Neuroimaging and Deep Brain Stimulation

Abstract

SUMMARY: Deep brain stimulation (DBS) is a new neurosurgical method principally used for the treatment of Parkinson disease (PD).Many new applications of DBS are under development, including the treatment of intractable psychiatric diseases. Brain imaging is used for the selection of patients for DBS, to localize the target nucleus, to detect complications, and to evaluate the final electrode contact position. In patients with implanted DBS systems, there is a risk of electrode heating when MR imaging is performed. This contraindicates MR imaging unless specific precautions are taken. Involvement of neuroradiologists in DBS procedures is essential to optimize presurgical evaluation, targeting, and postoperative anatomic results. The precision of the neuroradiologic correlation with anatomic data and clinical outcomes in DBS promises to yield significant basic science and clinical advances in the future. Chronic high-frequency stimulation of the ventral intermediate nucleus (VIM) of the thalamus was first described in the early 1990s by Benabid et al.1 These authors implanted chronic stimulating electrodes in the VIM connected to a subcutaneous pulse generator positioned in the thoracic region to treat disabling tremor in 26 patients with Parkinson disease (PD) and in 6 with essential tremor.1 They demonstrated the effectiveness of this technique and its ability to produce complete relief from tremor. Improvement was maintained for up to 29 months. This was the first clinical demonstration that chronic high-frequency stimulation of nuclei (deep brain stimulation [DBS]) could replace destructive lesion-producing functional neurosurgery such as thalamotomy. This new technique was reversible and led to a renaissance in functional neurosurgery.Next, the same team introduced bilateral DBS of the subthalamic nucleus (STN) in patients with disabling akineticrigid PD and severe motor fluctuations.2 This work extended data obtained in a 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine monkey model of PD showing that lesions and electric stimulation of the subthalamic nucleus reduced all of the major motor disturbances in this animal model. The results in patients with advanced PD were striking and were reproduced in many centers internationally. The US Food and Drug Administration approved the use of DBS for treatment of advanced PD with bilateral STN stimulation in 2002 and internal globus pallidus (GPi) stimulation in 2003. The main indication for DBS remains advanced PD, but numerous additional applications have been developed, ranging from dystonia to cluster headache, Tourette syndrome, and even psychiatric indications like obsessive-compulsive disorders (OCD) and major depression.DBS is a neurosurgical method, but the role of neuroimaging in successful DBS intervention is critical. Neuroimaging is used for the preoperative selection of patients who will have DBS and to localize the intended target nuclei. In the postoperative period, imaging detects complications that uncommonly accompany the procedure, confirms the pos...

Comparison of T2*-weighted and QSM contrasts in Parkinson's disease to visualize the STN with MRI

“…Electrode placement for DBS remains challenging and requires a high degree of precision. In preparation for the surgery, the target is defined using MR images, and during surgery using microrecordings and macrostimulation [45]. Neuroimaging is therefore crucial for successful DBS surgery, and surgical outcomes are likely to benefit from further optimalization of visualization techniques of the STN.…”

Stimulation of subterritories of the subthalamic nucleus reveals its role in the integration of the emotional and motor aspects of behavior

“…Our approach is based on the registration of the atlas with each patient's postoperative MRI. The possibility that the MR signals were distorted was excluded before MRI was chosen as the standard procedure for DBS targeting and electrode localization (35,36). As stimulating electrodes are known to produce artifacts on MRI (37), we previously verified that the electrode itself was localized at the geometric center of the artifact (20).…”

Diagnostic, pronostic et traitements des troubles de la conscience

“…Cette méthode était initialement principalement utilisée pour traiter la maladie de Parkinson [77], mais ses applications se sont diversifiées (dystonie, douleur chronique et troubles obsessionnels compulsifs) [78]. Pour les patients en ECA, le thalamus est une cible de choix de cette technique étant donné qu'il a un rôle clé dans l'éveil et les fonctions cognitives élémentaires de mémoire de travail et de planification du mouvement [79].…”