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Liu X, Chou KL, Patil PG, Malaga KA. Effect of Anisotropic Brain Conductivity on Patient-Specific Volume of Tissue Activation in Deep Brain Stimulation for Parkinson Disease. IEEE Trans Biomed Eng 2024; 71:1993-2000. [PMID: 38277250 DOI: 10.1109/tbme.2024.3359119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2024]
Abstract
OBJECTIVE Deep brain stimulation (DBS) modeling can improve surgical targeting by quantifying the spatial extent of stimulation relative to subcortical structures of interest. A certain degree of model complexity is required to obtain accurate predictions, particularly complexity regarding electrical properties of the tissue around DBS electrodes. In this study, the effect of anisotropy on the volume of tissue activation (VTA) was evaluated in an individualized manner. METHODS Tissue activation models incorporating patient-specific tissue conductivity were built for 40 Parkinson disease patients who had received bilateral subthalamic nucleus (STN) DBS. To assess the impact of local changes in tissue anisotropy, one VTA was computed at each electrode contact using identical stimulation parameters. For comparison, VTAs were also computed assuming isotropic tissue conductivity. Stimulation location was considered by classifying the anisotropic VTAs relative to the STN. VTAs were characterized based on volume, spread in three directions, sphericity, and Dice coefficient. RESULTS Incorporating anisotropy generated significantly larger and less spherical VTAs overall. However, its effect on VTA size and shape was variable and more nuanced at the individual patient and implantation levels. Dorsal VTAs had significantly higher sphericity than ventral VTAs, suggesting more isotropic behavior. Contrastingly, lateral and posterior VTAs had significantly larger and smaller lateral-medial spreads, respectively. Volume and spread correlated negatively with sphericity. CONCLUSION The influence of anisotropy on VTA predictions is important to consider, and varies across patients and stimulation location. SIGNIFICANCE This study highlights the importance of considering individualized factors in DBS modeling to accurately characterize the VTA.
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Ng PR, Bush A, Vissani M, McIntyre CC, Richardson RM. Biophysical Principles and Computational Modeling of Deep Brain Stimulation. Neuromodulation 2024; 27:422-439. [PMID: 37204360 DOI: 10.1016/j.neurom.2023.04.471] [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: 09/28/2022] [Revised: 04/02/2023] [Accepted: 04/24/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Deep brain stimulation (DBS) has revolutionized the treatment of neurological disorders, yet the mechanisms of DBS are still under investigation. Computational models are important in silico tools for elucidating these underlying principles and potentially for personalizing DBS therapy to individual patients. The basic principles underlying neurostimulation computational models, however, are not well known in the clinical neuromodulation community. OBJECTIVE In this study, we present a tutorial on the derivation of computational models of DBS and outline the biophysical contributions of electrodes, stimulation parameters, and tissue substrates to the effects of DBS. RESULTS Given that many aspects of DBS are difficult to characterize experimentally, computational models have played an important role in understanding how material, size, shape, and contact segmentation influence device biocompatibility, energy efficiency, the spatial spread of the electric field, and the specificity of neural activation. Neural activation is dictated by stimulation parameters including frequency, current vs voltage control, amplitude, pulse width, polarity configurations, and waveform. These parameters also affect the potential for tissue damage, energy efficiency, the spatial spread of the electric field, and the specificity of neural activation. Activation of the neural substrate also is influenced by the encapsulation layer surrounding the electrode, the conductivity of the surrounding tissue, and the size and orientation of white matter fibers. These properties modulate the effects of the electric field and determine the ultimate therapeutic response. CONCLUSION This article describes biophysical principles that are useful for understanding the mechanisms of neurostimulation.
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Affiliation(s)
| | - Alan Bush
- Harvard Medical School, Boston, MA, USA; Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA
| | - Matteo Vissani
- Harvard Medical School, Boston, MA, USA; Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA
| | - Cameron C McIntyre
- Department of Biomedical Engineering, Duke University, Durham, NC, USA; Department of Neurosurgery, Duke University, Durham, NC, USA
| | - Robert Mark Richardson
- Harvard Medical School, Boston, MA, USA; Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA
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Somma T, Fellico F, De Rosa A, Bocchino A, Corvino S, Milone A, Cappabianca P, Esposito F. Impact of deep brain stimulation therapy on the vertebral sagittal balance in Parkinson's disease patients. Neurosurg Rev 2023; 47:7. [PMID: 38063935 DOI: 10.1007/s10143-023-02243-6] [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: 08/08/2023] [Revised: 11/20/2023] [Accepted: 12/04/2023] [Indexed: 12/18/2023]
Abstract
Parkinson's disease (PD) is characterized by cardinal motor signs: 4-6 Hz resting tremor, rigidity, and bradykinesia. In addition, 3-18% of PD patients have camptocormia, an abnormal forward flexion of the thoracolumbar spine, which may have a negative impact on patients' quality of life. Different possible treatments have been suggested for such a condition, but no one is resolutive. This study aims to define the possible impact of DBS, with selective targeting on the dorsal-lateral region of the STN, on the sagittal balance of patients affected by PD. Among all patients that have undergone DBS procedures in our institution, we selected eight subjects, four females and four males, with selective targeting on the dorsal-lateral region of the subthalamic nucleus (STN) because of camptocormia and other severe postural changes. Radiological assessments of spinal balance parameters before surgery and at 6 and 12 months postoperatively were carried out. Comparison of preoperative and postoperative spine X-ray data showed a statistically significant improvement in dorsal kyphosis angle (D-Cobb) 12 months after the operation. Deep brain stimulation with selective targeting of the dorsal lateral part of the STN may induce changes of the posture in patients with Parkinson's disease 12 months after the operation, which appears to improve in this small sample size, but larger observational and controlled trials would be required to confirm this observation.
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Affiliation(s)
- Teresa Somma
- Department of Neuroscience and Reproductive and Dental Sciences, Division of Neurosurgery, Università Degli Studi Di Napoli Federico II, Naples, Italy
| | - Fabrizio Fellico
- Department of Neuroscience and Reproductive and Dental Sciences, Division of Neurosurgery, Università Degli Studi Di Napoli Federico II, Naples, Italy
| | - Andrea De Rosa
- Department of Neuroscience and Reproductive and Dental Sciences, Division of Neurosurgery, Università Degli Studi Di Napoli Federico II, Naples, Italy
| | - Andrea Bocchino
- Department of Neuroscience and Reproductive and Dental Sciences, Division of Neurosurgery, Università Degli Studi Di Napoli Federico II, Naples, Italy
| | - Sergio Corvino
- Department of Neuroscience and Reproductive and Dental Sciences, Division of Neurosurgery, Università Degli Studi Di Napoli Federico II, Naples, Italy
| | - Antonio Milone
- Department of Neuroscience and Reproductive and Dental Sciences, Division of Neurosurgery, Università Degli Studi Di Napoli Federico II, Naples, Italy
| | - Paolo Cappabianca
- Department of Neuroscience and Reproductive and Dental Sciences, Division of Neurosurgery, Università Degli Studi Di Napoli Federico II, Naples, Italy
| | - Felice Esposito
- Department of Neuroscience and Reproductive and Dental Sciences, Division of Neurosurgery, Università Degli Studi Di Napoli Federico II, Naples, Italy.
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Somma T, Esposito F, Scala MR, Scelzo A, Baiano C, Patti S, Meglio V, Iasevoli F, Cavallo LM, Solari D, De Bartolomeis A, Cappabianca P, D’Urso G. Psychiatric Symptoms in Parkinson's Disease Patients before and One Year after Subthalamic Nucleus Deep Brain Stimulation Therapy: Role of Lead Positioning and Not of Total Electrical Energy Delivered. J Pers Med 2022; 12:jpm12101643. [PMID: 36294782 PMCID: PMC9605574 DOI: 10.3390/jpm12101643] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 09/27/2022] [Accepted: 09/30/2022] [Indexed: 11/07/2022] Open
Abstract
Parkinson’s disease (PD) patients may experience neuropsychiatric symptoms, including depression, anxiety, sleep disturbances, psychosis, as well as behavioral and cognitive symptoms during all the different stages of the illness. Deep Brain Stimulation (DBS) therapy has proven to be successful in controlling the motor symptoms of PD and its possible correlation with the occurrence or worsening of neuropsychiatric symptoms has been reported. We aimed to assess the neuropsychiatric symptoms of 14 PD patients before and after one year of Subthalamic Nucleus (STN)-DBS and to correlate the possible changes to the lead placement and to the total electrical energy delivered. We assessed PD motor symptoms, depression, anxiety, apathy, impulsivity, and suicidality using clinician- and/or self-administered rating scales and correlated the results to the lead position using the Medtronic SuretuneTM software and to the total electrical energy delivered (TEED). At the 12-month follow-up, the patients showed a significant improvement in PD symptoms on the UPDRS (Unified Parkinson’s disease Rating Scale) (−38.5%; p < 0.001) and in anxiety on the Hamilton Anxiety Rating Scale (HAM-A) (−29%; p = 0.041), with the most significant reduction in the physiological anxiety subscore (−36.26%; p < 0.001). A mild worsening of impulsivity was detected on the Barratt Impulsiveness Scale (BIS-11) (+9%; p = 0.048), with the greatest increase in the attentional impulsiveness subscore (+13.60%; p = 0.050). No statistically significant differences were found for the other scales. No correlation was found between TEED and scales’ scores, while the positioning of the stimulating electrodes in the different portions of the STN was shown to considerably influence the outcome, with more anterior and/or medial lead position negatively influencing psychiatric symptoms.
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Affiliation(s)
- Teresa Somma
- Department of NeuroSciences and Reproductive and Dental Sciences, Division of NeuroSurgery, Università degli Studi di Napoli Federico II, 80131 Naples, Italy
| | - Felice Esposito
- Department of NeuroSciences and Reproductive and Dental Sciences, Division of NeuroSurgery, Università degli Studi di Napoli Federico II, 80131 Naples, Italy
- Department of NeuroSciences and Reproductive and Odontostomatological Sciences, Division of NeuroSurgery, Federico II University of Naples, 80131 Naples, Italy
- Neurosurgery Unit, Federico II Medical Center, 80131 Naples, Italy
- Correspondence: ; Tel.: +39-081-746 (ext. 2489)
| | - Maria Rosaria Scala
- Department of NeuroSciences and Reproductive and Dental Sciences, Division of NeuroSurgery, Università degli Studi di Napoli Federico II, 80131 Naples, Italy
| | - Antonio Scelzo
- Department of NeuroSciences and Reproductive and Dental Sciences, Division of Psychiatry, Università degli Studi di Napoli Federico II, 80131 Naples, Italy
| | - Cinzia Baiano
- Department of NeuroSciences and Reproductive and Dental Sciences, Division of NeuroSurgery, Università degli Studi di Napoli Federico II, 80131 Naples, Italy
| | - Sara Patti
- Department of NeuroSciences and Reproductive and Dental Sciences, Division of Psychiatry, Università degli Studi di Napoli Federico II, 80131 Naples, Italy
| | - Vincenzo Meglio
- Department of NeuroSciences and Reproductive and Dental Sciences, Division of NeuroSurgery, Università degli Studi di Napoli Federico II, 80131 Naples, Italy
| | - Felice Iasevoli
- Department of NeuroSciences and Reproductive and Dental Sciences, Division of Psychiatry, Università degli Studi di Napoli Federico II, 80131 Naples, Italy
| | - Luigi M. Cavallo
- Department of NeuroSciences and Reproductive and Dental Sciences, Division of NeuroSurgery, Università degli Studi di Napoli Federico II, 80131 Naples, Italy
| | - Domenico Solari
- Department of NeuroSciences and Reproductive and Dental Sciences, Division of NeuroSurgery, Università degli Studi di Napoli Federico II, 80131 Naples, Italy
| | - Andrea De Bartolomeis
- Department of NeuroSciences and Reproductive and Dental Sciences, Division of Psychiatry, Università degli Studi di Napoli Federico II, 80131 Naples, Italy
| | - Paolo Cappabianca
- Department of NeuroSciences and Reproductive and Dental Sciences, Division of NeuroSurgery, Università degli Studi di Napoli Federico II, 80131 Naples, Italy
| | - Giordano D’Urso
- Department of NeuroSciences and Reproductive and Dental Sciences, Division of Psychiatry, Università degli Studi di Napoli Federico II, 80131 Naples, Italy
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Avecillas-Chasin JM, Hurwitz TA, Bogod NM, Honey CR. Tractography-Guided Anterior Capsulotomy for Major Depression and Obsessive-Compulsive Disorder: Targeting the Emotion Network. Oper Neurosurg (Hagerstown) 2021; 20:406-412. [PMID: 33475697 DOI: 10.1093/ons/opaa420] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 10/07/2020] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Bilateral anterior capsulotomy (BAC) is an effective surgical option for patients with treatment-resistant major depression (TRMD) and treatment-resistant obsessive-compulsive disorder (TROCD). The size of the lesion and its precise dorsal-ventral location within the anterior limb of the internal capsule (ALIC) remain undefined. OBJECTIVE To present a method to identify the trajectories of the associative and limbic white matter pathways within the ALIC for targeting in BAC surgery. METHODS Using high-definition tractography, we prospectively tested the feasibility of this method in 2 patients with TRMD and TROCD to tailor the capsulotomy lesion to their limbic pathway. RESULTS The trajectories of the associative and limbic pathways were identified in the ALIC of both patients and we targeted the limbic pathways by defining the dorsal limit of the lesion in a way to minimize the damage to the associative pathways. The final lesions were smaller than those that have been previously published. This individualized procedure was associated with long-term benefit in both patients. CONCLUSION Tractography-guided capsulotomy is feasible and was associated with long-term benefit in patients with TRMD and TROCD.
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Affiliation(s)
| | - Trevor A Hurwitz
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nicholas M Bogod
- Neurosciences Program, Vancouver General Hospital, Division of Neurology, UBC Department of Medicine, Vancouver, British Columbia, Canada
| | - Christopher R Honey
- Department of Surgery, Division of Neurosurgery, University of British Columbia, Vancouver, British Columbia, Canada
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Pathak YJ, Greenleaf W, Verhagen Metman L, Kubben P, Sarma S, Pepin B, Lautner D, DeBates S, Benison AM, Balasingh B, Ross E. Digital Health Integration With Neuromodulation Therapies: The Future of Patient-Centric Innovation in Neuromodulation. Front Digit Health 2021; 3:618959. [PMID: 34713096 PMCID: PMC8521905 DOI: 10.3389/fdgth.2021.618959] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 04/12/2021] [Indexed: 01/30/2023] Open
Abstract
Digital health can drive patient-centric innovation in neuromodulation by leveraging current tools to identify response predictors and digital biomarkers. Iterative technological evolution has led us to an ideal point to integrate digital health with neuromodulation. Here, we provide an overview of the digital health building-blocks, the status of advanced neuromodulation technologies, and future applications for neuromodulation with digital health integration.
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Affiliation(s)
| | - Walter Greenleaf
- Department of Communication, Stanford University, Stanford, CA, United States
| | - Leo Verhagen Metman
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, United States
| | - Pieter Kubben
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, Netherlands
| | - Sridevi Sarma
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, United States
| | | | | | | | | | | | - Erika Ross
- Abbott Neuromodulation, Plano, TX, United States
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Luo M, Narasimhan S, Larson PS, Martin AJ, Konrad PE, Miga MI. Impact of brain shift on neural pathways in deep brain stimulation: a preliminary analysis via multi-physics finite element models. J Neural Eng 2021; 18. [PMID: 33740780 DOI: 10.1088/1741-2552/abf066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 03/19/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The effectiveness of deep brain stimulation (DBS) depends on electrode placement accuracy, which can be compromised by brain shift during surgery. While there have been efforts in assessing the impact of electrode misplacement due to brain shift using preop- and postop- imaging data, such analysis using preop- and intraop- imaging data via biophysical modeling has not been conducted. This work presents a preliminary study that applies a multi-physics analysis framework using finite element biomechanical and bioelectric models to examine the impact of realistic intraoperative shift on neural pathways determined by tractography. APPROACH The study examined six patients who had undergone interventional magnetic resonance (iMR)-guided DBS surgery. The modeling framework utilized a biomechanical approach to update preoperative MR to reflect shift-induced anatomical changes. Using this anatomically deformed image and its undeformed counterpart, bioelectric effects from shifting electrode leads could be simulated and neural activation differences were approximated. Specifically, for each configuration, volume of tissue activation (VTA) was computed and subsequently used for tractography estimation. Total tract volume and overlapping volume with motor regions as well as connectivity profile were compared. In addition, volumetric overlap between different fiber bundles among configurations was computed and correlated to estimated shift. MAIN RESULT The study found deformation-induced differences in tract volume, motor region overlap, and connectivity behavior, suggesting the impact of shift. There is a strong correlation (R=-0.83) between shift from intended target and intended neural pathway recruitment, where at threshold of ~2.94 mm, intended recruitment completely degrades. The determined threshold is consistent with and provides quantitative support to prior observations and literature that deviations of 2-3 mm are detrimental. SIGNIFICANCE The findings support and advance prior studies and understanding to illustrate the need to account for shift in DBS and the potentiality of computational modeling for estimating influence of shift on neural activation.
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Affiliation(s)
- Ma Luo
- Biomedical Engineering, Vanderbilt University, 5824 Stevenson Center, Nashville, Tennessee, 37232, UNITED STATES
| | - Saramati Narasimhan
- Department of Neurological Surgery, Vanderbilt University Medical Center, Village at Vanderbilt, 1500 21st Ave. South, Nashville, Tennessee, 37212, UNITED STATES
| | - Paul S Larson
- Department of Neurological Surgery, University of California San Francisco, Box 0112, 505 Parnassus Ave, Room M779, San Francisco, California, 94143, UNITED STATES
| | - Alastiar J Martin
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Avenue, San Francisco, California, 94143, UNITED STATES
| | - Peter E Konrad
- Department of Neurosurgery, West Virginia University, PO Box 9183, Morgantown, West Virginia, 26506, UNITED STATES
| | - Michael I Miga
- Department of Biomedical Engineering, Vanderbilt University, 5901 Stevenson Center, Nashville, Tennessee, 37235, UNITED STATES
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Automated detection of subthalamic nucleus in deep brain stimulation surgery for Parkinson’s disease using microelectrode recordings and wavelet packet features. J Neurosci Methods 2020; 343:108826. [DOI: 10.1016/j.jneumeth.2020.108826] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 06/22/2020] [Indexed: 01/02/2023]
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9
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Bertino S, Basile GA, Bramanti A, Anastasi GP, Quartarone A, Milardi D, Cacciola A. Spatially coherent and topographically organized pathways of the human globus pallidus. Hum Brain Mapp 2020; 41:4641-4661. [PMID: 32757349 PMCID: PMC7555102 DOI: 10.1002/hbm.25147] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 06/29/2020] [Accepted: 07/12/2020] [Indexed: 12/18/2022] Open
Abstract
Internal and external segments of globus pallidus (GP) exert different functions in basal ganglia circuitry, despite their main connectional systems share the same topographical organization, delineating limbic, associative, and sensorimotor territories. The identification of internal GP sensorimotor territory has therapeutic implications in functional neurosurgery settings. This study is aimed at assessing the spatial coherence of striatopallidal, subthalamopallidal, and pallidothalamic pathways by using tractography‐derived connectivity‐based parcellation (CBP) on high quality diffusion MRI data of 100 unrelated healthy subjects from the Human Connectome Project. A two‐stage hypothesis‐driven CBP approach has been carried out on the internal and external GP. Dice coefficient between functionally homologous pairs of pallidal maps has been computed. In addition, reproducibility of parcellation according to different pathways of interest has been investigated, as well as spatial relations between connectivity maps and existing optimal stimulation points for dystonic patients. The spatial organization of connectivity clusters revealed anterior limbic, intermediate associative and posterior sensorimotor maps within both internal and external GP. Dice coefficients showed high degree of coherence between functionally similar maps derived from the different bundles of interest. Sensorimotor maps derived from the subthalamopallidal pathway resulted to be the nearest to known optimal pallidal stimulation sites for dystonic patients. Our findings suggest that functionally homologous afferent and efferent connections may share similar spatial territory within the GP and that subcortical pallidal connectional systems may have distinct implications in the treatment of movement disorders.
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Affiliation(s)
- Salvatore Bertino
- Brain Mapping Lab, Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Gianpaolo Antonio Basile
- Brain Mapping Lab, Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
| | | | - Giuseppe Pio Anastasi
- Brain Mapping Lab, Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Angelo Quartarone
- Brain Mapping Lab, Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Demetrio Milardi
- Brain Mapping Lab, Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, Messina, Italy.,IRCCS Centro Neurolesi "Bonino Pulejo", Messina, Italy
| | - Alberto Cacciola
- Brain Mapping Lab, Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
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Avecillas-Chasin J, Hurwitz T, Bogod N, Honey C. An Analysis of Clinical Outcome and Tractography following Bilateral Anterior Capsulotomy for Depression. Stereotact Funct Neurosurg 2019; 97:369-380. [DOI: 10.1159/000505077] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 11/22/2019] [Indexed: 11/19/2022]
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11
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Dembek TA, Roediger J, Horn A, Reker P, Oehrn C, Dafsari HS, Li N, Kühn AA, Fink GR, Visser‐Vandewalle V, Barbe MT, Timmermann L. Probabilistic sweet spots predict motor outcome for deep brain stimulation in Parkinson disease. Ann Neurol 2019; 86:527-538. [DOI: 10.1002/ana.25567] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 07/07/2019] [Accepted: 07/28/2019] [Indexed: 01/02/2023]
Affiliation(s)
- Till A. Dembek
- Department of Neurology, Faculty of MedicineUniversity of Cologne Cologne Germany
- Department of Stereotactic and Functional Neurosurgery, Faculty of MedicineUniversity of Cologne Cologne Germany
| | - Jan Roediger
- Department of Neurology, Faculty of MedicineUniversity of Cologne Cologne Germany
| | - Andreas Horn
- Movement Disorders and Neuromodulation Unit, Department for NeurologyCharité–University Medicine Berlin Berlin Germany
| | - Paul Reker
- Department of Neurology, Faculty of MedicineUniversity of Cologne Cologne Germany
| | - Carina Oehrn
- Cognitive Neuroscience, Institute of Neuroscience and MedicineJülich Research Center Jülich Germany
| | - Haidar S. Dafsari
- Department of Neurology, Faculty of MedicineUniversity of Cologne Cologne Germany
| | - Ningfei Li
- Movement Disorders and Neuromodulation Unit, Department for NeurologyCharité–University Medicine Berlin Berlin Germany
| | - Andrea A. Kühn
- Movement Disorders and Neuromodulation Unit, Department for NeurologyCharité–University Medicine Berlin Berlin Germany
| | - Gereon R. Fink
- Department of Neurology, Faculty of MedicineUniversity of Cologne Cologne Germany
- Cognitive Neuroscience, Institute of Neuroscience and MedicineJülich Research Center Jülich Germany
| | - Veerle Visser‐Vandewalle
- Department of Stereotactic and Functional Neurosurgery, Faculty of MedicineUniversity of Cologne Cologne Germany
| | - Michael T. Barbe
- Department of Neurology, Faculty of MedicineUniversity of Cologne Cologne Germany
| | - Lars Timmermann
- Department of NeurologyUniversity Hospital of Marburg and Gießen Marburg Germany
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12
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Brusko GD, Wang MY. Towards the Connectome - Inching Closer Along the Frontiers of Neuroscience. Neurosurgery 2019; 85:E180-E181. [PMID: 30892633 DOI: 10.1093/neuros/nyz032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- G Damian Brusko
- Department of Neurological Surgery University of Miami Miller School of Medicine Miami, Florida
| | - Michael Y Wang
- Department of Neurological Surgery University of Miami Miller School of Medicine Miami, Florida
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13
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Zangiabadi N, Ladino LD, Sina F, Orozco-Hernández JP, Carter A, Téllez-Zenteno JF. Deep Brain Stimulation and Drug-Resistant Epilepsy: A Review of the Literature. Front Neurol 2019; 10:601. [PMID: 31244761 PMCID: PMC6563690 DOI: 10.3389/fneur.2019.00601] [Citation(s) in RCA: 97] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Accepted: 05/21/2019] [Indexed: 01/08/2023] Open
Abstract
Introduction: Deep brain stimulation is a safe and effective neurointerventional technique for the treatment of movement disorders. Electrical stimulation of subcortical structures may exert a control on seizure generators initiating epileptic activities. The aim of this review is to present the targets of the deep brain stimulation for the treatment of drug-resistant epilepsy. Methods: We performed a structured review of the literature from 1980 to 2018 using Medline and PubMed. Articles assessing the impact of deep brain stimulation on seizure frequency in patients with DRE were selected. Meta-analyses, randomized controlled trials, and observational studies were included. Results: To date, deep brain stimulation of various neural targets has been investigated in animal experiments and humans. This article presents the use of stimulation of the anterior and centromedian nucleus of the thalamus, hippocampus, basal ganglia, cerebellum and hypothalamus. Anterior thalamic stimulation has demonstrated efficacy and there is evidence to recommend it as the target of choice. Conclusion: Deep brain stimulation for seizures may be an option in patients with drug-resistant epilepsy. Anterior thalamic nucleus stimulation could be recommended over other targets.
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Affiliation(s)
- Nasser Zangiabadi
- Shefa Neuroscience Research Center, Khatam Alanbia Hospital, Tehran, Iran
- Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
| | - Lady Diana Ladino
- Epilepsy Program, Hospital Pablo Tobón Uribe, Neuroclinica, University of Antioquia, Medellín, Colombia
| | - Farzad Sina
- Department of Neurology, Rasool Akram Hospital, IUMS, Tehran, Iran
| | - Juan Pablo Orozco-Hernández
- Departamento de Investigación Clínica, Facultad de Ciencias de la Salud, Universidad Tecnológica de Pereira-Clínica Comfamiliar, Pereira, Colombia
| | - Alexandra Carter
- Saskatchewan Epilepsy Program, Department of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
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14
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The role that choice of model plays in predictions for epilepsy surgery. Sci Rep 2019; 9:7351. [PMID: 31089190 PMCID: PMC6517411 DOI: 10.1038/s41598-019-43871-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 05/02/2019] [Indexed: 12/26/2022] Open
Abstract
Mathematical modelling has been widely used to predict the effects of perturbations to brain networks. An important example is epilepsy surgery, where the perturbation in question is the removal of brain tissue in order to render the patient free of seizures. Different dynamical models have been proposed to represent transitions to ictal states in this context. However, our choice of which mathematical model to use to address this question relies on making assumptions regarding the mechanism that defines the transition from background to the seizure state. Since these mechanisms are unknown, it is important to understand how predictions from alternative dynamical descriptions compare. Herein we evaluate to what extent three different dynamical models provide consistent predictions for the effect of removing nodes from networks. We show that for small, directed, connected networks the three considered models provide consistent predictions. For larger networks, predictions are shown to be less consistent. However consistency is higher in networks that have sufficiently large differences in ictogenicity between nodes. We further demonstrate that heterogeneity in ictogenicity across nodes correlates with variability in the number of connections for each node.
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Bjerknes S, Toft M, Konglund AE, Pham U, Waage TR, Pedersen L, Skjelland M, Haraldsen I, Andersson S, Dietrichs E, Skogseid IM. Multiple Microelectrode Recordings in STN-DBS Surgery for Parkinson's Disease: A Randomized Study. Mov Disord Clin Pract 2018; 5:296-305. [PMID: 30009214 PMCID: PMC6033169 DOI: 10.1002/mdc3.12621] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 03/20/2018] [Accepted: 03/26/2018] [Indexed: 12/15/2022] Open
Abstract
Background Subthalamic nucleus deep brain stimulation improves motor symptoms and fluctuations in advanced Parkinson's disease, but the degree of clinical improvement depends on accurate anatomical electrode placement. Methods used to localize the sensory‐motor part of the nucleus vary substantially. Using microelectrode recordings, at least three inserted microelectrodes are needed to obtain a three‐dimensional map. Therefore, multiple simultaneously inserted microelectrodes should provide better guidance than single sequential microelectrodes. We aimed to compare the use of multiple simultaneous versus single sequential microelectrode recordings on efficacy and safety of subthalamic nucleus stimulation. Methods Sixty patients were included in this double‐blind, randomized study, 30 in each group. Primary outcome measures were the difference from baseline to 12 months in the MDS‐UPDRS motor score (part III) in the off‐medication state and quality of life using the Parkinson's Disease Questionnaire‐39 (PDQ‐39) scores. Results The mean reduction of the MDS‐UPDRS III off score was 35 (SD 12) in the group investigated with multiple simultaneous microelectrodes compared to 26 (SD 10) in the single sequential microelectrode group (p = 0.004). The PDQ‐39 Summary Index did not differ between the groups, but the domain scores activities of daily living and bodily discomfort improved significantly more in the multiple microelectrodes group. The frequency of serious adverse events did not differ significantly. Conclusions After 12 months of subthalamic nucleus stimulation, the multiple microelectrodes group had a significantly greater improvement both in MDS‐UPDRS III off score and in two PDQ‐39 domains. Our results may support the use of multiple simultaneous microelectrode recordings. Trial registration http://ClinicalTrials.gov Identifier: NCT00855621 (first received March 3, 2009).
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Affiliation(s)
- Silje Bjerknes
- Department of Neurology Oslo University Hospital Oslo Norway.,Institute of Clinical Medicine University of Oslo Oslo Norway
| | - Mathias Toft
- Department of Neurology Oslo University Hospital Oslo Norway.,Institute of Clinical Medicine University of Oslo Oslo Norway
| | - Ane E Konglund
- Department of Neurosurgery Oslo University Hospital Oslo Norway
| | - Uyen Pham
- Department of Neuropsychiatry and Psychosomatic Medicine Oslo University Hospital Oslo Norway
| | | | - Lena Pedersen
- Department of Neurology Oslo University Hospital Oslo Norway
| | - Mona Skjelland
- Department of Neurology Oslo University Hospital Oslo Norway
| | - Ira Haraldsen
- Department of Neuropsychiatry and Psychosomatic Medicine Oslo University Hospital Oslo Norway
| | | | - Espen Dietrichs
- Department of Neurology Oslo University Hospital Oslo Norway.,Institute of Clinical Medicine University of Oslo Oslo Norway
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