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Leplus A, Isan P, Balossier A, Mouffok S, Donnet A, Papadopoulo T, Lanteri‐Minet M, Regis J, Fontaine D. Somatotopy of the sensory thalamus: inputs from directional deep brain stimulation in pain patients. Ann Clin Transl Neurol 2024; 11:1502-1513. [PMID: 38668642 PMCID: PMC11187955 DOI: 10.1002/acn3.52067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 02/05/2024] [Accepted: 02/27/2024] [Indexed: 06/20/2024] Open
Abstract
OBJECTIVE The sensory ventroposterior (VP) thalamic nuclei display a mediolateral somatotopic organization (respectively head, arm, and leg). We studied this somatotopy using directional VP deep brain stimulation (DBS) in patients treated for chronic neuropathic pain. METHODS Six patients with central (four) or peripheral (two) neuropathic pain were treated by VP DBS using directional leads in a prospective study (clinicaltrials.gov NCT03399942). Lead-DBS toolbox was used for leads localization, visualization, and modeling of the volume of tissue activated (VTA). Stimulation was delivered in each direction, 1 month after surgery and correlated to the location of stimulation-induced paresthesias. The somatotopy was modeled by correlating the respective locations of paresthesias and VTAs. We recorded 48 distinct paresthesia maps corresponding to 48 VTAs (including 36 related to directional stimulation). RESULTS We observed that, in each patient, respective body representations of the trunk, upper limb, lower limb, and head were closely located around the lead. These representations differed across patients, did not follow a common organization and were not concordant with the previously described somatotopic organization of the sensory thalamus. INTERPRETATION Thalamic reorganization has been reported in chronic pain patients compared to non-pain patients operated for movement disorders in previous studies using intraoperative recordings and micro-stimulation. Using a different methodology, namely 3D representation of the VTA by the directional postoperative stimulation through a stationary electrode, our study brings additional arguments in favor of a reorganization of the VP thalamic somatotopy in patients suffering from chronic neuropathic pain of central or peripheral origin.
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Affiliation(s)
- Aurelie Leplus
- Department of Neurosurgery, FHU INOVPAIN, CHU de NiceUniversité Côte d'AzurNiceFrance
- UR2CAUniversité Côte d'AzurNiceFrance
| | - Petru Isan
- Department of Neurosurgery, FHU INOVPAIN, CHU de NiceUniversité Côte d'AzurNiceFrance
- UR2CAUniversité Côte d'AzurNiceFrance
| | - Anne Balossier
- Department of NeurosurgeryHopital La Timone, APHM, FHU INOVPAINMarseilleFrance
| | - Sarah Mouffok
- INRIA CenterUniversité Cote d'AzurSophia AntipolisFrance
| | - Anne Donnet
- Pain ClinicHopital La Timone, APHMMarseilleFrance
- Neuro‐Dol, Trigeminal PainINSERM/UCA, U1107Clermont‐FerrandFrance
| | | | - Michel Lanteri‐Minet
- UR2CAUniversité Côte d'AzurNiceFrance
- Neuro‐Dol, Trigeminal PainINSERM/UCA, U1107Clermont‐FerrandFrance
- Pain Clinic, FHU INOVPAIN, CHU de NiceUniversité Côte d'AzurNiceFrance
| | - Jean Regis
- Department of NeurosurgeryHopital La Timone, APHM, FHU INOVPAINMarseilleFrance
| | - Denys Fontaine
- Department of Neurosurgery, FHU INOVPAIN, CHU de NiceUniversité Côte d'AzurNiceFrance
- UR2CAUniversité Côte d'AzurNiceFrance
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Cavalloni F, Brugger F, Kägi G, Naseri Y, Brogle D, Bozinov O, Bauer R, Hägele-Link S, Krüger MT. Evaluation of the Rotational Stability of Directional Deep Brain Stimulation Leads: A Case Series and Systematic Review. J Neurol Surg A Cent Eur Neurosurg 2024; 85:288-293. [PMID: 37832590 DOI: 10.1055/s-0043-1775759] [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: 10/15/2023]
Abstract
BACKGROUND The rotational stability of directional deep brain stimulation leads is a major prerequisite for sustained clinical effects. Data on directional lead stability are limited and controversial. METHODS We aimed to evaluate the long-term rotational stability of directional leads and define confounding factors in our own population and the current literature. We retrospectively evaluated the orientation of directional leads in patients with available postoperative computed tomography (CT; T1; day of surgery) and an additional postoperative image (T2; CT or rotational fluoroscopy) performed more than 7 days after the initial scan. The potential impact of intracranial air was assessed. We also reviewed the literature to define factors impacting stability. RESULTS Thirty-six leads were evaluated. The mean follow-up between T1 and T2 was 413.3 (7-1,171) days. The difference in rotation between T1 and T2 was 2.444 ± 2.554 degrees (range: 0-9.0 degrees). The volume of intracranial air did not impact the rotation. The literature search identified one factor impacting the stability of directional leads, which is the amount of twist applied at implantation. CONCLUSION Directional leads for deep brain stimulation show stable long-term orientation after implantation. Based on our literature review, large amounts of twist during implantation can lead to delayed rotation and should thus be avoided.
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Affiliation(s)
- Fabian Cavalloni
- Department of Neurosurgery, Kantonsspital Sankt Gallen, Sankt Gallen, Switzerland
- Department of Neurosurgery, Inselspital, University Hospital of Berne, Berne, Switzerland
| | - Florian Brugger
- Department of Neurology, Kantonsspital Sankt Gallen, Sankt Gallen, Switzerland
| | - Georg Kägi
- Department of Neurology, Kantonsspital Sankt Gallen, Sankt Gallen, Switzerland
| | - Yashar Naseri
- Department of Neurosurgery, Kantonsspital Sankt Gallen, Sankt Gallen, Switzerland
- Department of Neurosurgery, Freiburg University Medical Center, Freiburg, Germany
| | - Deborah Brogle
- Department of Neurology, Kantonsspital Sankt Gallen, Sankt Gallen, Switzerland
| | - Oliver Bozinov
- Department of Neurosurgery, Kantonsspital Sankt Gallen, Sankt Gallen, Switzerland
| | - Ronald Bauer
- Department of Neurosurgery, Kantonsspital Aarau AG, Aarau, Switzerland
| | - Stefan Hägele-Link
- Department of Neurology, Kantonsspital Sankt Gallen, Sankt Gallen, Switzerland
| | - Marie Therese Krüger
- Department of Neurosurgery, Kantonsspital Sankt Gallen, Sankt Gallen, Switzerland
- Department of Neurosurgery, Freiburg University Medical Center, Freiburg, Germany
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Leserri S, Segura-Amil A, Nowacki A, Debove I, Petermann K, Schäppi L, Preti MG, Van De Ville D, Pollo C, Walther S, Nguyen TAK. Linking connectivity of deep brain stimulation of nucleus accumbens area with clinical depression improvements: a retrospective longitudinal case series. Eur Arch Psychiatry Clin Neurosci 2024; 274:685-696. [PMID: 37668723 PMCID: PMC10994999 DOI: 10.1007/s00406-023-01683-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 08/14/2023] [Indexed: 09/06/2023]
Abstract
Treatment-resistant depression is a severe form of major depressive disorder and deep brain stimulation is currently an investigational treatment. The stimulation's therapeutic effect may be explained through the functional and structural connectivities between the stimulated area and other brain regions, or to depression-associated networks. In this longitudinal, retrospective study, four female patients with treatment-resistant depression were implanted for stimulation in the nucleus accumbens area at our center. We analyzed the structural and functional connectivity of the stimulation area: the structural connectivity was investigated with probabilistic tractography; the functional connectivity was estimated by combining patient-specific stimulation volumes and a normative functional connectome. These structural and functional connectivity profiles were then related to four clinical outcome scores. At 1-year follow-up, the remission rate was 66%. We observed a consistent structural connectivity to Brodmann area 25 in the patient with the longest remission phase. The functional connectivity analysis resulted in patient-specific R-maps describing brain areas significantly correlated with symptom improvement in this patient, notably the prefrontal cortex. But the connectivity analysis was mixed across patients, calling for confirmation in a larger cohort and over longer time periods.
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Affiliation(s)
- Simona Leserri
- Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- ARTORG Center for Biomedical Engineering Research, University Bern, Bern, Switzerland
- Neuro-X Institute, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Alba Segura-Amil
- Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- ARTORG Center for Biomedical Engineering Research, University Bern, Bern, Switzerland
| | - Andreas Nowacki
- Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Ines Debove
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Katrin Petermann
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Lea Schäppi
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Maria Giulia Preti
- Neuro-X Institute, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
- CIBM Center for Biomedical Imaging, Lausanne, Switzerland
- Department of Radiology and Medical InformaticsFaculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Dimitri Van De Ville
- Neuro-X Institute, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
- CIBM Center for Biomedical Imaging, Lausanne, Switzerland
- Department of Radiology and Medical InformaticsFaculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Claudio Pollo
- Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sebastian Walther
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - T A Khoa Nguyen
- Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
- ARTORG Center for Biomedical Engineering Research, University Bern, Bern, Switzerland.
- ARTORG IGT, Murtenstrasse 50, 3008, Bern, Switzerland.
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Manfield J, Thomas S, Bogdanovic M, Sarangmat N, Antoniades C, Green AL, FitzGerald JJ. Seeing Is Believing: Photon Counting Computed Tomography Clearly Images Directional Deep Brain Stimulation Lead Segments and Markers After Implantation. Neuromodulation 2024; 27:557-564. [PMID: 37921733 DOI: 10.1016/j.neurom.2023.09.003] [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: 06/08/2023] [Revised: 08/11/2023] [Accepted: 09/12/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND AND OBJECTIVES Directional deep brain stimulation (DBS) electrodes are increasingly used, but conventional computed tomography (CT) is unable to directly image segmented contacts owing to physics-based resolution constraints. Postoperative electrode segment orientation assessment is necessary because of the possibility of significant deviation during or immediately after insertion. Photon-counting detector (PCD) CT is a relatively novel technology that enables high resolution imaging while addressing several limitations intrinsic to CT. We show how PCD CT can enable clear in vivo imaging of DBS electrodes, including segmented contacts and markers for all major lead manufacturers. MATERIALS AND METHODS We describe postoperative imaging and reconstruction protocols we have developed to enable optimal lead visualization. PCD CT images were obtained of directional leads from the three major manufacturers and fused with preoperative 3T magnetic resonance imaging (MRI). Radiation dosimetry also was evaluated and compared with conventional imaging controls. Orientation estimates from directly imaged leads were compared with validated software-based reconstructions (derived from standard CT imaging artifact analysis) to quantify congruence in alignment and directional orientation. RESULTS High-fidelity images were obtained for 15 patients, clearly indicating the segmented contacts and directional markers both on CT alone and when fused to MRI. Our routine imaging protocol is described. Ionizing radiation doses were significantly lower than with conventional CT. For most leads, the directly imaged lead orientations and depths corresponded closely to those predicted by CT artifact-based reconstructions. However, unlike direct imaging, the software reconstructions were susceptible to 180° error in orientation assessment. CONCLUSIONS High-resolution photon-counting CT can very clearly image segmented DBS electrode contacts and directional markers and unambiguously determine lead orientation, with lower radiation than in conventional imaging. This obviates the need for further imaging and may facilitate anatomically tailored directional programming.
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Affiliation(s)
- James Manfield
- Oxford Functional Neurosurgery, John Radcliffe Hospital, Oxford, UK
| | - Sheena Thomas
- Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Marko Bogdanovic
- Oxford Functional Neurosurgery, John Radcliffe Hospital, Oxford, UK
| | | | | | - Alexander L Green
- Oxford Functional Neurosurgery, John Radcliffe Hospital, Oxford, UK; Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - James J FitzGerald
- Oxford Functional Neurosurgery, John Radcliffe Hospital, Oxford, UK; Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.
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Lee WL, Ward N, Petoe M, Moorhead A, Lawson K, Xu SS, Bulluss K, Thevathasan W, McDermott H, Perera T. Detection of evoked resonant neural activity in Parkinson's disease. J Neural Eng 2024; 21:016031. [PMID: 38364279 DOI: 10.1088/1741-2552/ad2a36] [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: 09/18/2023] [Accepted: 02/16/2024] [Indexed: 02/18/2024]
Abstract
Objective. This study investigated a machine-learning approach to detect the presence of evoked resonant neural activity (ERNA) recorded during deep brain stimulation (DBS) of the subthalamic nucleus (STN) in people with Parkinson's disease.Approach. Seven binary classifiers were trained to distinguish ERNA from the background neural activity using eight different time-domain signal features.Main results. Nested cross-validation revealed a strong classification performance of 99.1% accuracy, with 99.6% specificity and 98.7% sensitivity to detect ERNA. Using a semi-simulated ERNA dataset, the results show that a signal-to-noise ratio of 15 dB is required to maintain a 90% classifier sensitivity. ERNA detection is feasible with an appropriate combination of signal processing, feature extraction and classifier. Future work should consider reducing the computational complexity for use in real-time applications.Significance. The presence of ERNA can be used to indicate the location of a DBS electrode array during implantation surgery. The confidence score of the detector could be useful for assisting clinicians to adjust the position of the DBS electrode array inside/outside the STN.
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Affiliation(s)
- Wee-Lih Lee
- Bionics Institute, East Melbourne, Australia
- Medical Bionics Department, University of Melbourne, Parkville, Australia
| | - Nicole Ward
- School of Biomedical Engineering, University of Sydney, Camperdown, Australia
| | - Matthew Petoe
- Bionics Institute, East Melbourne, Australia
- Medical Bionics Department, University of Melbourne, Parkville, Australia
- DBS Technologies Pty Ltd, East Melbourne, Australia
| | - Ashton Moorhead
- Bionics Institute, East Melbourne, Australia
- DBS Technologies Pty Ltd, East Melbourne, Australia
| | - Kiaran Lawson
- Bionics Institute, East Melbourne, Australia
- DBS Technologies Pty Ltd, East Melbourne, Australia
| | - San San Xu
- Bionics Institute, East Melbourne, Australia
- Medical Bionics Department, University of Melbourne, Parkville, Australia
- National Hospital for Neurology and Neurosurgery, Queen Square, United Kingdom
| | - Kristian Bulluss
- Bionics Institute, East Melbourne, Australia
- DBS Technologies Pty Ltd, East Melbourne, Australia
- Department of Neurosurgery, Austin Hospital, Heidelberg, Australia
- Department of Neurosurgery, Cabrini Hospital, Malvern, Australia
- Department of Neurosurgery, St. Vincent's Hospital, Fitzroy, Australia
- Department of Surgery, University of Melbourne, Parkville, Australia
| | - Wesley Thevathasan
- Bionics Institute, East Melbourne, Australia
- DBS Technologies Pty Ltd, East Melbourne, Australia
- Department of Neurology, Austin Hospital, Heidelberg, Australia
- Department of Neurology, The Royal Melbourne Hospital, Melbourne, Australia
- Department of Medicine, University of Melbourne, Parkville, Australia
| | - Hugh McDermott
- Medical Bionics Department, University of Melbourne, Parkville, Australia
- DBS Technologies Pty Ltd, East Melbourne, Australia
- Department of Medicine, University of Melbourne, Parkville, Australia
| | - Thushara Perera
- Bionics Institute, East Melbourne, Australia
- Medical Bionics Department, University of Melbourne, Parkville, Australia
- DBS Technologies Pty Ltd, East Melbourne, Australia
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Hunsche S, Fedders D, Hellerbach A, Eichner M, Wirths J, Dembek TA, Visser-Vandewalle V, Treuer H. General Algorithm Applicability in Determining DBS Lead Orientation: Adapting 2D and 3D X-Ray Techniques for SenSightTM Leads. Stereotact Funct Neurosurg 2024; 102:120-126. [PMID: 38219714 PMCID: PMC10997254 DOI: 10.1159/000535716] [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: 10/05/2023] [Accepted: 12/05/2023] [Indexed: 01/16/2024]
Abstract
INTRODUCTION With recent advancements in deep brain stimulation (DBS), directional leads featuring segmented contacts have been introduced, allowing for targeted stimulation of specific brain regions. Given that manufacturers employ diverse markers for lead orientation, our investigation focuses on the adaptability of the 2017 techniques proposed by the Cologne research group for lead orientation determination. METHODS We tailored the two separate 2D and 3D X-ray-based techniques published in 2017 and originally developed for C-shaped markers, to the dual-marker of the Medtronic SenSight™ lead. In a retrospective patient study, we evaluated their feasibility and consistency by comparing the degree of agreement between the two methods. RESULTS The Bland-Altman plot showed favorable concordance without any noticeable systematic errors. The mean difference was 0.79°, with limits of agreement spanning from 21.4° to -19.8°. The algorithms demonstrated high reliability, evidenced by an intraclass correlation coefficient of 0.99 (p < 0.001). CONCLUSION The 2D and 3D algorithms, initially formulated for discerning the circular orientation of a C-shaped marker, were adapted to the marker of the Medtronic SenSight™ lead. Statistical analyses revealed a significant level of agreement between the two methods. Our findings highlight the adaptability of these algorithms to different markers, achievable through both low-dose intraoperative 2D X-ray imaging and standard CT imaging.
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Affiliation(s)
- Stefan Hunsche
- Department of Stereotactic and Functional Neurosurgery, University Hospital Cologne and Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Dieter Fedders
- Institute and Policlinic for Diagnostic and Interventional Radiology, Technical University Dresden, Dresden, Germany
- Department of Radiology and Neuroradiology, Chemnitz Hospital, Dresden, Germany
| | - Alexandra Hellerbach
- Department of Stereotactic and Functional Neurosurgery, University Hospital Cologne and Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Markus Eichner
- Department of Stereotactic and Functional Neurosurgery, University Hospital Cologne and Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Jochen Wirths
- Department of Stereotactic and Functional Neurosurgery, University Hospital Cologne and Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Till A. Dembek
- Department of Neurology, University Hospital Cologne and Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Veerle Visser-Vandewalle
- Department of Stereotactic and Functional Neurosurgery, University Hospital Cologne and Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Harald Treuer
- Department of Stereotactic and Functional Neurosurgery, University Hospital Cologne and Faculty of Medicine, University of Cologne, Cologne, Germany
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Brandt GA, Stopic V, van der Linden C, Strelow JN, Petry-Schmelzer JN, Baldermann JC, Visser-Vandewalle V, Fink GR, Barbe MT, Dembek TA. A Retrospective Comparison of Multiple Approaches to Anatomically Informed Contact Selection in Subthalamic Deep Brain Stimulation for Parkinson's Disease. JOURNAL OF PARKINSON'S DISEASE 2024; 14:575-587. [PMID: 38427498 DOI: 10.3233/jpd-230200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/03/2024]
Abstract
Background Conventional deep brain stimulation (DBS) programming via trial-and-error warrants improvement to ensure swift achievement of optimal outcomes. The definition of a sweet spot for subthalamic DBS in Parkinson's disease (PD-STN-DBS) may offer such advancement. Objective This investigation examines the association of long-term motor outcomes with contact selection during monopolar review and different strategies for anatomically informed contact selection in a retrospective real-life cohort of PD-STN-DBS. Methods We compared contact selection based on a monopolar review (MPR) to multiple anatomically informed contact selection strategies in a cohort of 28 PD patients with STN-DBS. We employed a commercial software package for contact selection based on visual assessment of individual anatomy following two predefined strategies and two algorithmic approaches with automatic targeting of either the sensorimotor STN or our previously published sweet spot. Similarity indices between chronic stimulation and contact selection strategies were correlated to motor outcomes at 12 months follow-up. Results Lateralized motor outcomes of chronic DBS were correlated to the similarity between chronic stimulation and visual contact selection targeting the dorsal part of the posterior STN (rho = 0.36, p = 0.007). Similar relationships could not be established for MPR or any of the other investigated strategies. Conclusions Our data demonstrates that a visual contact selection following a predefined strategy can be linked to beneficial long-term motor outcomes in PD-STN-DBS. Since similar correlations could not be observed for the other approaches to anatomically informed contact selection, we conclude that clear definitions and prospective validation of any approach to imaging-based DBS-programming is warranted.
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Affiliation(s)
- Gregor A Brandt
- Faculty of Medicine, University of Cologne, Cologne, Germany
- Department of Neurology, University Hospital Cologne, Cologne, Germany
| | - Vasilija Stopic
- Faculty of Medicine, University of Cologne, Cologne, Germany
- Department of Neurology, University Hospital Cologne, Cologne, Germany
| | - Christina van der Linden
- Faculty of Medicine, University of Cologne, Cologne, Germany
- Department of Neurology, University Hospital Cologne, Cologne, Germany
| | - Joshua N Strelow
- Faculty of Medicine, University of Cologne, Cologne, Germany
- Department of Neurology, University Hospital Cologne, Cologne, Germany
- Department of Stereotactic and Functional Neurosurgery, University Hospital Cologne, Cologne, Germany
| | - Jan N Petry-Schmelzer
- Faculty of Medicine, University of Cologne, Cologne, Germany
- Department of Neurology, University Hospital Cologne, Cologne, Germany
| | - Juan Carlos Baldermann
- Faculty of Medicine, University of Cologne, Cologne, Germany
- Department of Neurology, University Hospital Cologne, Cologne, Germany
- Department of Psychiatry and Psychotherapy, University Hospital Cologne, Cologne, Germany
| | - Veerle Visser-Vandewalle
- Faculty of Medicine, University of Cologne, Cologne, Germany
- Department of Stereotactic and Functional Neurosurgery, University Hospital Cologne, Cologne, Germany
| | - Gereon R Fink
- Faculty of Medicine, University of Cologne, Cologne, Germany
- Department of Neurology, University Hospital Cologne, Cologne, Germany
| | - Michael T Barbe
- Faculty of Medicine, University of Cologne, Cologne, Germany
- Department of Neurology, University Hospital Cologne, Cologne, Germany
| | - Till A Dembek
- Faculty of Medicine, University of Cologne, Cologne, Germany
- Department of Neurology, University Hospital Cologne, Cologne, Germany
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Fayed I, Syed M, Gingold E, Alizadeh M, Sharan A, Wu C. A Novel and Simple Method Using Computed Tomography Streak Artifact to Determine the Orientation of Directional Deep Brain Stimulation Leads. Neurosurgery 2023; 93:1036-1045. [PMID: 37227135 DOI: 10.1227/neu.0000000000002536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 03/27/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Directional leads have garnered widespread use in deep brain stimulation (DBS) because of the ability to steer current and maximize the therapeutic window. Accurate identification of lead orientation is critical to effective programming. Although directional markers are visible on 2-dimensional imaging, precise orientation may be difficult to interpret. Recent studies have suggested methods of determining lead orientation, but these involve advanced intraoperative imaging and/or complex computational algorithms. Our objective is to develop a precise and reliable method of determining orientation of directional leads using conventional imaging techniques and readily available software. METHODS We examined postoperative thin-cut computed tomography (CT) scans and x-rays of patients who underwent DBS with directional leads from 3 vendors. Using commercially available stereotactic software, we localized the leads and planned new trajectories precisely overlaying the leads visualized on CT. We used trajectory view to locate the directional marker in a plane orthogonal to the lead and inspected the streak artifact. We then validated this method with a phantom CT model by acquiring thin-cut CT images orthogonal to 3 different leads in various orientations confirmed under direct visualization. RESULTS The directional marker creates a unique streak artifact that reflects the orientation of the directional lead. There is a hyperdense symmetric streak artifact parallel to the axis of the directional marker and a symmetric hypodense dark band orthogonal to the marker. This is often sufficient to infer the direction of the marker. If not, it at least renders 2 opposite possibilities for the direction of the marker, which can then be easily reconciled by comparison with x-ray images. CONCLUSION We propose a method to determine orientation of directional DBS leads in a precise manner on conventional imaging and readily available software. This method is reliable across DBS vendors, and it can simplify this process and aid in effective programming.
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Affiliation(s)
- Islam Fayed
- Department of Neurosurgery, Vickie and Jack Farber Institute for Neuroscience, Thomas Jefferson University, Philadelphia , Pennsylvania , USA
| | - Mashaal Syed
- Department of Neurosurgery, Vickie and Jack Farber Institute for Neuroscience, Thomas Jefferson University, Philadelphia , Pennsylvania , USA
| | - Eric Gingold
- Department of Radiology, Thomas Jefferson University, Philadelphia , Pennsylvania , USA
| | - Mahdi Alizadeh
- Department of Neurosurgery, Vickie and Jack Farber Institute for Neuroscience, Thomas Jefferson University, Philadelphia , Pennsylvania , USA
- Department of Radiology, Thomas Jefferson University, Philadelphia , Pennsylvania , USA
| | - Ashwini Sharan
- Department of Neurosurgery, Vickie and Jack Farber Institute for Neuroscience, Thomas Jefferson University, Philadelphia , Pennsylvania , USA
| | - Chengyuan Wu
- Department of Neurosurgery, Vickie and Jack Farber Institute for Neuroscience, Thomas Jefferson University, Philadelphia , Pennsylvania , USA
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Henry KR, Miulli MM, Nuzov NB, Nolt MJ, Rosenow JM, Elahi B, Pilitsis J, Golestanirad L. Variations in Determining Actual Orientations of Segmented Deep Brain Stimulation Leads Using the DiODe Algorithm: A Retrospective Study Across Different Lead Designs and Medical Institutions. Stereotact Funct Neurosurg 2023; 101:338-347. [PMID: 37717576 PMCID: PMC10866684 DOI: 10.1159/000531644] [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: 03/11/2023] [Accepted: 06/12/2023] [Indexed: 09/19/2023]
Abstract
INTRODUCTION Directional deep brain stimulation (DBS) leads have become widely used in the past decade. Understanding the asymmetric stimulation provided by directional leads requires precise knowledge of the exact orientation of the lead in respect to its anatomical target. Recently, the DiODe algorithm was developed to automatically determine the orientation angle of leads from the artifact on postoperative computed tomography (CT) images. However, manual DiODe results are user-dependent. This study analyzed the extent of lead rotation as well as the user agreement of DiODe calculations across the two most common DBS systems, namely, Boston Scientific's Vercise and Abbott's Infinity, and two independent medical institutions. METHODS Data from 104 patients who underwent an anterior-facing unilateral/bilateral directional DBS implantation at either Northwestern Memorial Hospital (NMH) or Albany Medical Center (AMC) were retrospectively analyzed. Actual orientations of the implanted leads were independently calculated by three individual users using the DiODe algorithm in Lead-DBS and patients' postoperative CT images. The deviation from the intended orientation and user agreement were assessed. RESULTS All leads significantly deviated from the intended 0° orientation (p < 0.001), regardless of DBS lead design (p < 0.05) or institution (p < 0.05). However, the Boston Scientific leads showed an implantation bias toward the left at both institutions (p = 0.014 at NMH, p = 0.029 at AMC). A difference of 10° between at least two users occurred in 28% (NMH) and 39% (AMC) of all Boston Scientific and 76% (NMH) and 53% (AMC) of all Abbott leads. CONCLUSION Our results show that there is a significant lead rotation from the intended surgical orientation across both DBS systems and both medical institutions; however, a bias toward a single direction was only seen in the Boston Scientific leads. Additionally, these results raise questions into the user error that occurs when manually refining the orientation angles calculated with DiODe.
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Affiliation(s)
- Kaylee R Henry
- Department of Biomedical Engineering, Northwestern University, Evanston, Illinois, USA,
| | - Milina Michelle Miulli
- Department of Neuroscience and Department of Global Health Studies, Northwestern University, Evanston, Illinois, USA
| | - Noa B Nuzov
- Department of Biomedical Engineering, Northwestern University, Evanston, Illinois, USA
- Department of Radiology, Northwestern University, Chicago, Illinois, USA
| | - Mark J Nolt
- Department of Neurosurgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Joshua M Rosenow
- Department of Neurosurgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Behzad Elahi
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, Illinois, USA
- Department of Neurology, Loyola Medical Center, Maywood, Illinois, USA
| | - Julie Pilitsis
- Department of Neurosciences and Experimental Therapeutics, Albany Medical College, Albany, New York, USA
| | - Laleh Golestanirad
- Department of Biomedical Engineering, Northwestern University, Evanston, Illinois, USA
- Department of Radiology, Northwestern University, Chicago, Illinois, USA
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10
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Manfield J, Thomas S, Antoniades C, Green AL, FitzGerald JJ. High resolution photon counting CT permits direct visualisation of directional deep brain stimulation lead segments and markers. Brain Stimul 2023; 16:1276-1277. [PMID: 37611658 DOI: 10.1016/j.brs.2023.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 06/29/2023] [Accepted: 08/18/2023] [Indexed: 08/25/2023] Open
Affiliation(s)
- James Manfield
- Oxford Functional Neurosurgery, John Radcliffe Hospital, Oxford, UK
| | - Sheena Thomas
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Charalambos Antoniades
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Alexander L Green
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK; Oxford Functional Neurosurgery, John Radcliffe Hospital, Oxford, UK
| | - James J FitzGerald
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK; Oxford Functional Neurosurgery, John Radcliffe Hospital, Oxford, UK.
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11
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Boëx C, Awadhi AA, Tyrand R, Corniola MV, Kibleur A, Fleury V, Burkhard PR, Momjian S. Validation of Lead-DBS β-Oscillation Localization with Directional Electrodes. Bioengineering (Basel) 2023; 10:898. [PMID: 37627782 PMCID: PMC10451384 DOI: 10.3390/bioengineering10080898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 07/17/2023] [Accepted: 07/21/2023] [Indexed: 08/27/2023] Open
Abstract
In deep brain stimulation (DBS) studies in patients with Parkinson's disease, the Lead-DBS toolbox allows the reconstruction of the location of β-oscillations in the subthalamic nucleus (STN) using Vercise Cartesia directional electrodes (Boston Scientific). The objective was to compare these probabilistic locations with those of intraoperative monopolar β-oscillations computed from local field potentials (0.5-3 kHz) recorded by using shielded single wires and an extracranial shielded reference electrode. For each electrode contact, power spectral densities of the β-band (13-31 Hz) were compared with those of all eight electrode contacts on the directional electrodes. The DBS Intrinsic Template AtLas (DISTAL), electrophysiological, and DBS target atlases of the Lead-DBS toolbox were applied to the reconstructed electrodes from preoperative MRI and postoperative CT. Thirty-six electrodes (20 patients: 7 females, 13 males; both STN electrodes for 16 of 20 patients; one single STN electrode for 4 of 20 patients) were analyzed. Stimulation sites both dorsal and/or lateral to the sensorimotor STN were the most efficient. In 33 out of 36 electrodes, at least one contact was measured with stronger β-oscillations, including 23 electrodes running through or touching the ventral subpart of the β-oscillations' probabilistic volume, while 10 did not touch it but were adjacent to this volume; in 3 out of 36 electrodes, no contact was found with β-oscillations and all 3 were distant from this volume. Monopolar local field potentials confirmed the ventral subpart of the probabilistic β-oscillations.
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Affiliation(s)
- Colette Boëx
- Department of Neurosurgery, University Hospitals of Geneva, CH-1205 Geneva, Switzerland (S.M.)
- Faculty of Medicine, University of Geneva, 1206 Geneva, Switzerland (P.R.B.)
| | - Abdullah Al Awadhi
- Department of Neurosurgery, University Hospitals of Geneva, CH-1205 Geneva, Switzerland (S.M.)
| | - Rémi Tyrand
- Department of Neurosurgery, University Hospitals of Geneva, CH-1205 Geneva, Switzerland (S.M.)
- Faculty of Medicine, University of Geneva, 1206 Geneva, Switzerland (P.R.B.)
| | - Marco V. Corniola
- Department of Neurosurgery, Pontchaillou Hospitals, CEDEX 9, F-35033 Rennes, France
| | - Astrid Kibleur
- Centre Hospitalier Universitaire Caen Normandie, F-14000 Caen, France
| | - Vanessa Fleury
- Faculty of Medicine, University of Geneva, 1206 Geneva, Switzerland (P.R.B.)
- Department of Neurosurgery, Pontchaillou Hospitals, CEDEX 9, F-35033 Rennes, France
| | - Pierre R. Burkhard
- Faculty of Medicine, University of Geneva, 1206 Geneva, Switzerland (P.R.B.)
| | - Shahan Momjian
- Department of Neurosurgery, University Hospitals of Geneva, CH-1205 Geneva, Switzerland (S.M.)
- Faculty of Medicine, University of Geneva, 1206 Geneva, Switzerland (P.R.B.)
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12
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Lead-DBS v3.0: Mapping deep brain stimulation effects to local anatomy and global networks. Neuroimage 2023; 268:119862. [PMID: 36610682 PMCID: PMC10144063 DOI: 10.1016/j.neuroimage.2023.119862] [Citation(s) in RCA: 34] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 12/22/2022] [Accepted: 01/03/2023] [Indexed: 01/07/2023] Open
Abstract
Following its introduction in 2014 and with support of a broad international community, the open-source toolbox Lead-DBS has evolved into a comprehensive neuroimaging platform dedicated to localizing, reconstructing, and visualizing electrodes implanted in the human brain, in the context of deep brain stimulation (DBS) and epilepsy monitoring. Expanding clinical indications for DBS, increasing availability of related research tools, and a growing community of clinician-scientist researchers, however, have led to an ongoing need to maintain, update, and standardize the codebase of Lead-DBS. Major development efforts of the platform in recent years have now yielded an end-to-end solution for DBS-based neuroimaging analysis allowing comprehensive image preprocessing, lead localization, stimulation volume modeling, and statistical analysis within a single tool. The aim of the present manuscript is to introduce fundamental additions to the Lead-DBS pipeline including a deformation warpfield editor and novel algorithms for electrode localization. Furthermore, we introduce a total of three comprehensive tools to map DBS effects to local, tract- and brain network-levels. These updates are demonstrated using a single patient example (for subject-level analysis), as well as a retrospective cohort of 51 Parkinson's disease patients who underwent DBS of the subthalamic nucleus (for group-level analysis). Their applicability is further demonstrated by comparing the various methodological choices and the amount of explained variance in clinical outcomes across analysis streams. Finally, based on an increasing need to standardize folder and file naming specifications across research groups in neuroscience, we introduce the brain imaging data structure (BIDS) derivative standard for Lead-DBS. Thus, this multi-institutional collaborative effort represents an important stage in the evolution of a comprehensive, open-source pipeline for DBS imaging and connectomics.
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13
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Yalaz M, Maling N, Deuschl G, Juárez-Paz LM, Butz M, Schnitzler A, Helmers AK, Höft M. MaDoPO: Magnetic Detection of Positions and Orientations of Segmented Deep-Brain Stimulation Electrodes: A Radiation-Free Method Based on Magnetoencephalography. Brain Sci 2022; 12:brainsci12010086. [PMID: 35053829 PMCID: PMC8774199 DOI: 10.3390/brainsci12010086] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 01/04/2022] [Accepted: 01/06/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Current approaches to detect the positions and orientations of directional deep-brain stimulation (DBS) electrodes rely on radiative imaging data. In this study, we aim to present an improved version of a radiation-free method for magnetic detection of the position and the orientation (MaDoPO) of directional electrodes based on a series of magnetoencephalography (MEG) measurements and a possible future solution for optimized results using emerging on-scalp MEG systems. Methods: A directional DBS system was positioned into a realistic head–torso phantom and placed in the MEG scanner. A total of 24 measurements of 180 s each were performed with different predefined electrode configurations. Finite element modeling and model fitting were used to determine the position and orientation of the electrode in the phantom. Related measurements were fitted simultaneously, constraining solutions to the a priori known geometry of the electrode. Results were compared with the results of the high-quality CT imaging of the phantom. Results: The accuracy in electrode localization and orientation detection depended on the number of combined measurements. The localization error was minimized to 2.02 mm by considering six measurements with different non-directional bipolar electrode configurations. Another six measurements with directional bipolar stimulations minimized the orientation error to 4°. These values are mainly limited due to the spatial resolution of the MEG. Moreover, accuracies were investigated as a function of measurement time, number of sensors, and measurement direction of the sensors in order to define an optimized MEG device for this application. Conclusion: Although MEG introduces inaccuracies in the detection of the position and orientation of the electrode, these can be accepted when evaluating the benefits of a radiation-free method. Inaccuracies can be further reduced by the use of on-scalp MEG sensor arrays, which may find their way into clinics in the foreseeable future.
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Affiliation(s)
- Mevlüt Yalaz
- Microwave Engineering, Christian-Albrechts-Universität zu Kiel, 24143 Kiel, Germany;
- Correspondence:
| | - Nicholas Maling
- Boston Scientific Corporation, Santa Clarita, CA 91355, USA; (N.M.); (L.M.J.-P.)
| | - Günther Deuschl
- Department of Neurology, Christian-Albrechts-Universität zu Kiel, 24105 Kiel, Germany;
| | - León M. Juárez-Paz
- Boston Scientific Corporation, Santa Clarita, CA 91355, USA; (N.M.); (L.M.J.-P.)
| | - Markus Butz
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine-Universität Düsseldorf, 40225 Düsseldorf, Germany; (M.B.); (A.S.)
| | - Alfons Schnitzler
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine-Universität Düsseldorf, 40225 Düsseldorf, Germany; (M.B.); (A.S.)
| | - Ann-Kristin Helmers
- Department of Neurosurgery, Christian-Albrechts-Universität zu Kiel, 24105 Kiel, Germany;
| | - Michael Höft
- Microwave Engineering, Christian-Albrechts-Universität zu Kiel, 24143 Kiel, Germany;
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14
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Mishra A, Ramdhani RA. Directional Deep Brain Stimulation in the Treatment of Parkinson's Disease. Neurology 2022. [DOI: 10.17925/usn.2022.18.1.64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Deep brain stimulation (DBS) is a treatment modality that has been shown to improve the clinical outcomes of individuals with movement disorders, including Parkinson's disease. Directional DBS represents an advance in the field that allows clinicians to better modulate the electrical stimulation to increase therapeutic gains while minimizing side effects. In this review, we summarize the principles of directional DBS, including available technologies and stimulation paradigms, and examine the growing clinical study data with respect to its use in Parkinson's disease.
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