R.M., D.S., A.F.); GE Global Research Center, Niskayuna, NY (E.F.); Krembil Brain Institute, Toronto, Canada (A.F.); and Department of Neurosurgery, Albany Medical Center, Albany, NY (J.P.)
| | - Mojgan Hodaie
- From the Joint Department of Medical Imaging, University of Toronto, Toronto, Canada (A.B., A.C., W.K.); Division of Neurosurgery, Toronto Western Hospital, University Health Network, 399 Bathurst St, WW 4-437, Toronto, ON, Canada M5T 2S8 (A.B., G.J.B.E., R.M.G., J.G., B.L., V.P., S.P., M.R., A.C., D.G., C.T.C., R.M., D.S., M.H., S.K.K., A.F., W.K., A.M.L.); Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY (T.R., M.D., J.P.); Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Division of Neurology, University of Toronto, Toronto, Ontario, Canada (I.H., V.P., S.P., R.M., D.S., A.F.); GE Global Research Center, Niskayuna, NY (E.F.); Krembil Brain Institute, Toronto, Canada (A.F.); and Department of Neurosurgery, Albany Medical Center, Albany, NY (J.P.)
| | - Suneil K Kalia
- From the Joint Department of Medical Imaging, University of Toronto, Toronto, Canada (A.B., A.C., W.K.); Division of Neurosurgery, Toronto Western Hospital, University Health Network, 399 Bathurst St, WW 4-437, Toronto, ON, Canada M5T 2S8 (A.B., G.J.B.E., R.M.G., J.G., B.L., V.P., S.P., M.R., A.C., D.G., C.T.C., R.M., D.S., M.H., S.K.K., A.F., W.K., A.M.L.); Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY (T.R., M.D., J.P.); Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Division of Neurology, University of Toronto, Toronto, Ontario, Canada (I.H., V.P., S.P., R.M., D.S., A.F.); GE Global Research Center, Niskayuna, NY (E.F.); Krembil Brain Institute, Toronto, Canada (A.F.); and Department of Neurosurgery, Albany Medical Center, Albany, NY (J.P.)
| | - Alfonso Fasano
- From the Joint Department of Medical Imaging, University of Toronto, Toronto, Canada (A.B., A.C., W.K.); Division of Neurosurgery, Toronto Western Hospital, University Health Network, 399 Bathurst St, WW 4-437, Toronto, ON, Canada M5T 2S8 (A.B., G.J.B.E., R.M.G., J.G., B.L., V.P., S.P., M.R., A.C., D.G., C.T.C., R.M., D.S., M.H., S.K.K., A.F., W.K., A.M.L.); Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY (T.R., M.D., J.P.); Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Division of Neurology, University of Toronto, Toronto, Ontario, Canada (I.H., V.P., S.P., R.M., D.S., A.F.); GE Global Research Center, Niskayuna, NY (E.F.); Krembil Brain Institute, Toronto, Canada (A.F.); and Department of Neurosurgery, Albany Medical Center, Albany, NY (J.P.)
| | - Walter Kucharczyk
- From the Joint Department of Medical Imaging, University of Toronto, Toronto, Canada (A.B., A.C., W.K.); Division of Neurosurgery, Toronto Western Hospital, University Health Network, 399 Bathurst St, WW 4-437, Toronto, ON, Canada M5T 2S8 (A.B., G.J.B.E., R.M.G., J.G., B.L., V.P., S.P., M.R., A.C., D.G., C.T.C., R.M., D.S., M.H., S.K.K., A.F., W.K., A.M.L.); Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY (T.R., M.D., J.P.); Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Division of Neurology, University of Toronto, Toronto, Ontario, Canada (I.H., V.P., S.P., R.M., D.S., A.F.); GE Global Research Center, Niskayuna, NY (E.F.); Krembil Brain Institute, Toronto, Canada (A.F.); and Department of Neurosurgery, Albany Medical Center, Albany, NY (J.P.)
| | - Julie Pilitsis
- From the Joint Department of Medical Imaging, University of Toronto, Toronto, Canada (A.B., A.C., W.K.); Division of Neurosurgery, Toronto Western Hospital, University Health Network, 399 Bathurst St, WW 4-437, Toronto, ON, Canada M5T 2S8 (A.B., G.J.B.E., R.M.G., J.G., B.L., V.P., S.P., M.R., A.C., D.G., C.T.C., R.M., D.S., M.H., S.K.K., A.F., W.K., A.M.L.); Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY (T.R., M.D., J.P.); Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Division of Neurology, University of Toronto, Toronto, Ontario, Canada (I.H., V.P., S.P., R.M., D.S., A.F.); GE Global Research Center, Niskayuna, NY (E.F.); Krembil Brain Institute, Toronto, Canada (A.F.); and Department of Neurosurgery, Albany Medical Center, Albany, NY (J.P.)
| | - Andres M Lozano
- From the Joint Department of Medical Imaging, University of Toronto, Toronto, Canada (A.B., A.C., W.K.); Division of Neurosurgery, Toronto Western Hospital, University Health Network, 399 Bathurst St, WW 4-437, Toronto, ON, Canada M5T 2S8 (A.B., G.J.B.E., R.M.G., J.G., B.L., V.P., S.P., M.R., A.C., D.G., C.T.C., R.M., D.S., M.H., S.K.K., A.F., W.K., A.M.L.); Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY (T.R., M.D., J.P.); Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Division of Neurology, University of Toronto, Toronto, Ontario, Canada (I.H., V.P., S.P., R.M., D.S., A.F.); GE Global Research Center, Niskayuna, NY (E.F.); Krembil Brain Institute, Toronto, Canada (A.F.); and Department of Neurosurgery, Albany Medical Center, Albany, NY (J.P.)
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Fečíková A, Jech R, Čejka V, Čapek V, Šťastná D, Štětkářová I, Mueller K, Schroeter ML, Růžička F, Urgošík D. Benefits of pallidal stimulation in dystonia are linked to cerebellar volume and cortical inhibition. Sci Rep 2018; 8:17218. [PMID: 30464181 PMCID: PMC6249276 DOI: 10.1038/s41598-018-34880-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 10/26/2018] [Indexed: 11/18/2022] Open
Abstract
Clinical benefits of pallidal deep brain stimulation (GPi DBS) in dystonia increase relatively slowly suggesting slow plastic processes in the motor network. Twenty-two patients with dystonia of various distribution and etiology treated by chronic GPi DBS and 22 healthy subjects were examined for short-latency intracortical inhibition of the motor cortex elicited by paired transcranial magnetic stimulation. The relationships between grey matter volume and intracortical inhibition considering the long-term clinical outcome and states of the GPi DBS were analysed. The acute effects of GPi DBS were associated with a shortening of the motor response whereas the grey matter of chronically treated patients with a better clinical outcome showed hypertrophy of the supplementary motor area and cerebellar vermis. In addition, the volume of the cerebellar hemispheres of patients correlated with the improvement of intracortical inhibition which was generally less effective in patients than in controls regardless of the DBS states. Importantly, good responders to GPi DBS showed a similar level of short-latency intracortical inhibition in the motor cortex as healthy controls whereas non-responders were unable to increase it. All these results support the multilevel impact of effective DBS on the motor networks in dystonia and suggest potential biomarkers of responsiveness to this treatment.
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Affiliation(s)
- Anna Fečíková
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic
| | - Robert Jech
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic.
| | - Václav Čejka
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic.,Faculty of Biomedical Engineering, Czech Technical University in Prague, Prague, Czech Republic
| | - Václav Čapek
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic
| | - Daniela Šťastná
- Department of Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | - Ivana Štětkářová
- Department of Neurology, Third Faculty of Medicine, Charles University and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Karsten Mueller
- Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Matthias L Schroeter
- Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.,Clinic for Cognitive Neurology, University Hospital, Leipzig, Germany
| | - Filip Růžička
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic
| | - Dušan Urgošík
- Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
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23
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Lehner KR, Yeagle EM, Argyelan M, Klimaj Z, Du V, Megevand P, Hwang ST, Mehta AD. Validation of corpus callosotomy after laser interstitial thermal therapy: a multimodal approach. J Neurosurg 2018; 131:1095-1105. [PMID: 30497188 DOI: 10.3171/2018.4.jns172588] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Accepted: 04/17/2018] [Indexed: 11/06/2022]
Abstract
Objective Disconnection of the cerebral hemispheres by corpus callosotomy (CC) is an established means to palliate refractory generalized epilepsy. Laser interstitial thermal therapy (LITT) is gaining acceptance as a minimally invasive approach to treating epilepsy, but this method has not been evaluated in clinical series using established methodologies to assess connectivity. The goal in this study was to demonstrate the safety and feasibility of MRI-guided LITT for CC and to assess disconnection by using electrophysiology- and imaging-based methods. Methods Retrospective chart and imaging review was performed in 5 patients undergoing LITT callosotomy at a single center. Diffusion tensor imaging and resting functional MRI were performed in all patients to assess anatomical and functional connectivity. In 3 patients undergoing simultaneous intracranial electroencephalography monitoring, corticocortical evoked potentials and resting electrocorticography were used to assess electrophysiological correlates. Results All patients had generalized or multifocal seizure onsets. Three patients with preoperative evidence for possible lateralization underwent stereoelectroencephalography depth electrode implantation during the perioperative period. LITT ablation of the anterior corpus callosum was completed in a single procedure in 4 patients. One complication involving misplaced devices required a second procedure. Adequacy of the anterior callosotomy was confirmed using contrast-enhanced MRI and diffusion tensor imaging. Resting functional MRI, corticocortical evoked potentials, and resting electrocorticography demonstrated functional disconnection of the hemispheres. Postcallosotomy monitoring revealed lateralization of the seizures in all 3 patients with preoperatively suspected occult lateralization. Four of 5 patients experienced > 80% reduction in generalized seizure frequency. Two patients undergoing subsequent focal resection are free of clinical seizures at 2 years. One patient developed a 9-mm intraparenchymal hematoma at the site of entry and continued to have seizures after the procedure. Conclusions MRI-guided LITT provides an effective minimally invasive alternative method for CC in the treatment of seizures associated with drop attacks, bilaterally synchronous onset, and rapid secondary generalization. The disconnection is confirmed using anatomical and functional neuroimaging and electrophysiological measures.
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Affiliation(s)
- Kurt R Lehner
- 1Department of Neurosurgery, Hofstra Northwell School of Medicine
| | - Erin M Yeagle
- 1Department of Neurosurgery, Hofstra Northwell School of Medicine
- 2The Feinstein Institute for Medical Research; and
| | | | | | - Victor Du
- 1Department of Neurosurgery, Hofstra Northwell School of Medicine
| | | | - Sean T Hwang
- 3Department of Neurology, North Shore University Hospital, Manhasset, New York
| | - Ashesh D Mehta
- 1Department of Neurosurgery, Hofstra Northwell School of Medicine
- 2The Feinstein Institute for Medical Research; and
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24
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Rusz J, Tykalová T, Fečíková A, Šťastná D, Urgošík D, Jech R. Dualistic effect of pallidal deep brain stimulation on motor speech disorders in dystonia. Brain Stimul 2018; 11:896-903. [DOI: 10.1016/j.brs.2018.03.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 01/24/2018] [Accepted: 03/09/2018] [Indexed: 10/17/2022] Open
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25
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Erhardt JB, Fuhrer E, Gruschke OG, Leupold J, Wapler MC, Hennig J, Stieglitz T, Korvink JG. Should patients with brain implants undergo MRI? J Neural Eng 2018. [DOI: 10.1088/1741-2552/aab4e4] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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26
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Bhusal B, Bhattacharyya P, Baig T, Jones S, Martens M. Measurements and simulation of RF heating of implanted stereo-electroencephalography electrodes during MR scans. Magn Reson Med 2018; 80:1676-1685. [DOI: 10.1002/mrm.27144] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 01/26/2018] [Accepted: 01/31/2018] [Indexed: 12/18/2022]
Affiliation(s)
- Bhumi Bhusal
- Department of Physics; Case Western Reserve University; Cleveland Ohio USA
| | - Pallab Bhattacharyya
- Imaging Institute, Cleveland Clinic; Cleveland Ohio USA
- Radiology, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University; Cleveland Ohio USA
| | - Tanvir Baig
- Department of Physics; Case Western Reserve University; Cleveland Ohio USA
| | - Stephen Jones
- Imaging Institute, Cleveland Clinic; Cleveland Ohio USA
- Epilepsy Center, Cleveland Clinic; Cleveland Ohio USA
| | - Michael Martens
- Department of Physics; Case Western Reserve University; Cleveland Ohio USA
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28
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Silemek B, Acikel V, Oto C, Alipour A, Aykut ZG, Algin O, Atalar E. A temperature sensor implant for active implantable medical devices for in vivo subacute heating tests under MRI. Magn Reson Med 2017; 79:2824-2832. [DOI: 10.1002/mrm.26914] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Revised: 08/17/2017] [Accepted: 08/17/2017] [Indexed: 11/09/2022]
Affiliation(s)
- Berk Silemek
- National Magnetic Resonance Research Center (UMRAM)Bilkent UniversityAnkara Turkey
| | - Volkan Acikel
- Aselsan, REHIS Power Amplifier TechnologiesAnkara Turkey
| | - Cagdas Oto
- Department of AnatomyAnkara UniversityAnkara Turkey
| | - Akbar Alipour
- National Magnetic Resonance Research Center (UMRAM)Bilkent UniversityAnkara Turkey
- Department of Electrical and Electronics EngineeringBilkent UniversityAnkara Turkey
| | - Zaliha Gamze Aykut
- Department of Molecular Biology and GeneticsBilkent UniversityAnkara Turkey
| | - Oktay Algin
- National Magnetic Resonance Research Center (UMRAM)Bilkent UniversityAnkara Turkey
- Department of RadiologyAtaturk Training and Research HospitalAnkara Turkey
| | - Ergin Atalar
- National Magnetic Resonance Research Center (UMRAM)Bilkent UniversityAnkara Turkey
- Department of Electrical and Electronics EngineeringBilkent UniversityAnkara Turkey
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29
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Edwards CA, Kouzani A, Lee KH, Ross EK. Neurostimulation Devices for the Treatment of Neurologic Disorders. Mayo Clin Proc 2017; 92:1427-1444. [PMID: 28870357 DOI: 10.1016/j.mayocp.2017.05.005] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 04/16/2017] [Accepted: 05/01/2017] [Indexed: 12/01/2022]
Abstract
Rapid advancements in neurostimulation technologies are providing relief to an unprecedented number of patients affected by debilitating neurologic and psychiatric disorders. Neurostimulation therapies include invasive and noninvasive approaches that involve the application of electrical stimulation to drive neural function within a circuit. This review focuses on established invasive electrical stimulation systems used clinically to induce therapeutic neuromodulation of dysfunctional neural circuitry. These implantable neurostimulation systems target specific deep subcortical, cortical, spinal, cranial, and peripheral nerve structures to modulate neuronal activity, providing therapeutic effects for a myriad of neuropsychiatric disorders. Recent advances in neurotechnologies and neuroimaging, along with an increased understanding of neurocircuitry, are factors contributing to the rapid rise in the use of neurostimulation therapies to treat an increasingly wide range of neurologic and psychiatric disorders. Electrical stimulation technologies are evolving after remaining fairly stagnant for the past 30 years, moving toward potential closed-loop therapeutic control systems with the ability to deliver stimulation with higher spatial resolution to provide continuous customized neuromodulation for optimal clinical outcomes. Even so, there is still much to be learned about disease pathogenesis of these neurodegenerative and psychiatric disorders and the latent mechanisms of neurostimulation that provide therapeutic relief. This review provides an overview of the increasingly common stimulation systems, their clinical indications, and enabling technologies.
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Affiliation(s)
- Christine A Edwards
- School of Engineering, Deakin University, Geelong, Victoria, Australia; Department of Neurologic Surgery, Mayo Clinic, Rochester, MN
| | - Abbas Kouzani
- School of Engineering, Deakin University, Geelong, Victoria, Australia
| | - Kendall H Lee
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN; Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN
| | - Erika K Ross
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN; Department of Surgery, Mayo Clinic, Rochester, MN.
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30
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Saenger VM, Kahan J, Foltynie T, Friston K, Aziz TZ, Green AL, van Hartevelt TJ, Cabral J, Stevner ABA, Fernandes HM, Mancini L, Thornton J, Yousry T, Limousin P, Zrinzo L, Hariz M, Marques P, Sousa N, Kringelbach ML, Deco G. Uncovering the underlying mechanisms and whole-brain dynamics of deep brain stimulation for Parkinson's disease. Sci Rep 2017; 7:9882. [PMID: 28851996 PMCID: PMC5574998 DOI: 10.1038/s41598-017-10003-y] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 06/28/2017] [Indexed: 12/01/2022] Open
Abstract
Deep brain stimulation (DBS) for Parkinson's disease is a highly effective treatment in controlling otherwise debilitating symptoms. Yet the underlying brain mechanisms are currently not well understood. Whole-brain computational modeling was used to disclose the effects of DBS during resting-state functional Magnetic Resonance Imaging in ten patients with Parkinson's disease. Specifically, we explored the local and global impact that DBS has in creating asynchronous, stable or critical oscillatory conditions using a supercritical bifurcation model. We found that DBS shifts global brain dynamics of patients towards a Healthy regime. This effect was more pronounced in very specific brain areas such as the thalamus, globus pallidus and orbitofrontal regions of the right hemisphere (with the left hemisphere not analyzed given artifacts arising from the electrode lead). Global aspects of integration and synchronization were also rebalanced. Empirically, we found higher communicability and coherence brain measures during DBS-ON compared to DBS-OFF. Finally, using our model as a framework, artificial in silico DBS was applied to find potential alternative target areas for stimulation and whole-brain rebalancing. These results offer important insights into the underlying large-scale effects of DBS as well as in finding novel stimulation targets, which may offer a route to more efficacious treatments.
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Affiliation(s)
- Victor M Saenger
- Center for Brain and Cognition, Computational Neuroscience Group, Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, 08018, Spain
| | - Joshua Kahan
- Sobell Department of Motor Neuroscience & Movement Disorders, UCL Institute of Neurology, London, WC1N 3BG, United Kingdom
| | - Tom Foltynie
- Sobell Department of Motor Neuroscience & Movement Disorders, UCL Institute of Neurology, London, WC1N 3BG, United Kingdom
| | - Karl Friston
- Wellcome Trust Centre for Neuroimaging, Institute of Neurology, University College London, London, WC1N 3BG, United Kingdom
| | - Tipu Z Aziz
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, United Kingdom
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, OX3 9DU, United Kingdom
| | - Alexander L Green
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, United Kingdom
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, OX3 9DU, United Kingdom
| | - Tim J van Hartevelt
- Department of Psychiatry, University of Oxford, Oxford, OX3 7JX, United Kingdom
- Center for Music in the Brain, Aarhus University, Aarhus, 8000, Aarhus C, Denmark
| | - Joana Cabral
- Department of Psychiatry, University of Oxford, Oxford, OX3 7JX, United Kingdom
- Center for Music in the Brain, Aarhus University, Aarhus, 8000, Aarhus C, Denmark
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, 4710-057, Braga, Portugal
| | - Angus B A Stevner
- Department of Psychiatry, University of Oxford, Oxford, OX3 7JX, United Kingdom
- Center for Music in the Brain, Aarhus University, Aarhus, 8000, Aarhus C, Denmark
| | - Henrique M Fernandes
- Department of Psychiatry, University of Oxford, Oxford, OX3 7JX, United Kingdom
- Center for Music in the Brain, Aarhus University, Aarhus, 8000, Aarhus C, Denmark
| | - Laura Mancini
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, UCLH NHS Foundation Trust, London, WC1N 3BG, United Kingdom
| | - John Thornton
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, UCLH NHS Foundation Trust, London, WC1N 3BG, United Kingdom
| | - Tarek Yousry
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, UCLH NHS Foundation Trust, London, WC1N 3BG, United Kingdom
| | - Patricia Limousin
- Sobell Department of Motor Neuroscience & Movement Disorders, UCL Institute of Neurology, London, WC1N 3BG, United Kingdom
| | - Ludvic Zrinzo
- Sobell Department of Motor Neuroscience & Movement Disorders, UCL Institute of Neurology, London, WC1N 3BG, United Kingdom
| | - Marwan Hariz
- Sobell Department of Motor Neuroscience & Movement Disorders, UCL Institute of Neurology, London, WC1N 3BG, United Kingdom
| | - Paulo Marques
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, 4710-057, Braga, Portugal
- ICVS/3B's - PT Government Associate Laboratory, 4710-057, Braga, Portugal
- Clinical Academic Center, 4710-057, Braga, Portugal
| | - Nuno Sousa
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, 4710-057, Braga, Portugal
- ICVS/3B's - PT Government Associate Laboratory, 4710-057, Braga, Portugal
- Clinical Academic Center, 4710-057, Braga, Portugal
| | - Morten L Kringelbach
- Department of Psychiatry, University of Oxford, Oxford, OX3 7JX, United Kingdom.
- Center for Music in the Brain, Aarhus University, Aarhus, 8000, Aarhus C, Denmark.
| | - Gustavo Deco
- Center for Brain and Cognition, Computational Neuroscience Group, Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, 08018, Spain
- Instituci Catalana de la Recerca i Estudis Avanats (ICREA), Universitat Pompeu Fabra, Barcelona, 08010, Spain
- Department of Neuropsychology, Max Planck Institute for Human Cognitive and Brain Sciences, 04103, Leipzig, Germany
- School of Psychological Sciences, Monash University, Clayton VIC, 3800, Melbourne, Australia
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MB-SWIFT functional MRI during deep brain stimulation in rats. Neuroimage 2017; 159:443-448. [PMID: 28797739 DOI: 10.1016/j.neuroimage.2017.08.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 07/05/2017] [Accepted: 08/03/2017] [Indexed: 12/24/2022] Open
Abstract
Recently introduced 3D radial MRI pulse sequence entitled Multi-Band SWeep Imaging with Fourier Transformation (MB-SWIFT) having virtually zero acquisition delay was used to obtain functional MRI (fMRI) contrast in rat's brain at 9.4 T during deep brain stimulation (DBS). The results demonstrate that MB-SWIFT allows functional images free of susceptibility artifacts, and provides an excellent fMRI activation contrast in the brain. Flip angle dependence of the MB-SWIFT fMRI signal and elimination of the fMRI contrast while using saturation bands, indicate a blood flow origin of the observed fMRI contrast. MB-SWIFT fMRI modality permits activation studies in the close proximity to an implanted lead, which is not possible to achieve with conventionally used gradient echo and spin echo - echo planar imaging fMRI techniques. We conclude that MB-SWIFT fMRI is a powerful imaging modality for investigations of functional responses during DBS.
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Thornton JS. Technical challenges and safety of magnetic resonance imaging with in situ neuromodulation from spine to brain. Eur J Paediatr Neurol 2017; 21:232-241. [PMID: 27430172 DOI: 10.1016/j.ejpn.2016.06.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 06/13/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE This review summarises the need for MRI with in situ neuromodulation, the key safety challenges and how they may be mitigated, and surveys the current status of MRI safety for the main categories of neuro-stimulation device, including deep brain stimulation, vagus nerve stimulation, sacral neuromodulation, spinal cord stimulation systems, and cochlear implants. REVIEW SUMMARY When neuro-stimulator systems are introduced into the MRI environment a number of hazards arise with potential for patient harm, in particular the risk of thermal injury due to MRI-induced heating. For many devices however, safe MRI conditions can be determined, and MRI safely performed, albeit with possible compromise in anatomical coverage, image quality or extended acquisition time. CONCLUSIONS The increasing availability of devices conditional for 3 T MRI, whole-body transmit imaging, and imaging in the on-stimulation condition, will be of significant benefit to the growing population of patients benefitting from neuromodulation therapy, and open up new opportunities for functional imaging research.
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Affiliation(s)
- John S Thornton
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, UCLH NHS Foundation Trust, Queen Square, London, UK; Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, University College London, London, UK.
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Yeoh TY, Manninen P, Kalia SK, Venkatraghavan L. Anesthesia considerations for patients with an implanted deep brain stimulator undergoing surgery: a review and update. Can J Anaesth 2016; 64:308-319. [DOI: 10.1007/s12630-016-0794-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 10/06/2016] [Accepted: 12/08/2016] [Indexed: 11/25/2022] Open
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Sammartino F, Krishna V, Sankar T, Fisico J, Kalia SK, Hodaie M, Kucharczyk W, Mikulis DJ, Crawley A, Lozano AM. 3-Tesla MRI in patients with fully implanted deep brain stimulation devices: a preliminary study in 10 patients. J Neurosurg 2016; 127:892-898. [PMID: 28009238 DOI: 10.3171/2016.9.jns16908] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the safety of 3-T MRI in patients with implanted deep brain stimulation (DBS) systems. METHODS This study was performed in 2 phases. In an initial phantom study, a Lucite phantom filled with tissue-mimicking gel was assembled. The system was equipped with a single DBS electrode connected to an internal pulse generator. The tip of the electrode was coupled to a fiber optic thermometer with a temperature resolution of 0.1°C. Both anatomical (T1- and T2-weighted) and functional MRI sequences were tested. A temperature change within 2°C from baseline was considered safe. After findings from the phantom study suggested safety, 10 patients with implanted DBS systems targeting various brain areas provided informed consent and underwent 3-T MRI using the same imaging sequences. Detailed neurological evaluations and internal pulse generator interrogations were performed before and after imaging. RESULTS During phantom testing, the maximum temperature increase was registered using the T2-weighted sequence. The maximal temperature changes at the tip of the DBS electrode were < 1°C for all sequences tested. In all patients, adequate images were obtained with structural imaging, although a significant artifact from lead connectors interfered with functional imaging quality. No heating, warmth, or adverse neurological effects were observed. CONCLUSIONS To the authors' knowledge, this was the first study to assess the clinical safety of 3-T MRI in patients with a fully implanted DBS system (electrodes, extensions, and pulse generator). It provided preliminary data that will allow further examination and assessment of the safety of 3-T imaging studies in patients with implanted DBS systems. The authors cannot advocate widespread use of this type of imaging in patients with DBS implants until more safety data are obtained.
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Affiliation(s)
| | | | - Tejas Sankar
- Division of Neurosurgery, University of Alberta, Edmonton, Alberta, Canada
| | - Jason Fisico
- Department of Medical Imaging, University of Toronto, Ontario; and
| | | | - Mojgan Hodaie
- Division of Neurosurgery, Department of Surgery, and
| | | | - David J Mikulis
- Department of Medical Imaging, University of Toronto, Ontario; and
| | - Adrian Crawley
- Department of Medical Imaging, University of Toronto, Ontario; and
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Geevarghese R, O''Gorman Tuura R, Lumsden DE, Samuel M, Ashkan K. Registration Accuracy of CT/MRI Fusion for Localisation of Deep Brain Stimulation Electrode Position: An Imaging Study and Systematic Review. Stereotact Funct Neurosurg 2016; 94:159-63. [DOI: 10.1159/000446609] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 05/04/2016] [Indexed: 11/19/2022]
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Rowland NC, Sammartino F, Lozano AM. Advances in surgery for movement disorders. Mov Disord 2016; 32:5-10. [PMID: 27125681 DOI: 10.1002/mds.26636] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Revised: 03/03/2016] [Accepted: 03/06/2016] [Indexed: 12/27/2022] Open
Abstract
Movement disorder surgery has evolved throughout history as our knowledge of motor circuits and ways in which to manipulate them have expanded. Today, the positive impact on patient quality of life for a growing number of movement disorders such as Parkinson's disease is now well accepted and confirmed through several decades of randomized, controlled trials. Nevertheless, residual motor symptoms after movement disorder surgery such as deep brain stimulation and lack of a definitive cure for these conditions demand that advances continue to push the boundaries of the field and maximize its therapeutic potential. Similarly, advances in related fields - wireless technology, artificial intelligence, stem cell and gene therapy, neuroimaging, nanoscience, and minimally invasive surgery - mean that movement disorder surgery stands at a crossroads to benefit from unique combinations of all these developments. In this minireview, we outline some of these developments as well as evidence supporting topics of recent discussion and controversy in our field. Moving forward, expectations remain high that these improvements will come to encompass an even broader range of patients who might benefit from this therapy and decrease the burden of disease associated with these conditions. © 2016 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Nathan C Rowland
- Toronto Western Hospital, Division of Neurosurgery, Toronto, Ontario, Canada
| | | | - Andres M Lozano
- Toronto Western Hospital, Division of Neurosurgery, Toronto, Ontario, Canada
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