Directional stimulation of subthalamic nucleus sweet spot predicts clinical efficacy: Proof of concept
Background: Directional deep brain stimulation (dDBS) of the subthalamic nucleus for Parkinson's disease (PD) increases the therapeutic window. However, empirical programming of the neurostimulator becomes more complex given the increasing number of stimulation parameters. A better understandin...
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doaj-7c0b39c3224f4a3da677caeaa96fc1f62021-03-19T07:20:14ZengElsevierBrain Stimulation1935-861X2019-09-0112511271134Directional stimulation of subthalamic nucleus sweet spot predicts clinical efficacy: Proof of conceptT.A. Khoa Nguyen0Andreas Nowacki1Ines Debove2Katrin Petermann3Gerd Tinkhauser4Roland Wiest5Michael Schüpbach6Paul Krack7Claudio Pollo8Department of Neurosurgery, Inselspital, University Hospital Bern, University of Bern, Bern, SwitzerlandDepartment of Neurosurgery, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland; Corresponding author.Department of Neurology, Inselspital, University Hospital Bern, University of Bern, Bern, SwitzerlandDepartment of Neurology, Inselspital, University Hospital Bern, University of Bern, Bern, SwitzerlandDepartment of Neurology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland; Medical Research Council Brain Network Dynamics Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, United KingdomDepartment of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital Bern, and University of Bern, Bern, SwitzerlandDepartment of Neurology, Inselspital, University Hospital Bern, University of Bern, Bern, SwitzerlandDepartment of Neurology, Inselspital, University Hospital Bern, University of Bern, Bern, SwitzerlandDepartment of Neurosurgery, Inselspital, University Hospital Bern, University of Bern, Bern, SwitzerlandBackground: Directional deep brain stimulation (dDBS) of the subthalamic nucleus for Parkinson's disease (PD) increases the therapeutic window. However, empirical programming of the neurostimulator becomes more complex given the increasing number of stimulation parameters. A better understanding of dDBS is needed to improve therapy and help guide postoperative programming. Objective: To determine whether clinical effects of dDBS can be predicted in individual patients based on lead location and volume of tissue activated (VTA) modelling. Methods: We analysed a prospective series of 28 PD patients. Imaging analysis and systematic clinical testing performed 4–6 months postoperatively yielded location, clinical efficacy and corresponding therapeutic windows for 272 directional contacts. We calculated the corresponding VTAs to build a probabilistic stimulation map using voxel-wise statistical analysis. Results: We found a positive and statistically significant correlation between the overlap ratio of a patient's individual stimulation volume and the probabilistic map's sweet spot –defined as the 10% voxels with the highest clinical efficacy values (average Spearman's rho = 0.43, average p ≤ 0.036). Patients who had a larger therapeutic window with directional compared to omnidirectional stimulation had a larger distance between the electrode and the sweet spot centroid (average distances 2.3 vs. 1.5 mm, p = 0.0019). Conclusion: Our analysis provides new insights into how the definition of a probabilistic sweet spot based on directional stimulation data and individual VTA modelling can be applied to predict clinically effective directional stimulation and help guide clinicians with the intricate postoperative DBS programming.http://www.sciencedirect.com/science/article/pii/S1935861X19302074Deep brain stimulationDirectional electrodeParkinson's diseaseVolume of tissue activatedProbabilistic stimulation map |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
T.A. Khoa Nguyen Andreas Nowacki Ines Debove Katrin Petermann Gerd Tinkhauser Roland Wiest Michael Schüpbach Paul Krack Claudio Pollo |
spellingShingle |
T.A. Khoa Nguyen Andreas Nowacki Ines Debove Katrin Petermann Gerd Tinkhauser Roland Wiest Michael Schüpbach Paul Krack Claudio Pollo Directional stimulation of subthalamic nucleus sweet spot predicts clinical efficacy: Proof of concept Brain Stimulation Deep brain stimulation Directional electrode Parkinson's disease Volume of tissue activated Probabilistic stimulation map |
author_facet |
T.A. Khoa Nguyen Andreas Nowacki Ines Debove Katrin Petermann Gerd Tinkhauser Roland Wiest Michael Schüpbach Paul Krack Claudio Pollo |
author_sort |
T.A. Khoa Nguyen |
title |
Directional stimulation of subthalamic nucleus sweet spot predicts clinical efficacy: Proof of concept |
title_short |
Directional stimulation of subthalamic nucleus sweet spot predicts clinical efficacy: Proof of concept |
title_full |
Directional stimulation of subthalamic nucleus sweet spot predicts clinical efficacy: Proof of concept |
title_fullStr |
Directional stimulation of subthalamic nucleus sweet spot predicts clinical efficacy: Proof of concept |
title_full_unstemmed |
Directional stimulation of subthalamic nucleus sweet spot predicts clinical efficacy: Proof of concept |
title_sort |
directional stimulation of subthalamic nucleus sweet spot predicts clinical efficacy: proof of concept |
publisher |
Elsevier |
series |
Brain Stimulation |
issn |
1935-861X |
publishDate |
2019-09-01 |
description |
Background: Directional deep brain stimulation (dDBS) of the subthalamic nucleus for Parkinson's disease (PD) increases the therapeutic window. However, empirical programming of the neurostimulator becomes more complex given the increasing number of stimulation parameters. A better understanding of dDBS is needed to improve therapy and help guide postoperative programming. Objective: To determine whether clinical effects of dDBS can be predicted in individual patients based on lead location and volume of tissue activated (VTA) modelling. Methods: We analysed a prospective series of 28 PD patients. Imaging analysis and systematic clinical testing performed 4–6 months postoperatively yielded location, clinical efficacy and corresponding therapeutic windows for 272 directional contacts. We calculated the corresponding VTAs to build a probabilistic stimulation map using voxel-wise statistical analysis. Results: We found a positive and statistically significant correlation between the overlap ratio of a patient's individual stimulation volume and the probabilistic map's sweet spot –defined as the 10% voxels with the highest clinical efficacy values (average Spearman's rho = 0.43, average p ≤ 0.036). Patients who had a larger therapeutic window with directional compared to omnidirectional stimulation had a larger distance between the electrode and the sweet spot centroid (average distances 2.3 vs. 1.5 mm, p = 0.0019). Conclusion: Our analysis provides new insights into how the definition of a probabilistic sweet spot based on directional stimulation data and individual VTA modelling can be applied to predict clinically effective directional stimulation and help guide clinicians with the intricate postoperative DBS programming. |
topic |
Deep brain stimulation Directional electrode Parkinson's disease Volume of tissue activated Probabilistic stimulation map |
url |
http://www.sciencedirect.com/science/article/pii/S1935861X19302074 |
work_keys_str_mv |
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