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

Grewal, Sanjeet S.; Middlebrooks, Erik H.; Kaufmann, Timothy J.; Stead, Matthew; Lundstrom, Brian Nils; Worrell, Gregory A.; Lin, Chen; Baydın, Serhat; Gompel, Jamie J. Van

doi:10.3171/2018.4.focus18147

Cited by 52 publications

(27 citation statements)

References 34 publications

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“…High accuracy (90%) for placing contacts into the ANT was found with this approach leveraging the MTT junction as an anatomical landmark. 38 Future studies comparing lead placement, stimulation sites, and clinical outcome of patients with different surgical trajectories will shed more light on the optimal surgical approach and stimulation site in ANT-DBS for epilepsy.…”

Section: Discussionmentioning

confidence: 99%

Deep Brain Stimulation in Epilepsy: A Role for Modulation of the Mammillothalamic Tract in Seizure Control?

et al. 2020

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BACKGROUND Deep brain stimulation of the anterior nucleus of the thalamus (ANT-DBS) can improve seizure control for patients with drug-resistant epilepsy (DRE). Yet, one cannot overlook the high discrepancy in efficacy among patients, possibly resulting from differences in stimulation site. OBJECTIVE To test the hypothesis that stimulation at the junction of the ANT and mammillothalamic tract (ANT-MTT junction) increases seizure control. METHODS The relationship between seizure control and the location of the active contacts to the ANT-MTT junction was investigated in 20 patients treated with ANT-DBS for DRE. Coordinates and Euclidean distance of the active contacts relative to the ANT-MTT junction were calculated and related to seizure control. Stimulation sites were mapped by modelling the volume of tissue activation (VTA) and generating stimulation heat maps. RESULTS After 1 yr of stimulation, patients had a median 46% reduction in total seizure frequency, 50% were responders, and 20% of patients were seizure-free. The Euclidean distance of the active contacts to the ANT-MTT junction correlates to change in seizure frequency (r2 = 0.24, P = .01) and is ∼30% smaller (P = .015) in responders than in non-responders. VTA models and stimulation heat maps indicate a hot-spot at the ANT-MTT junction for responders, whereas non-responders had no evident hot-spot. CONCLUSION Stimulation at the ANT-MTT junction correlates to increased seizure control. Our findings suggest a relationship between the stimulation site and therapy response in ANT-DBS for epilepsy with a potential role for the MTT. DBS directed at white matter merits further exploration for the treatment of epilepsy.

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Section: Discussionmentioning

confidence: 99%

Deep Brain Stimulation in Epilepsy: A Role for Modulation of the Mammillothalamic Tract in Seizure Control?

et al. 2020

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“…With the development of new imaging techniques, studies have reported that 3 T MRI STIR and 3 T MRI T1w MPRAGE can be used to direct the stereotactic targeting of the ANT through the visualization of white matter structures, such as the mtt, eml, and iml, which envelope the ANT ( Buentjen et al, 2014 ). Diffusion tensor imaging sequences have also been postulated as possible methods for tracking the mtt ( Grewal et al, 2018 ). These imaging sequences are not direct methods for visualizing the ANT, but by virtue of visualizing the surrounding structures, they can consequently delineate the ANT borders with relative accuracy.…”

Section: Discussionmentioning

confidence: 99%

Direct Targeting of the Anterior Nucleus of the Thalamus via 3 T Quantitative Susceptibility Mapping

Ren

et al. 2021

Front. Neurosci.

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Objective: Deep brain stimulation (DBS) of the anterior nucleus of the thalamus (ANT) is a potentially effective, minimally invasive, and reversible method for treating epilepsy. The goal of this study was to explore whether 3 T quantitative susceptibility mapping (QSM) could delineate the ANT from surrounding structures, which is important for the direct targeting of DBS surgery.Methods: We obtained 3 T QSM, T1-weighted (T1w), and T2-weighted (T2w) images from 11 patients with Parkinson’s disease or dystonia who received subthalamic nucleus (STN) or globus pallidus interna (GPi) DBS surgery in our center. The ANT and its surrounding white matter structures on QSM were compared with available atlases. The contrast-to-noise ratios (CNRs) of ANT relative to the external medullary lamina (eml) were compared across the three imaging modalities. Additionally, the morphology and location of the ANT were depicted in the anterior commissure (AC)-posterior commissure (PC)-based system.Results: ANT can be clearly distinguished from the surrounding white matter laminas and appeared hyperintense on QSM. The CNRs of the ANT-eml on QSM, T1w, and T2w images were 10.20 ± 4.23, 1.71 ± 1.03, and 1.35 ± 0.70, respectively. One-way analysis of variance (ANOVA) indicated significant differences in CNRs among QSM, T1w, and T2w imaging modalities [F(2) = 85.28, p < 0.0001]. In addition, both the morphology and location of the ANT were highly variable between patients in the AC–PC-based system.Conclusion: The potential utility of QSM for the visualization of ANTs in clinical imaging is promising and may be suitable for targeting the ANT for DBS to treat epilepsy.

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“…Magnetic resonance imaging (MRI) was performed after Leksell (Elekta Inc.) frame fixation for stereotactic targeting. Medtronic 3387s electrodes were then implanted in the ANT by direct targeting of the mammillothalamic tract on MRI (FGATIR sequence ( 66 )). Medtronic 3391 electrodes were implanted into the hippocampus through direct targeting of the amygdala and hippocampal head.…”

Section: Methodsmentioning

confidence: 99%

Distributed brain co-processor for tracking electrophysiology and behavior during electrical brain stimulation

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Nejedlý

Mívalt

et al. 2021

Preprint

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Electrical brain stimulation is a proven therapy for epilepsy, but long-term seizure free outcomes are rare. Early implantable devices were developed for open-loop stimulation without sensing, embedded computing or adaptive therapy. Recent device advances include sensing and closed-loop responsive stimulation, but these clinically available devices lack adequate computing, data storage and patient interface to concisely catalog behavior, seizures, and brain electrophysiology, despite the critical importance of these details for epilepsy management. Here we describe the first application of a distributed brain co-processor providing an intuitive, bi-directional interface between device implant, patient & physician, and implement it in human and canine patients with epilepsy living in their natural environments. Automated behavioral state tracking (awake and sleep) and electrophysiologic classifiers for interictal epileptiform discharges and electrographic seizures are run on local hand-held and distributed cloud computing resources to guide adaptive electrical stimulation. These algorithms were first developed and parameterized using long-term retrospective data from 10 humans and 11 canines with epilepsy and then implemented prospectively in two pet canines and one human with drug resistant epilepsy as they naturally navigate their lives in society.

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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

Cited by 52 publications

References 34 publications

Deep Brain Stimulation in Epilepsy: A Role for Modulation of the Mammillothalamic Tract in Seizure Control?

Deep Brain Stimulation in Epilepsy: A Role for Modulation of the Mammillothalamic Tract in Seizure Control?

Direct Targeting of the Anterior Nucleus of the Thalamus via 3 T Quantitative Susceptibility Mapping

Distributed brain co-processor for tracking electrophysiology and behavior during electrical brain stimulation

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