Statistical Analysis of 168 Bilateral Subthalamic Nucleus Implantations by Means of the Probabilistic Functional Atlas

Nowinski, Wiesław L.; Belov, Dmitry I.; Pollak, Pierre; Benabid, Alim‐Louis

doi:10.1227/01.neu.0000180960.75347.11

Cited by 52 publications

(61 citation statements)

References 17 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: 89%

“…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%

“…To better define the therapeutic target VTA, our next goal is to use the methodology presented in this study to develop voxelbased, probabilistic maps of VTAs and their corresponding behavioral outcomes from a large cohort of patients. This fundamental concept was pioneered by Nowiniski et al (Nowinski et al, 2005) who developed probabilistic maps of the location of therapeutic electrode contacts. We believe integration of stimulation spread into these probabilistic maps will find utility in the surgical targeting for electrode implantation (Miocinovic et al, 2006a), identification of optimal stimulation parameter settings following implantation , and design of DBS electrodes customized to generate VTAs that best match the anatomical and electrical constraints of the target region (Butson and McIntyre, 2006).…”

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%

“…The position of the stimulating electrode in this patient was just medial to the STN, as defined by the 3D brain atlas. While the surgical goal is placement within the STN, the estimated electrode location in this patient-specific model is within the inherent error of the stereotactic neurosurgical procedure (Maciunas et al, 1994) and the brain atlas warping (Christensen et al, 1997;Nowinski et al, 2005).…”

Section: Image Coregistration and Brain Atlas Warpingmentioning

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: 89%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

confidence: 99%

Section: Image Coregistration and Brain Atlas Warpingmentioning

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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Subthalamic nucleus volumes are highly consistent but decrease age-dependently-a combined magnetic resonance imaging and stereology approach in humans

et al. 2016

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The subthalamic nucleus (STN) is a main target structure of deep brain stimulation (DBS) in idiopathic Parkinson's disease. Nevertheless, there is an ongoing discussion regarding human STN volumes and neuron count, which could potentially have an impact on STN-DBS. Moreover, a suspected functional subdivision forms the basis of the tripartite hypothesis, which has not yet been morphologically substantiated. In this study, it was aimed to investigate the human STN by means of combined magnetic resonance imaging (MRI) and stereology. STN volumes were obtained from 14 individuals (ranging from 65 to 96 years, 25 hemispheres) in 3 T MRI and in luxol-stained histology slices. Neuron number and cell densities were investigated stereologically over the entire STN and in pre-defined subregions in anti-human neuronal protein HuC/D-stained slices. STN volumes measured with MRI were smaller than in stereology but appeared to be highly consistent, measuring on average 99 ± 6 mm (MRI) and 132 ± 20 mm (stereology). The neuron count was 431,088 ± 72,172. Both STN volumes and cell count decreased age-dependently. Neuron density was different for the dorsal, medial and ventral subregion with significantly higher values ventrally than dorsally. Small variations in STN volumes in both MRI and stereology contradict previous findings of large variations in STN size. Age-dependent decreases in STN volumes and neuron numbers might influence the efficacy of STN-DBS in a geriatric population. Though the study is limited in sample size, site-dependent differences for the STN subregions form a morphological basis for the tripartite theory. Hum Brain Mapp 38:909-922, 2017. © 2016 Wiley Periodicals, Inc.

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Toward an electrophysiological “sweet spot” for deep brain stimulation in the subthalamic nucleus

Horn

Neumann

Degen

et al. 2017

Human Brain Mapping

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238

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Enhanced beta-band activity recorded in patients suffering from Parkinson's Disease (PD) has been described as a potential physiomarker for disease severity. Beta power is suppressed by Levodopa intake and STN deep brain stimulation (DBS) and correlates with disease severity across patients. The aim of the present study was to explore the promising signature of the physiomarker in the spatial domain. Based on local field potential data acquired from 54 patients undergoing STN-DBS, power values within alpha, beta, low beta, and high beta bands were calculated. Values were projected into common stereotactic space after DBS lead localization. Recorded beta power values were significantly higher at posterior and dorsal lead positions, as well as in active compared with inactive pairs. The peak of activity in the beta band was situated within the sensorimotor functional zone of the nucleus. In contrast, higher alpha activity was found in a more ventromedial region, potentially corresponding to associative or premotor functional zones of the STN. Beta- and alpha-power peaks were then used as seeds in a fiber tracking experiment. Here, the beta-site received more input from primary motor cortex whereas the alpha-site was more strongly connected to premotor and prefrontal areas. The results summarize predominant spatial locations of frequency signatures recorded in STN-DBS patients in a probabilistic fashion. The site of predominant beta-activity may serve as an electrophysiologically determined target for optimal outcome in STN-DBS for PD in the future. Hum Brain Mapp, 2017. © 2017 Wiley Periodicals, Inc.

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Statistical Analysis of 168 Bilateral Subthalamic Nucleus Implantations by Means of the Probabilistic Functional Atlas

Cited by 52 publications

References 17 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

Subthalamic nucleus volumes are highly consistent but decrease age-dependently-a combined magnetic resonance imaging and stereology approach in humans

Toward an electrophysiological “sweet spot” for deep brain stimulation in the subthalamic nucleus

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