Electrophysiological confrontation of Lead-DBS-based electrode localizations in patients with Parkinson’s disease undergoing deep brain stimulation

Awadhi, Abdullah Al; Tyrand, Rémi; Horn, Andreas; Kibleur, Astrid; Vincentini, Julia; Zacharia, André; Burkhard, Pierre; Momjian, Shahan; Boëx, Colette

doi:10.1016/j.nicl.2022.102971

Cited by 10 publications

(11 citation statements)

References 41 publications

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“…Additionally, they found that the STN differed by subdivision by their beta oscillations; there was more beta activity in the sensorimotor and associative division than in the limbic division. The authors of this paper theorize that differences in beta oscillation and spike patterns could provide additional markers when attempting to localize electrode targets [16]. Stimulation of the STN (specifically the pars reticulata, which serves as an output to the basal ganglia) at low intensities, such as 14 Hz, did not modify the oscillatory activity of the STN neurons.…”

Section: Intraoperative Neurophysiological Signals Monitored During I...mentioning

confidence: 87%

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Deep Brain Stimulation and Microelectrode Recording for the Treatment of Parkinson’s Disease

Fejeran¹,

Salazar²,

Alvarez³

et al. 2022

Cureus

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Parkinson's disease (PD) is a neurological disorder in which nigrostriatal pathways involving the basal ganglia experience a decrease in neural activity regarding dopaminergic neurons. PD symptoms, such as muscle stiffness and involuntary tremors, have an adverse impact on the daily lives of those affected. Current medical treatments seek to decrease the severity of these symptoms. Deep brain stimulation (DBS) has become the preferred safe, and reliable treatment approach. DBS involves implanting microelectrodes into subcortical areas that produce electrical impulses directly to high populations of dopaminergic neurons. The most common targets are the subthalamic nucleus (STN), and the basal ganglia's globus pallidus pars interna (GPi). Research studies suggest that DBS of the STN may cause a significant reduction in the daily dose of L-DOPA compared to DBS of the GPi. DBS of the STN has suggested that there may be sweet spots within the STN that provide hyper-direct cortical connectivity pathways to the primary motor cortex (M1), supplementary motor area (SMA), and prefrontal cortex (PFC). In addition, the pedunculopontine nucleus (PPN) may be a new target for DBS that helps treat locomotion problems associated with gait and posture. Both microelectrode recording (MER) and magnetic resonance imaging (MRI) are used to ensure electrode placement accuracy. Using MER, stimulation of the STN at high frequencies (140<) decreased oscillatory neuronal firing by 67%. This paper investigates methods of intraoperative neuromonitoring during DBS as a form of PD treatment.

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Section: Intraoperative Neurophysiological Signals Monitored During I...mentioning

confidence: 87%

“…The researchers then used MRI to verify the localization and trajectories used intraoperatively. The data collected found that spike amplitudes were higher in the limbic region of the STN than in the distal lateral STN [16].…”

Section: Intraoperative Neurophysiological Signals Monitored During I...mentioning

confidence: 94%

Deep Brain Stimulation and Microelectrode Recording for the Treatment of Parkinson’s Disease

Fejeran¹,

Salazar²,

Alvarez³

et al. 2022

Cureus

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“…A possible explanation for the similar performance may be related to the location of the sweet spot, which is located at the dorsal border of the subthalamic nucleus. Two studies have shown that imaging and electrophysiology highly agree in detecting that dorsal border or entry into the subthalamic nucleus ( Nowacki et al, 2018 ; Al Awadhi et al, 2022 ).…”

Section: Discussionmentioning

confidence: 99%

Programming of subthalamic nucleus deep brain stimulation for Parkinson’s disease with sweet spot-guided parameter suggestions

Nordenström

Petermann

Debove

et al. 2022

Front. Hum. Neurosci.

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Deep Brain Stimulation (DBS) is an effective treatment for advanced Parkinson’s disease. However, identifying stimulation parameters, such as contact and current amplitudes, is time-consuming based on trial and error. Directional leads add more stimulation options and render this process more challenging with a higher workload for neurologists and more discomfort for patients. In this study, a sweet spot-guided algorithm was developed that automatically suggested stimulation parameters. These suggestions were retrospectively compared to clinical monopolar reviews. A cohort of 24 Parkinson’s disease patients underwent bilateral DBS implantation in the subthalamic nucleus at our center. First, the DBS’ leads were reconstructed with the open-source toolbox Lead-DBS. Second, a sweet spot for rigidity reduction was set as the desired stimulation target for programming. This sweet spot and estimations of the volume of tissue activated were used to suggest (i) the best lead level, (ii) the best contact, and (iii) the effect thresholds for full therapeutic effect for each contact. To assess these sweet spot-guided suggestions, the clinical monopolar reviews were considered as ground truth. In addition, the sweet spot-guided suggestions for best lead level and best contact were compared against reconstruction-guided suggestions, which considered the lead location with respect to the subthalamic nucleus. Finally, a graphical user interface was developed as an add-on to Lead-DBS and is publicly available. With the interface, suggestions for all contacts of a lead can be generated in a few seconds. The accuracy for suggesting the best out of four lead levels was 56%. These sweet spot-guided suggestions were not significantly better than reconstruction-guided suggestions (p = 0.3). The accuracy for suggesting the best out of eight contacts was 41%. These sweet spot-guided suggestions were significantly better than reconstruction-guided suggestions (p < 0.001). The sweet spot-guided suggestions of each contact’s effect threshold had a mean error of 1.2 mA. On an individual lead level, the suggestions can vary more with mean errors ranging from 0.3 to 4.8 mA. Further analysis is warranted to improve the sweet spot-guided suggestions and to account for more symptoms and stimulation-induced side effects.

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“…Multiple human intraoperative centres showed that MERs yield accurate electrophysiological spatial demarcation of target borders and identification of neural patterns that highlight optimal stimulation settings as well as discriminate clinical states [12][13][14][15][16][17][18][19][20]. Most of these studies focused on the Subthalamic nucleus (STN) per se, which represents another important DBS target for dystonia and other movement disorders, such as Parkinson's Disease (PD) [21,22].…”

Section: Introductionmentioning

confidence: 99%

“…The peculiar characteristics of the transition from the external segment of the globus pallidus (GPe) to GPi, such as the sparseness of the neurons along the pallidum, the absence of a marked reduction in neuronal activity, and the high discharge rate variability, challenged the electrophysiological determination of GPi borders [27,28]. Occasionally, the identification of increasing background activity and border cells, characterized by low firing rates (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20), may help identify the GPe-GPi transition.…”

Section: Introductionmentioning

confidence: 99%

Mapping the electrophysiological structure of dystonic Globus Pallidus pars interna through intraoperative microelectrode recordings

Kaymak

Vissani

Rinaldo

et al. 2022

Preprint

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Objective. The Globus Pallidus pars interna (GPi) is one of the main targets for Deep Brain Stimulation (DBS) therapies for dystonia and other movement disorders. Still, a complete picture of the spiking dynamics of the nucleus is far from being achieved. Microelectrode recordings (MER) provide a unique brain window opportunity to shed light on GPi organization, which might support intraoperative DBS target localization, as previously done for the Subthalamic nucleus (STN). Approach. Here we propose a novel procedure to analyze explorative MERs from DBS implants in dystonic patients. The procedure identifies the neural activity markers discriminating neurons in the GPi from those in the neighbouring structures, as well as the markers discriminating neurons located in different regions within the GPi. Main results. The identification of the borders of the GPi based on neural markers was a difficult task, due to internal inhomogeneities in GPi firing dynamics. However, the procedure was able to exploit these inhomogeneities to characterize the internal electrophysiological structure of the GPi. In particular, we found a reliable dorsolateral gradient in firing activity and regularity. Significance. Overall, we characterized the spatial distribution of neural activity markers in the dystonic GPi, paving the way for the use of these markers for DBS target localization. The procedure we developed to achieve this result could be easily extended to MER performed for other disorders and in other areas.

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Electrophysiological confrontation of Lead-DBS-based electrode localizations in patients with Parkinson’s disease undergoing deep brain stimulation

Cited by 10 publications

References 41 publications

Deep Brain Stimulation and Microelectrode Recording for the Treatment of Parkinson’s Disease

Deep Brain Stimulation and Microelectrode Recording for the Treatment of Parkinson’s Disease

Programming of subthalamic nucleus deep brain stimulation for Parkinson’s disease with sweet spot-guided parameter suggestions

Mapping the electrophysiological structure of dystonic Globus Pallidus pars interna through intraoperative microelectrode recordings

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