Classification and Prediction of Clinical Improvement in Deep Brain Stimulation From Intraoperative Microelectrode Recordings

2017 ◽  
Vol 64 (5) ◽  
pp. 1123-1130 ◽  
Author(s):  
Kyriaki Kostoglou ◽  
Konstantinos P. Michmizos ◽  
Pantelis Stathis ◽  
Damianos Sakas ◽  
Konstantina S. Nikita ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Clinical Improvement ◽  
Brain Stimulation ◽  
Microelectrode Recordings ◽  
Deep Brain

Pallidal Deep Brain Stimulation for Primary Dystonia in Children

Neurosurgery ◽  
2011 ◽  
Vol 68 (3) ◽  
pp. 738-743 ◽  
Author(s):  
Abilash Haridas ◽  
Michele Tagliati ◽  
Irene Osborn ◽  
Ioannis Isaias ◽  
Yakov Gologorsky ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Clinical Improvement ◽  
Brain Stimulation ◽  
Functional Disability ◽  
Rating Scale ◽  
Retrospective Chart Review ◽  
Consecutive Series ◽  
Internal Globus Pallidus ◽  
Deep Brain

Abstract BACKGROUND: Deep brain stimulation (DBS) at the internal globus pallidus (GPi) has replaced ablative procedures for the treatment of primary generalized dystonia (PGD) because it is adjustable, reversible, and yields robust clinical improvement that appears to be long lasting. OBJECTIVE: To describe the long-term responses to pallidal DBS of a consecutive series of 22 pediatric patients with PGD. METHODS: Retrospective chart review of 22 consecutive PGD patients, ≤21 years of age treated by one DBS team over an 8-year period. The Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) was used to evaluate symptom severity and functional disability, pre- and post-operatively. Adverse events and medication changes were also noted. RESULTS: The median follow-up was 2 years (range, 1-8 years). All 22 patients reached 1-year follow-up; 14 reached 2 years, and 11 reached 3 years. The BFMDRS motor subscores were improved 84%, 93%, and 94% (median) at these time points. These motor responses were matched by equivalent improvements in function, and the response to DBS resulted in significant reductions in oral and intrathecal medication requirements after 12 and 24 months of stimulation. There were no hemorrhages or neurological complications related to surgery and no adverse effects from stimulation. Significant hardware-related complications were noted, in particular, infection (14%), which delayed clinical improvement. CONCLUSION: Pallidal DBS is a safe and effective treatment for PGD in patients <21 years of age. The improvement appears durable. Improvement in device design should reduce hardware-related complications over time.

scholarly journals Toward a unified connectomic target for deep brain stimulation in obsessive-compulsive disorder

2019 ◽  
Author(s):  
Ningfei Li ◽  
Juan Carlos Baldermann ◽  
Astrid Kibleur ◽  
Svenja Treu ◽  
Harith Akram ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Clinical Improvement ◽  
Obsessive Compulsive Disorder ◽  
Brain Stimulation ◽  
Internal Capsule ◽  
Anterior Cingulate ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Fiber Tracts ◽  
Deep Brain

AbstractMultiple surgical targets have been proposed for treating obsessive-compulsive disorder (OCD) with deep brain stimulation (DBS). However, different targets may modulate the same neural network responsible for clinical improvement. Here we analyzed data from four cohorts of OCD patients (N = 50) that underwent DBS to the anterior limb of the internal capsule (ALIC), the nucleus accumbens (NAcc) or the subthalamic nucleus (STN). Fiber tracts that were predominantly connected to electrodes in good or poor DBS responders were isolated from a normative structural connectome and assigned a predictive value. Strikingly, the same fiber bundle was related to treatment response when independently analyzing two large training cohorts that targeted either ALIC or STN. This discriminative tract is a subsection of the ALIC and connects frontal regions (such as the dorsal anterior cingulate, dACC, and ventral prefrontal, vlPFC, cortices to the STN). When informing the tract solely based on one cohort (e.g. ALIC), clinical improvements in the other (e.g. STN) could be significantly predicted, and vice versa. Finally, clinical improvements of eight patients from a third center with electrodes in the NAcc and six patients from a fourth center in which electrodes had been implanted in both STN and ALIC were significantly predicted based on this novel tract-based DBS target. Results suggest a functional role of a limbic hyperdirect pathway that projects from dACC and vlPFC to anteriomedial STN. Obsessive-compulsive symptoms seem to be tractable by modulating the specific bundle isolated here. Our results show that connectivity-derived improvement models can inform clinical improvement across DBS targets, surgeons and centers. The identified tract is now three-dimensionally defined in stereotactic standard space and will be made openly available.

scholarly journals Clinically Weighted Probabilistic Tractography Mapping of Therapeutic Thalamic Deep Brain Stimulation for Essential Tremor

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Evangelia Tsolaki ◽  
Alon Kashanian ◽  
Nader Pouratian
Keyword(s):  
Deep Brain Stimulation ◽  
Clinical Outcome ◽  
Essential Tremor ◽  
Clinical Improvement ◽  
Brain Stimulation ◽  
Structural Connectivity ◽  
Precentral Gyrus ◽  
Probabilistic Tractography ◽  
Whole Brain ◽  
Deep Brain

Abstract INTRODUCTION Traditional targeting methods rely on indirect targeting with atlas-defined coordinates that induce interpatient anatomical and functional variability. Precise targeting is crucial for successful surgical intervention associated with improved surgical outcomes. Here, we use clinically weighted probabilistic tractography to investigate the connectivity from volume of tissue activated (VTA) to whole brain in order to evaluate the relationship between structural connectivity and clinical outcome of patients that underwent thalamic deep brain stimulation (DBS). METHODS Magnetic resonance imaging and clinical outcomes from 10 essential tremor (ET) patients who were treated by VIM-DBS at the University of California Los Angeles were evaluated. LeadBDS was used for the VTA calculation and FSL was used to evaluate the whole brain probabilistic tractography of VTA. Tractography maps were binarized and weighted based on the percent of clinical improvement using the Fahn-Tolosa-Martin Tremor Rating Score. The resulting clinically weighted maps were non-linearly fused to MNI space and averaged. These population maps provide a voxel-by-voxel map of the average clinical improvement observed when the VTA demonstrates structural connectivity to the whole brain. RESULTS The VTA connectivity to the whole brain was delineated. Superior clinical improvement was associated with connectivity to voxels connecting the thalamus to the precentral gyrus and to the brainstem/cerebellum. Also, the clinical efficacy map showed that patients with higher clinical improvement (>70%) presented stronger structural connectivity to the precentral gyrus and to the caudal projection to the cerebellum. CONCLUSION Stronger connectivity to the precentral gyrus and to brainstem/cerebellum is associated with superior clinical outcome in thalamic DBS for ET. In the future, rather than focusing on connectivity to predetermined targets, these clinically weighted tractography maps can be used with a reverse algorithm to identify the optimal region of the thalamus to provide clinically superior results.

Effect of Anesthesia on Microelectrode Recordings During Deep Brain Stimulation Surgery

2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Michaël J. Bos ◽  
Wolfgang Buhre ◽  
Yasin Temel ◽  
Elbert A.J. Joosten ◽  
Anthony R. Absalom ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Microelectrode Recordings ◽  
Deep Brain Stimulation Surgery ◽  
Deep Brain

scholarly journals Automated 3-Dimensional Brain Atlas Fitting to Microelectrode Recordings from Deep Brain Stimulation Surgeries

2009 ◽  
Vol 87 (4) ◽  
pp. 229-240 ◽  
Author(s):  
J. Luis Luján ◽  
Angela M. Noecker ◽  
Christopher R. Butson ◽  
Scott E. Cooper ◽  
Benjamin L. Walter ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Brain Atlas ◽  
3 Dimensional ◽  
Microelectrode Recordings ◽  
Deep Brain

scholarly journals Normative vs. patient-specific brain connectivity in Deep Brain Stimulation

2020 ◽  
Author(s):  
Qiang Wang ◽  
Harith Akram ◽  
Muthuraman Muthuraman ◽  
Gabriel Gonzalez-Escamilla ◽  
Sameer A. Sheth ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Clinical Improvement ◽  
Brain Stimulation ◽  
Primary Motor Cortex ◽  
Supplementary Motor Area ◽  
Brain Connectivity ◽  
Motor Area ◽  
Patient Specific ◽  
Out Of Sample ◽  
Deep Brain

AbstractBrain connectivity profiles seeding from deep brain stimulation (DBS) electrodes have emerged as informative tools to estimate outcome variability across DBS patients. Given the limitations of acquiring and processing patient-specific diffusion-weighted imaging data, most studies have employed normative atlases of the human connectome. To date, it remains unclear whether patient-specific connectivity information would strengthen the accuracy of such analyses. Here, we compared similarities and differences between patient-specific, disease-matched and normative structural connectivity data and retrospective estimation of clinical improvement that they may generate.Data from 33 patients suffering from Parkinson’s Disease who underwent surgery at three different centers were retrospectively collected. Stimulation-dependent connectivity profiles seeding from active contacts were estimated using three modalities, namely either patient-specific diffusion-MRI data, disease-matched or normative group connectome data (acquired in healthy young subjects). Based on these profiles, models of optimal connectivity were constructed and used to retrospectively estimate the clinical improvement in out of sample data.All three modalities resulted in highly similar optimal connectivity profiles that could largely reproduce findings from prior research based on a novel multi-center cohort. Connectivity estimates seeding from electrodes when using either patient-specific or normative connectomes correlated significantly to primary motor cortex (R = 0.57, p = 0.001, R=0.73, p=0.001), supplementary motor area (R = 0.40, p = 0.005, R = 0.43, p = 0.003), pre-supplementary motor area (R = 0.33, p = 0.022, R = 0.33, p = 0.031), but not to more frontal regions such as the dorsomedial prefrontal cortex (R = 0.21, p = 0.17, R = 0.18, p = 0.17).However, in a data-driven approach that estimated optimal whole-brain connectivity profiles, out-of-sample estimation of clinical improvements were made and ranged within a similar magnitude when applying either of the three modalities (R = 0.43 at p = 0.001 for patient-specific connectivity; R = 0.25, p = 0.048 for the age- and disease-matched group connectome; R = 0.31 at p = 0.028 for healthy-/young connectome).ConclusionsThe use of patient-specific connectivity and normative connectomes lead to identical main conclusions about which brain areas are associated with clinical improvement. Still, although results were not significantly different, they hint at the fact that patient-specific connectivity may bear the potential of estimating slightly more variance when compared to group connectomes. Our findings further support the role of DBS electrode connectivity profiles as a promising method to guide surgical targeting and DBS programming.

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