Localization of clinically effective stimulating electrodes in the human subthalamic nucleus on magnetic resonance imaging

Saint‐Cyr, Jean A.; Hoque, Tasnuva; Pereira, Luiz Cláudio; Dostrovsky, Jonathan O.; Hutchison, William D.; Mikulis, David J.; Abosch, Aviva; Sime, Elspeth; Lang, Anthony E.; Lozano, Andrés M.

doi:10.3171/jns.2002.97.5.1152

Cited by 270 publications

(204 citation statements)

References 95 publications

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“…While our patient-specific model system suffers from a number of limitations, the comparisons with our clinical measurements are consistent with previous studies on location of therapeutically effective electrode contacts (Saint-Cyr et al, 2002;Voges and J, 2002;Herzog et al, 2004;Zonenshayn et al, 2004;Kitagawa et al, 2005;Nowinski et al, 2005;Plaha et al, 2006). The results of this study, though limited to a single patient, suggest that the therapeutic volume of tissue to activate is centered on ZI/H2 (Fig.…”

Section: Discussionsupporting

confidence: 79%

“…These studies have resulted in general guidelines on the selection of stimulation parameters, as well as clinical algorithms for programming the devices. Imaging studies have developed correlations between stimulation parameters and markers of brain activity (Hershey et al, 2003;Haslinger et al, 2005;Phillips et al, 2006;Trost et al, 2006), and identified the location of therapeutic DBS electrode contacts (Saint-Cyr et al, 2002;Voges and J, 2002;Herzog et al, 2004;Zonenshayn et al, 2004;Kitagawa et al, 2005;Nowinski et al, 2005;Plaha et al, 2006). Modeling studies have characterized the theoretical effects of DBS electric fields on the underlying neural tissue (McIntyre et al, 2004b;Miocinovic et al, 2006b).…”

Section: Discussionmentioning

confidence: 99%

“…However, there is substantial debate regarding the optimal anatomical location for the DBS electrodes in the STN region (Saint-Cyr et al, 2002;Voges and J, 2002;Herzog et al, 2004;Zonenshayn et al, 2004;Kitagawa et al, 2005;Nowinski et al, 2005;Plaha et al, 2006). And, while guidelines exist on stimulation parameter settings that are typically effective (Volkmann et al, 2006), it is infeasible to clinically evaluate each of the thousands of stimulation parameter combinations that are possible.…”

Section: Deep Brain Stimulation (Dbs) Is An Established Therapy For Tmentioning

confidence: 99%

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Patient-specific analysis of the volume of tissue activated during deep brain stimulation

et al. 2007

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Despite the clinical success of deep brain stimulation (DBS) for the treatment of movement disorders, many questions remain about its effects on the nervous system. We have developed a methodology to predict the volume of tissue activated (VTA) by DBS on a patient-specific basis. Our goals are to identify the intersection between the VTA and surrounding anatomical structures and to compare activation of these structures with clinical outcomes. The model system consists of three fundamental components: 1) a 3D anatomical model of the subcortical nuclei and DBS electrode position in the brain, each derived from magnetic resonance imaging (MRI); 2) a finite element model of the DBS electrode and electric field transmitted to the brain, with tissue conductivity properties derived from diffusion tensor MRI; 3) VTA prediction derived from the response of myelinated axons to the applied electric field, which is a function of the stimulation parameters (contact, impedance, voltage, pulse width, frequency). We used this model system to analyze the effects of subthalamic nucleus (STN) DBS in a patient with Parkinson's disease. Quantitative measurements of bradykinesia, rigidity, and corticospinal tract (CST) motor thresholds were evaluated over a range of stimulation parameter settings. Our model predictions showed good agreement with CST thresholds. Additionally, stimulation through electrode contacts that improved bradykinesia and rigidity generated VTAs that overlapped the zona incerta / fields of Forel (ZI/H2). Application of DBS technology to various neurological disorders has preceded scientific characterization of the volume of tissue directly affected by the stimulation. Synergistic integration of clinical analysis, neuroimaging, neuroanatomy, and neurostimulation modeling provides the opportunity to address wide ranging questions on the factors linked with the therapeutic benefits and side effects of DBS.

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Section: Discussionsupporting

confidence: 79%

Section: Discussionmentioning

confidence: 99%

Section: Deep Brain Stimulation (Dbs) Is An Established Therapy For Tmentioning

confidence: 99%

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Patient-specific analysis of the volume of tissue activated during deep brain stimulation

et al. 2007

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“…Finally, the process of fusing the CT scans and MRI scans is imperfect and the hyperdense appearance of the electrode tips on CT scan makes the precise location of the electrode tip difficult to determine. Some studies have utilized the superior soft tissue imaging characteristics of MRI to image DBS electrodes during or after placement to establish the exact location of contact points 37, 38, 39. However, the presence of ferromagnetic material in the electrodes raises the concern of thermal injuries when MRI is performed, as well as generating a signal void as a result of local distortion of the magnetic field 39.…”

Section: Discussionmentioning

confidence: 99%

Placement of Deep Brain Electrodes in the Dog Using the Brainsight Frameless Stereotactic System: A Pilot Feasibility Study

Long

Frey

Freestone

et al. 2013

Veterinary Internal Medicne

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BackgroundDeep brain stimulation (DBS) together with concurrent EEG recording has shown promise in the treatment of epilepsy. A novel device is capable of combining these 2 functions and may prove valuable in the treatment of epilepsy in dogs. However, stereotactic implantation of electrodes in dogs has not yet been evaluated.ObjectiveTo evaluate the feasibility and safety of implanting stimulating and recording electrodes in the brain of normal dogs using the Brainsight system and to evaluate the function of a novel DBS and recording device.AnimalsFour male intact Greyhounds, confirmed to be normal by clinical and neurologic examinations and hematology and biochemistry testing.Methods MRI imaging of the brain was performed after attachment of fiducial markers. MRI scans were used to calculate trajectories for electrode placement in the thalamus and hippocampus, which was performed via burr hole craniotomy. Postoperative CT scanning was performed to evaluate electrode location and accuracy of placement was calculated. Serial neurologic examinations were performed to evaluate neurologic deficits and EEG recordings obtained to evaluate the effects of stimulation.ResultsElectrodes were successfully placed in 3 of 4 dogs with a mean accuracy of 4.6 ± 1.5 mm. EEG recordings showed evoked potentials in response to stimulation with a circadian variation in time‐to‐maximal amplitude. No neurologic deficits were seen in any dog.Conclusions and Clinical ImportanceStereotactic placement of electrodes is safe and feasible in the dog. The development of a novel device capable of providing simultaneous neurostimulation and EEG recording potentially represents a major advance in the treatment of epilepsy.

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“…Authors of several studies based on MR imaging alone or multimodal imaging coregistration have described methods for electrode localization. 15,17,18,26 In these studies, it has been assumed that the position of the electrode artifact and the actual electrode position are highly correlated, but the accuracy of direct localization of the artifact remains to be determined.…”

mentioning

confidence: 99%

Localization of electrodes in the subthalamic nucleus on magnetic resonance imaging

Pollo

Vingerhoets

Pralong

et al. 2007

JNS

112

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Thirty-one patients (18 males and 13 females, mean age 63 Ϯ 8 years) with advanced PD treated with bilateral STN Object. The authors describe a new method of localizing electrodes on magnetic resonance (MR) images and focus on the positions of both the most efficient contact and the electrode related to the MR imaging target.Methods. Thirty-one patients who had undergone bilateral subthalamic nucleus (STN) deep brain stimulation (DBS) were included in this study. Target coordinates were calculated in the anterior commissure-posterior commissure referential. A study of the correlation between the artifact and the related contact allowed one to deduce the contact position from the identification of the distal artifact on MR imaging. The best stimulation point corresponded with the contact resulting in the best Unified Parkinson's Disease Rating Scale (UPDRS) motor score improvement. It was compared (Student t-test) with the dorsal margin of the STN (DM STN), which was determined electrophysiologically. The distance between the target and the electrode was calculated individually in each axis.The best stimulation point was located at anteroposterior Ϫ2.34 Ϯ 1.63 mm, lateral 12.04 Ϯ 1.62 mm, and vertical Ϫ2.57 Ϯ 1.68 mm. This point was not significantly different from the DM STN (p Ͻ 0.05). The postoperative UPDRS motor score was 28.07 Ϯ 12.16, as opposed to the preoperative score of 46.27 Ϯ 13.89. The distance between the expected and actual target in the x-and y-axes was 1.34 Ϯ 1.02 and 1.03 Ϯ 0.76 mm, respectively. In the z-axis, 39.7% of the distal contacts were located proximal to the target.Conclusions. This approach proposed for the localization of the electrodes on MR imaging shows that DBS is most effective in the dorsal and lateral part of the STN and indicates that the DBS electrode can be located more proximally than originally expected because of the caudal brain shift that may occur during the implantation procedure. KEY WORDS •

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Localization of clinically effective stimulating electrodes in the human subthalamic nucleus on magnetic resonance imaging

Abstract: The anatomical localization of clinically effective electrode contacts provided in this study yields useful information for the postoperative programming of DBS electrodes.

Cited by 270 publications

References 95 publications

Patient-specific analysis of the volume of tissue activated during deep brain stimulation

Patient-specific analysis of the volume of tissue activated during deep brain stimulation

Placement of Deep Brain Electrodes in the Dog Using the Brainsight Frameless Stereotactic System: A Pilot Feasibility Study

Localization of electrodes in the subthalamic nucleus on magnetic resonance imaging

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