Directional stimulation of subthalamic nucleus sweet spot predicts clinical efficacy: Proof of concept

Nguyen, T. A. Khoa; Nowacki, Andreas; Debove, Ines; Petermann, Katrin; Tinkhauser, Gerd; Wiest, Roland; Schüpbach, Michaël; Krack, Paul; Pollo, Claudio

doi:10.1016/j.brs.2019.05.001

Cited by 46 publications

(56 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Lead reconstruction and volume of tissue activated modelling was performed with the Lead-DBS toolbox (version 2.2.3) in Matlab 2016b (The Mathworks, Natick, MA, USA) as described recently by our and other groups ( Nowacki et al, 2018b , Horn et al, 2019 , Nguyen et al, 2019b ). Image sets were co-registered and normalized into the MNI space (MNI ICMB 2009b) using Statistical Parametric Mapping 12 and Advanced Normalization Tools ( Avants et al, 2008 ).…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Structure-function relationship of the posterior subthalamic area with directional deep brain stimulation for essential tremor

Lévy

Nguyen

Lachenmayer

et al. 2020

NeuroImage: Clinical

Self Cite

View full text Add to dashboard Cite

show abstract

Section: Methodsmentioning

confidence: 99%

“…To that end, we included all stimulation settings from each lead. These were used to compute mean effect and significant mean effect images ( Dembek et al, 2017 , Dembek et al, 2019 , Nguyen et al, 2019b ).…”

Section: Methodsmentioning

confidence: 99%

Structure-function relationship of the posterior subthalamic area with directional deep brain stimulation for essential tremor

Lévy

Nguyen

Lachenmayer

et al. 2020

NeuroImage: Clinical

Self Cite

View full text Add to dashboard Cite

show abstract

“…Lead reconstruction and stimulation volume modelling was performed with the Lead-DBS toolbox (version 2.2.3) in Matlab 2016b (The Mathworks, Natick, MA) as described recently by our group and others. 12,13 Image sets were co-registered and normalized into the Montreal Neurological Institute (MNI) space (MNI ICBM 2009b) using statistical parametric mapping and advanced normalization tools with additional brainshift correction. 14,15 The electrode position was reconstructed semiautomatically and corrected manually where necessary.…”

Section: Lead Reconstruction and Estimation Of Stimulation Volumesmentioning

confidence: 99%

Deep Brain Stimulation for Chronic Cluster Headache: Meta‐Analysis of Individual Patient Data

Nowacki

Schöber

Nader

et al. 2020

Annals of Neurology

Self Cite

View full text Add to dashboard Cite

Objective: Deep brain stimulation (DBS) is a treatment option for refractory chronic cluster headache (CCH). Despite several recent prospective case series reporting a good outcome, the effectiveness and the optimal stimulation target of DBS for CCH remain unclear. We aimed to obtain precise estimates and predictors of long-term pain relief in an individual patient data meta-analysis. Furthermore, we aimed to construct a probabilistic stimulation map of effective DBS. Methods: We invited investigators of published cohorts of patients undergoing DBS for CCH, identified by a systematic review of MEDLINE from inception to Febuary 15, 2019, to provide individual patient data on baseline covariates, pre-and postoperative headache scores at median (12-month) and long-term follow-up, in addition to individual imaging data to obtain individual electrode positions. We calculated a stimulation map using voxel-wise statistical analysis. We used multiple regression analysis to estimate predictors of pain relief. Results: Among 40 patients from four different cohorts representing 50% of all previously published cases, we found a significant 77% mean reduction in headache attack frequency over a mean follow-up of 44 months, with an overall response rate of 75%. Positive outcome was not associated with baseline covariates. We identified 2 hotspots of stimulation covering the midbrain ventral and retrorubral tegmentum. Interpretation: This study supports the hypothesis that DBS provides long-term pain relief for the majority of CCH patients. Our stimulation map of the region of influence of therapeutic DBS identified an optimal anatomical target site that can help surgeons to guide their surgical planning in the future.

show abstract

“…It can reduce undesired activation of adjacent structures such as the internal capsule, and indeed, it has demonstrated higher side effect thresholds than classical omnidirectional stimulation in implanted patients (Steigerwald et al, 2016;Dembek et al, 2017). Directional stimulation may further be leveraged to target very specific and clinically effective regions of the subthalamic nucleus, also known as "sweet spots" obtained from probabilistic mapping (Horn et al, 2017;Dembek et al, 2019;Nguyen et al, 2019b). These regions are associated with abnormal electrophysiological activity recorded through local field potentials (LFPs).…”

Section: Introductionmentioning

confidence: 99%

Directional Local Field Potentials in the Subthalamic Nucleus During Deep Brain Implantation of Parkinson’s Disease Patients

Nguyen

Schüpbach

Mercanzini

et al. 2020

Front. Hum. Neurosci.

Self Cite

View full text Add to dashboard Cite

Segmented deep brain stimulation leads feature directional electrodes that allow for a finer spatial control of electrical stimulation compared to traditional ring-shaped electrodes. These segmented leads have demonstrated enlarged therapeutic windows and have thus the potential to improve the treatment of Parkinson's disease patients. Moreover, they provide a unique opportunity to record directional local field potentials. Here, we investigated whether directional local field potentials can help identify the best stimulation direction to assist device programming. Four Parkinson's disease patients underwent routine implantation of the subthalamic nucleus. Firstly, local field potentials were recorded in three directions for two conditions: In one condition, the patient was at rest; in the other condition, the patient's arm was moved. Secondly, current thresholds for therapeutic and side effects were identified intraoperatively for directional stimulation. Therapeutic windows were calculated from these two thresholds. Thirdly, the spectral power of the total beta band (13-35 Hz) and its sub-bands low, high, and peak beta were analyzed post hoc. Fourthly, the spectral power was used by different algorithms to predict the ranking of directions. The spectral power profiles were patient-specific, and spectral peaks were found both in the low beta band (13-20 Hz) and in the high beta band (20.5-35 Hz). The direction with the highest spectral power in the total beta band was most indicative of the 1 st best direction when defined by therapeutic window. Based on the total beta band, the resting condition and the moving condition were similarly predictive about the direction ranking and classified 83.3% of directions correctly. However, different algorithms were needed to predict the ranking defined by therapeutic window or therapeutic current threshold. Directional local field potentials may help predict the best stimulation direction. Further studies with larger sample sizes are needed to better distinguish the informative value of different conditions and the beta sub-bands.

show abstract

Directional stimulation of subthalamic nucleus sweet spot predicts clinical efficacy: Proof of concept

Cited by 46 publications

References 34 publications

Structure-function relationship of the posterior subthalamic area with directional deep brain stimulation for essential tremor

Structure-function relationship of the posterior subthalamic area with directional deep brain stimulation for essential tremor

Deep Brain Stimulation for Chronic Cluster Headache: Meta‐Analysis of Individual Patient Data

Directional Local Field Potentials in the Subthalamic Nucleus During Deep Brain Implantation of Parkinson’s Disease Patients

Contact Info

Product

Resources

About