scholarly journals Fast gray matter acquisition T1 inversion recovery MRI to delineate the mammillothalamic tract for preoperative direct targeting of the anterior nucleus of the thalamus for deep brain stimulation in epilepsy

2018 ◽  
Vol 45 (2) ◽  
pp. E6 ◽  
Author(s):  
Sanjeet S. Grewal ◽  
Erik H. Middlebrooks ◽  
Timothy J. Kaufmann ◽  
Matthew Stead ◽  
Brian N. Lundstrom ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Gray Matter ◽  
Brain Stimulation ◽  
Inversion Recovery ◽  
Healthcare Sector ◽  
Anterior Nucleus ◽  
Patient Reported ◽  
Direct Targeting ◽  
Mammillothalamic Tract ◽  
Deep Brain

When medically intractable epilepsy is multifocal or focal but poorly localized, neuromodulation can be useful therapy. One such technique is deep brain stimulation (DBS) targeting the anterior nucleus of the thalamus (ANT). Unfortunately, the ANT is difficult to visualize in standard MRI sequences and its indirect targeting is difficult because of thalamic variability and atrophy in patients with epilepsy. The following study describes the novel use of the fast gray matter acquisition T1 inversion recovery (FGATIR) MRI sequence to delineate the mammillothalamic tract for direct targeting of the ANT through visualizing the termination of the mammillothalamic tract in the ANT.The day prior to surgery in a 19-year-old, right-handed woman with a 5-year history of epilepsy, MRI was performed on a 3-T Siemens Prisma scanner (Siemens AG, Healthcare Sector) using a 64-channel head and neck coil. As part of the imaging protocol, noncontrast magnetization-prepared rapid gradient echo (MP-RAGE) and diffusion tensor imaging (DTI) sequences were obtained for targeting purposes. The ANT was directly targeted using the FGATIR sequence, and bilateral Medtronic 3389 leads were placed. At the last follow-up (2 months), the patient reported an approximate 75% decrease in seizure frequency, as well as a decrease in seizure severity.

scholarly journals Fully Automated Targeting Using Nonrigid Image Registration Matches Accuracy and Exceeds Precision of Best Manual Approaches to Subthalamic Deep Brain Stimulation Targeting in Parkinson Disease

Neurosurgery ◽  
2015 ◽  
Vol 76 (6) ◽  
pp. 756-765 ◽  
Author(s):  
Srivatsan Pallavaram ◽  
Pierre-François D'Haese ◽  
Wendell Lake ◽  
Peter E. Konrad ◽  
Benoit M. Dawant ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Image Registration ◽  
Parkinson Disease ◽  
Brain Stimulation ◽  
Red Nucleus ◽  
Nonrigid Image Registration ◽  
Direct Targeting ◽  
Fully Automatic ◽  
Stn Dbs ◽  
Deep Brain

Abstract BACKGROUND: Finding the optimal location for the implantation of the electrode in deep brain stimulation (DBS) surgery is crucial for maximizing the therapeutic benefit to the patient. Such targeting is challenging for several reasons, including anatomic variability between patients as well as the lack of consensus about the location of the optimal target. OBJECTIVE: To compare the performance of popular manual targeting methods against a fully automatic nonrigid image registration-based approach. METHODS: In 71 Parkinson disease subthalamic nucleus (STN)-DBS implantations, an experienced functional neurosurgeon selected the target manually using 3 different approaches: indirect targeting using standard stereotactic coordinates, direct targeting based on the patient magnetic resonance imaging, and indirect targeting relative to the red nucleus. Targets were also automatically predicted by using a leave-one-out approach to populate the CranialVault atlas with the use of nonrigid image registration. The different targeting methods were compared against the location of the final active contact, determined through iterative clinical programming in each individual patient. RESULTS: Targeting by using standard stereotactic coordinates corresponding to the center of the motor territory of the STN had the largest targeting error (3.69 mm), followed by direct targeting (3.44 mm), average stereotactic coordinates of active contacts from this study (3.02 mm), red nucleus-based targeting (2.75 mm), and nonrigid image registration-based automatic predictions using the CranialVault atlas (2.70 mm). The CranialVault atlas method had statistically smaller variance than all manual approaches. CONCLUSION: Fully automatic targeting based on nonrigid image registration with the use of the CranialVault atlas is as accurate and more precise than popular manual methods for STN-DBS.

scholarly journals Open-loop deep brain stimulation for the treatment of epilepsy: a systematic review of clinical outcomes over the past decade (2008–present)

2018 ◽  
Vol 45 (2) ◽  
pp. E5 ◽  
Author(s):  
James J. Zhou ◽  
Tsinsue Chen ◽  
S. Harrison Farber ◽  
Andrew G. Shetter ◽  
Francisco A. Ponce
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Refractory Epilepsy ◽  
Open Loop ◽  
Electric Stimulation Therapy ◽  
Anterior Nucleus ◽  
The Past ◽  
Centromedian Nucleus ◽  
Deep Brain ◽  
Stimulation Of

OBJECTIVEThe field of deep brain stimulation (DBS) for epilepsy has grown tremendously since its inception in the 1970s and 1980s. The goal of this review is to identify and evaluate all studies published on the topic of open-loop DBS for epilepsy over the past decade (2008 to present).METHODSA PubMed search was conducted to identify all articles reporting clinical outcomes of open-loop DBS for the treatment of epilepsy published since January 1, 2008. The following composite search terms were used: (“epilepsy” [MeSH] OR “seizures” [MeSH] OR “kindling, neurologic” [MeSH] OR epilep* OR seizure* OR convuls*) AND (“deep brain stimulation” [MeSH] OR “deep brain stimulation” OR “DBS”) OR (“electric stimulation therapy” [MeSH] OR “electric stimulation therapy” OR “implantable neurostimulators” [MeSH]).RESULTSThe authors identified 41 studies that met the criteria for inclusion. The anterior nucleus of the thalamus, centromedian nucleus of the thalamus, and hippocampus were the most frequently evaluated targets. Among the 41 articles, 19 reported on stimulation of the anterior nucleus of the thalamus, 6 evaluated stimulation of the centromedian nucleus of the thalamus, and 9 evaluated stimulation of the hippocampus. The remaining 7 articles reported on the evaluation of alternative DBS targets, including the posterior hypothalamus, subthalamic nucleus, ventral intermediate nucleus of the thalamus, nucleus accumbens, caudal zone incerta, mammillothalamic tract, and fornix. The authors evaluated each study for overall epilepsy response rates as well as adverse events and other significant, nonepilepsy outcomes.CONCLUSIONSLevel I evidence supports the safety and efficacy of stimulating the anterior nucleus of the thalamus and the hippocampus for the treatment of medically refractory epilepsy. Level III and IV evidence supports stimulation of other targets for epilepsy. Ongoing research into the efficacy, adverse effects, and mechanisms of open-loop DBS continues to expand the knowledge supporting the use of these treatment modalities in patients with refractory epilepsy.

scholarly journals Deep brain stimulation of the anterior nucleus of the thalamus for drug-resistant epilepsy

2018 ◽  
Vol 42 (2) ◽  
pp. 287-296 ◽  
Author(s):  
Tim A. M. Bouwens van der Vlis ◽  
Olaf E. M. G. Schijns ◽  
Frédéric L. W. V. J. Schaper ◽  
Govert Hoogland ◽  
Pieter Kubben ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Drug Resistant ◽  
Anterior Nucleus ◽  
Drug Resistant Epilepsy ◽  
Deep Brain ◽  
Stimulation Of

scholarly journals Predictors of second-sided deep brain stimulation for Parkinson’s disease

2020 ◽  
pp. 1-7
Author(s):  
Joshua L. Golubovsky ◽  
Hong Li ◽  
Arbaz Momin ◽  
Jianning Shao ◽  
Maxwell Y. Lee ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Rating Scale ◽  
Intraoperative Complications ◽  
Cohort Analysis ◽  
Initial Surgery ◽  
Patient Reported ◽  
Deep Brain

OBJECTIVEParkinson’s disease (PD) is a progressive neurological movement disorder that is commonly treated with deep brain stimulation (DBS) surgery in advanced stages. The purpose of this study was to investigate factors that affect time to placement of a second-sided DBS lead for PD when a unilateral lead is initially placed for asymmetrical presentation. The decision whether to initially perform unilateral or bilateral DBS is largely based on physician and/or patient preference.METHODSThis study was a retrospective cohort analysis of patients with PD undergoing initial unilateral DBS for asymmetrical disease between January 1999 and December 2017 at the authors’ institution. Patients treated with DBS for essential tremor or other conditions were excluded. Variables collected included demographics at surgery, time since diagnosis, Unified Parkinson’s Disease Rating Scale motor scores (UPDRS-III), patient-reported quality-of-life outcomes, side of operation, DBS target, intraoperative complications, and date of follow-up. Paired t-tests were used to assess mean changes in UPDRS-III. Cox proportional hazards analysis and the Kaplan-Meier method were used to determine factors associated with time to second lead insertion over 5 years.RESULTSThe final cohort included 105 patients who underwent initial unilateral DBS for asymmetrical PD; 59% of patients had a second-sided lead placed within 5 years with a median time of 34 months. Factors found to be significantly associated with early second-sided DBS included patient age 65 years or younger, globus pallidus internus (GPi) target, and greater off-medication reduction in UPDRS-III score following initial surgery. Older age was also found to be associated with a smaller preoperative UPDRS-III levodopa responsiveness score and with a smaller preoperative to postoperative medication-off UPDRS-III change.CONCLUSIONSYounger patients, those undergoing GPi-targeted unilateral DBS, and patients who responded better to the initial DBS were more likely to undergo early second-sided lead placement. Therefore, these patients, and patients who are more responsive to medication preoperatively (as a proxy for DBS responsiveness), may benefit from consideration of initial bilateral DBS.

scholarly journals Deep Brain Stimulation of Medial Dorsal and Ventral Anterior Nucleus of the Thalamus in OCD: A Retrospective Case Series

PLoS ONE ◽  
2016 ◽  
Vol 11 (8) ◽  
pp. e0160750 ◽  
Author(s):  
Mohammad Maarouf ◽  
Clemens Neudorfer ◽  
Faycal El Majdoub ◽  
Doris Lenartz ◽  
Jens Kuhn ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Case Series ◽  
Retrospective Case ◽  
Anterior Nucleus ◽  
Medial Dorsal ◽  
Retrospective Case Series ◽  
Deep Brain ◽  
Stimulation Of

Deep brain stimulation for pain relief with special reference to midbrain periaqueductal gray matter

Pain ◽  
1984 ◽  
Vol 18 ◽  
pp. S114
Author(s):  
K. Amano ◽  
H. Kawamura ◽  
T. Tanikawa ◽  
H. Kawabatake ◽  
M. Notani ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Pain Relief ◽  
Special Reference ◽  
Gray Matter ◽  
Brain Stimulation ◽  
Periaqueductal Gray ◽  
Periaqueductal Gray Matter ◽  
Deep Brain

Magnetic resonance imaging techniques for visualization of the subthalamic nucleus

2011 ◽  
Vol 115 (5) ◽  
pp. 971-984 ◽  
Author(s):  
Ellen J. L. Brunenberg ◽  
Bram Platel ◽  
Paul A. M. Hofman ◽  
Bart M. ter Haar Romeny ◽  
Veerle Visser-Vandewalle
Keyword(s):  
Deep Brain Stimulation ◽  
Mr Imaging ◽  
Subthalamic Nucleus ◽  
Brain Stimulation ◽  
Imaging Techniques ◽  
Patient Specific ◽  
Anatomical Landmarks ◽  
Indirect Methods ◽  
Direct Targeting ◽  
Deep Brain

The authors reviewed 70 publications on MR imaging–based targeting techniques for identifying the subthalamic nucleus (STN) for deep brain stimulation in patients with Parkinson disease. Of these 70 publications, 33 presented quantitatively validated results. There is still no consensus on which targeting technique to use for surgery planning; methods vary greatly between centers. Some groups apply indirect methods involving anatomical landmarks, or atlases incorporating anatomical or functional data. Others perform direct visualization on MR imaging, using T2-weighted spin echo or inversion recovery protocols. The combined studies do not offer a straightforward conclusion on the best targeting protocol. Indirect methods are not patient specific, leading to varying results between cases. On the other hand, direct targeting on MR imaging suffers from lack of contrast within the subthalamic region, resulting in a poor delineation of the STN. These deficiencies result in a need for intraoperative adaptation of the original target based on test stimulation with or without microelectrode recording. It is expected that future advances in MR imaging technology will lead to improvements in direct targeting. The use of new MR imaging modalities such as diffusion MR imaging might even lead to the specific identification of the different functional parts of the STN, such as the dorsolateral sensorimotor part, the target for deep brain stimulation.

Anterior Nucleus Deep Brain Stimulation for Refractory Epilepsy

Neurosurgery ◽  
2016 ◽  
Vol 78 (6) ◽  
pp. 802-811 ◽  
Author(s):  
Vibhor Krishna ◽  
Nicolas Kon Kam King ◽  
Francesco Sammartino ◽  
Ido Strauss ◽  
Danielle M. Andrade ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Seizure Frequency ◽  
Brain Stimulation ◽  
Refractory Epilepsy ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Anterior Nucleus ◽  
Term Efficacy ◽  
Deep Brain

Abstract BACKGROUND: Anterior nucleus (AN) deep brain stimulation (DBS) is a palliative treatment for medically refractory epilepsy. The long-term efficacy and the optimal target localization for AN DBS are not well understood. OBJECTIVE: To analyze the long-term efficacy of AN DBS and its predictors. METHODS: We performed a retrospective review of 16 patients who underwent AN DBS. We selected only patients with reliable seizure frequency data and at least a 1-year follow-up. We studied the duration of the seizure reduction after DBS insertion and before stimulation (the insertional effect) and its association with long-term outcome. We modeled the volume of activation using the active contacts, stimulation parameters, and postoperative imaging. The overlap of this volume was plotted in Montreal Neurological Institute 152 space in 7 patients with significant clinical efficacy. RESULTS: Nine patients reported a decrease in seizure frequency immediately after electrode insertion (insertional or microthalamotomy effect). The duration of insertional effect varied from 2 to 4 months. However, 1 patient had a long-term insertional effect of 36 months. Altogether, 11 patients reported >50% decrease in seizure frequency with long-term stimulation. The most common pattern of seizure control was immediate and sustained stimulation benefit (n = 8). In patients with long-term stimulation benefit, the efficacious target was localized in the anteroventral AN in close proximity to the mammillothalamic tract. CONCLUSION: AN DBS is efficacious in the control of seizure frequency in selected patients. An insertional effect is commonly observed (56%). The most efficacious site of stimulation appears to be the anteroventral AN.

scholarly journals Neuropsychiatric Outcome of an Adolescent Who Received Deep Brain Stimulation for Tourette's Syndrome

2011 ◽  
Vol 2011 ◽  
pp. 1-4 ◽  
Author(s):  
S. J. Pullen ◽  
C. A. Wall ◽  
K. H. Lee ◽  
S. M. Stead ◽  
B. T. Klassen ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Adaptive Functioning ◽  
Case Reports ◽  
Tourette's Syndrome ◽  
Adolescent Male ◽  
Tourette’S Syndrome ◽  
Patient Reported ◽  
Deep Brain ◽  
Neuropsychiatric Outcome

This case study followed one adolescent patient who underwent bilateral deep brain stimulation of the centromedian parafascicular complex (CM-Pf) for debilitating, treatment refractory Tourette's syndrome for a period of 1.5 years. Neurocognitive testing showed no significant changes between baseline and follow-up assessments. Psychiatric assessment revealed positive outcomes in overall adaptive functioning and reduction in psychotropic medication load in this patient. Furthermore, despite significant baseline psychiatric comorbidity, this patient reported no suicidal ideation following electrode implantation. Deep brain stimulation is increasingly being used in children and adolescents. This case reports on the positive neurologic and neuropsychiatric outcome of an adolescent male with bilateral CM-Pf stimulation.

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