Image-guided preoperative prediction of pyramidal tract side effect in deep brain stimulation: proof of concept and application to the pyramidal tract side effect induced by pallidal stimulation

Abstract

, "Imageguided preoperative prediction of pyramidal tract side effect in deep brain stimulation: proof of concept and application to the pyramidal tract side effect induced by pallidal stimulation," J. Abstract. Deep brain stimulation of the medial globus pallidus (GPm) is a surgical procedure for treating patients suffering from Parkinson's disease. Its therapeutic effect may be limited by the presence of pyramidal tract side effect (PTSE). PTSE is a contraction time-locked to the stimulation when the current spreading reaches the motor fibers of the pyramidal tract within the internal capsule. The objective of the study was to propose a preoperative predictive model of PTSE. A machine learning-based method called PyMAN (PTSE model based on artificial neural network) accounting for the current used in stimulation, the three-dimensional electrode coordinates and the angle of the trajectory, was designed to predict the occurrence of PTSE. Ten patients implanted in the GPm have been tested by a clinician to create a labeled dataset of the stimulation parameters that trigger PTSE. The kappa index value between the data predicted by PyMAN and the labeled data was 0.78. Further evaluation studies are desirable to confirm whether PyMAN could be a reliable tool for assisting the surgeon to prevent PTSE during the preoperative planning.

Comparison of Awake and Asleep Deep Brain Stimulation for Parkinson’s Disease: A Detailed Analysis Through Literature Review

“…However, with improvements and advances in magnetic resonance imaging (MRI), direct anatomic targeting of structures such as subthalamic nucleus (STN), globus pallidus interna (GPi), or even ventralis intermedius nucleus (VIM) is now possible. Next, in place of intraoperative electrophysiologic mapping of the structure or test stimulation of symptoms and side effects in the awake patient, the use of intraoperative imaging to verify lead accuracy has been reported in several studies of PD patients undergoing DBS under general anesthesia (“asleep” DBS) . The results demonstrated that the clinical outcomes, complication rates and costs were comparable to those in historical studies using MER to guide lead placement under local anesthesia .…”

Machine Learning’s Application in Deep Brain Stimulation for Parkinson’s Disease: A Review

“…Their linear regression models determined classification with an AUC of 0.92. Baumgarten et al [52] examined ten patients with GPi implanted DBS for pyramidal tract side effects (PTSE). An NN classified PTSE in patients whose parameters had been designed to trigger PTSE by clinicians.…”

Data-Driven Prediction of the Therapeutic Window during Subthalamic Deep Brain Stimulation Surgery

“…In previous works, we proposed and validated data-driven predictions as an additional modality to assist the clinician [8,9]. Simply, we correlated the electrode coordinates and the current to predict side effects.…”

“…The patient's images were registered with the ParkMedAtlis anatomical atlas [14]. Details of the registration methods were described in previous works [8,9]. The surgical procedure involved first attachment to the patient's head of a stereotactic Leksell frame, under local anesthesia, then the implantation of quadripolar DBS electrodes (3389 Medtronic, Minneapolis, MN, USA) in the posterodorsal part of one or two STN in a single operating session.…”

“…Our team has recently proposed and validated a datadriven method, or artificial intelligence-based method, to predict one main side effect of globus pallidus [8] and STN DBS [9]. This effect was the pyramidal tract side effect (PTSE) which is one of the most common and immediate side effects in DBS.…”