Directional stimulation of subthalamic nucleus sweet spot predicts clinical efficacy: Proof of concept.

Nguyen, Thuy Anh Khoa; Nowacki, Andreas; Debove, Ines; Petermann, Katrin; Tinkhauser, Gerd; Wiest, Roland; Schüpbach, Michael; Krack, Paul; Pollo, Claudio (2019). Directional stimulation of subthalamic nucleus sweet spot predicts clinical efficacy: Proof of concept. Brain stimulation, 12(5), pp. 1127-1134. Elsevier 10.1016/j.brs.2019.05.001

[img] Text
1-s2.0-S1935861X19302074-main.pdf - Published Version
Restricted to registered users only
Available under License Publisher holds Copyright.

Download (1MB) | Request a copy

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.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurosurgery
04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology
04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic and Interventional Neuroradiology

UniBE Contributor:

Nguyen, Thuy Anh Khoa; Nowacki, Andreas; Debove, Ines; Petermann, Katrin; Tinkhauser, Gerd; Wiest, Roland; Schüpbach, Michael; Krack, Paul and Pollo, Claudio

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1935-861X

Publisher:

Elsevier

Language:

English

Submitter:

Martin Zbinden

Date Deposited:

18 Jul 2019 09:37

Last Modified:

23 Aug 2019 01:31

Publisher DOI:

10.1016/j.brs.2019.05.001

PubMed ID:

31130498

Uncontrolled Keywords:

Deep brain stimulation Directional electrode Parkinson's disease Probabilistic stimulation map Volume of tissue activated

BORIS DOI:

10.7892/boris.131186

URI:

https://boris.unibe.ch/id/eprint/131186

Actions (login required)

Edit item Edit item
Provide Feedback