Selecting the most effective DBS contact in essential tremor patients based on individual tractography

Petry‐Schmelzer, Jan Niklas; Dembek, Till A.; Steffen, Julia; Jergas, Hannah; Dafsari, Haidar S.; Fink, Gereon R.; Visser‐Vandewalle, Veerle; Barbe, Michael T.

doi:10.1101/2020.11.03.20211847

Cited by 5 publications

(3 citation statements)

References 19 publications

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“…Crucially, however, although retrospective screening of patient records in the Berlin and Florida cohorts revealed no intolerable side effects at 12-month follow-up, the lack of recorded minor stimulationinduced adverse events prevented their direct investigation in the present study (similar to several recent studies suggesting efficient tremor suppression along the entirety of DRT). 2,38 Further prospective validation is required to characterize the side effect profile of the hypointensity marker.…”

Section: Discussionmentioning

confidence: 99%

Personalizing Deep Brain Stimulation Using Advanced Imaging Sequences

Neudorfer

Kroneberg

Al‐Fatly

et al. 2022

Annals of Neurology

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Objective: With a growing appreciation for interindividual anatomical variability and patient-specific brain connectivity, advanced imaging sequences offer the opportunity to directly visualize anatomical targets for deep brain stimulation (DBS). The lack of quantitative evidence demonstrating their clinical utility, however, has hindered their broad implementation in clinical practice. Methods: Using fast gray matter acquisition T1 inversion recovery (FGATIR) sequences, the present study identified a thalamic hypointensity that holds promise as a visual marker in DBS. To validate the clinical utility of the identified hypointensity, we retrospectively analyzed 65 patients (26 female, mean age = 69.1 AE 12.7 years) who underwent DBS in the treatment of essential tremor. We characterized its neuroanatomical substrates and evaluated the hypointensity's ability to predict clinical outcome using stimulation volume modeling and voxelwise mapping. Finally, we determined whether the hypointensity marker could predict symptom improvement on a patient-specific level. Results: Anatomical characterization suggested that the identified hypointensity constituted the terminal part of the dentatorubrothalamic tract. Overlap between DBS stimulation volumes and the hypointensity in standard space significantly correlated with tremor improvement (R 2 = 0.16, p = 0.017) and distance to hotspots previously reported in the literature (R 2 = 0.49, p = 7.9e-4). In contrast, the amount of variance explained by other anatomical atlas structures was reduced. When accounting for interindividual neuroanatomical variability, the predictive power of the hypointensity increased further (R 2 = 0.37, p = 0.002). Interpretation: Our findings introduce and validate a novel imaging-based marker attainable from FGATIR sequences that has the potential to personalize and inform targeting and programming in DBS for essential tremor.

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Section: Discussionmentioning

confidence: 99%

Personalizing Deep Brain Stimulation Using Advanced Imaging Sequences

Neudorfer

Kroneberg

Al‐Fatly

et al. 2022

Annals of Neurology

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“…The copyright holder for this preprint this version posted January 18, 2023. ; https://doi.org/10.1101/2023.01.17.23284553 doi: medRxiv preprint Assessment of white matter tracts offer an additional approach to assess brain structure in relation to DBS outcomes. The dentatorubrothalamic tract (DRTT) is a tract that has gained increasing popularity for importance of DBS outcomes in movement disorders including Parkinson's disease and essential tremor, (25)(26)(27)(28) but has yet to be explored in cervical dystonia. Originating at the dentate nucleus of the cerebellum, classically defined decussating and more recently disclosed nondecussating tracts, convey cerebellar output to the thalamus, with onward projections to sensorimotor cortex.…”

Section: (Which Was Not Certified By Peer Review)mentioning

confidence: 99%

WITHDRAWN: Infratentorial Morphometry and Deep Brain Stimulation Outcome in Cervical Dystonia

Andrews

Keller

Osman-Farah

et al. 2023

Preprint

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Background: Cervical dystonia is a movement disorder, characterised by involuntary head and neck muscle contractions. Although deep brain stimulation (DBS) of the globus pallidus internus (GPi) is an effective treatment option, motor outcomes can vary even when sufficient targeting accuracy is achieved. Increasing evidence supports a role of brainstem and cerebellum dysfunction in cervical dystonia pathogenesis. Objective: To determine whether morphometry of brainstem and dentate nuclei, and DBS stimulatory overlap with cerebello-thalamic tracts modelled from normative connectivity, were related to DBS clinical motor outcomes. Methods: 27 patients with idiopathic cervical dystonia underwent bilateral targeting of the GPi. and were separated into suboptimal and optimal motor outcome groups. Dentate nuclei and brainstem volumes were quantified in association with clinical outcomes. A brainstem shape analysis was conducted and used as a seed to assess connectivity from a normative structural connectome. Patient-specific electrodes were modelled to quantify stimulatory overlap with the GPi and proximity to cerebellothalamic tracts. Results: GPi implantation accuracy did not significantly differ between groups. Significantly reduced dentate nuclei and brainstem volumes were observed in patients with poorer clinical outcomes. Regional surface shape change of the brainstem was also observed in patients with poorer responses. Fibre tracking from this area intersected cerebellar, pallidal and cortical motor regions. Electrode field intersection with the non-decussating dentatorubrothalamic tract in the right, and in both hemispheres were also positively associated with clinical outcome. Conclusions: Variability in cerebellar and brainstem morphometry, and stimulation of non-decussating cerebello-thalamic pathways may contribute to the mediation of DBS motor outcomes.

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“…Even with Vim-DBS, the optimal site is not definitive, and lead placement with MER and test stimulation is common. Recently, segmentation of the thalamic nuclei 53) and detection of optimal site using imaging methods such as drawing the dentato- rubro-thalamic tract 54 , 55) and connectivity analysis 56) have become possible thanks to advances in imaging technology. On the other hand, Gravbrot, et al reported that about 12 patients received asleep D-lead implantation to Vim for ET.…”

Section: Introductionmentioning

confidence: 99%

Surgical Strategy for Directional Deep Brain Stimulation

Masuda

Shirozu

Ito

et al. 2022

Neurol. Med. Chir.(Tokyo)

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Deep brain stimulation (DBS) is a well-established treatment for drug-resistant involuntary movements. However, the conventional quadripole cylindrical lead creates electrical fields in all directions, and the resulting spread to adjacent eloquent structures may induce unintended effects. Novel directional leads have therefore been designed to allow directional stimulation (DS). Directional leads have the advantage of widening the therapeutic window (TW), compensating for slight misplacement of the lead and requiring less electrical power to provide the same effect as a cylindrical lead. Conversely, the increase in the number of contacts from four to eight and the addition of directional elements has made stimulation programming more complex. For these reasons, new treatment strategies are required to allow effective directional DBS. During lead implantation, the directional segment should be placed in a “sweet spot,” and the orientation of the directional segment is important for programming. Trial-and-error testing of a large number of contacts is unnecessary, and efficient and systematic execution of the programmed procedure is desirable. Recent improvements in imaging technologies have enabled image-guided programming. In the future, optimal stimulations are expected to be programmed by directional recording of local field potentials.

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Selecting the most effective DBS contact in essential tremor patients based on individual tractography

Cited by 5 publications

References 19 publications

Personalizing Deep Brain Stimulation Using Advanced Imaging Sequences

Personalizing Deep Brain Stimulation Using Advanced Imaging Sequences

WITHDRAWN: Infratentorial Morphometry and Deep Brain Stimulation Outcome in Cervical Dystonia

Surgical Strategy for Directional Deep Brain Stimulation

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