Intra-operative Identification of the Subthalamic Nucleus Motor Zone Using Goniometers

Shamir, Reuben R.; Eitan, Renana; Sheffer, Sivan; Marmor-Levin, Odeya; Valsky, D. V.; Moshel, Shay; Zaidel, Adam; Bergman, Hagai; Israel, Zvi

doi:10.1007/978-3-642-38568-1_3

Cited by 3 publications

(1 citation statement)

References 17 publications

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“…These descriptions were mostly for research purposes, for example the one-time use of inertial sensors during a thalamotomy [21], the evaluation of the effect of non-constant interpulse intervals of DBS stimulation on tremor [4], or the identification of a target structure by spectral correlation of a tremor signal from goniometers with the electrophysiological signal from microelectrode recording [43]. To our knowledge, only Journee et al [14] and Papapetropoulos et al [27] evaluated tremor intraoperatively in a relatively large patient cohort.…”

Section: Introductionmentioning

confidence: 99%

Intraoperative acceleration measurements to quantify improvement in tremor during deep brain stimulation surgery

Shah

Coste

Lemaire

et al. 2016

Med Biol Eng Comput

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Intraoperative acceleration measurements to quantify improvement in tremor during deep brain stimulation surgery. Medical and Biological Engineering and Computing, Springer Verlag, 2017, 55 (5) AbstractDeep brain stimulation (DBS) surgery is extensively used in the treatment of movement disorders. Nevertheless, methods to evaluate the clinical response during intraoperative stimulation tests to identify the optimal position for the implantation of the chronic DBS lead remain subjective. In this paper, we describe a new, versatile method for quantitative intraoperative evaluation of improvement in tremor with an acceleration sensor that is mounted on the patient's wrist during surgery. At each anatomical test position, the improvement in tremor compared to the initial tremor is estimated on the basis of extracted outcome measures. This method was tested on 15 tremor patients undergoing DBS surgery in two centers. Data from 359 stimulation tests were acquired. Our results suggest that accelerometric evaluation detects tremor changes more sensitively than subjective visual ratings. The effective stimulation current amplitudes identified from the quantitative data (1.1 ± 0.8 mA) are lower than those identified by visual evaluation (1.7 ± 0.8 mA) for similar improvement in tremor. Additionally, if these data had been used to choose the chronic implant position of the DBS lead, 15 of the 26 choices would have been different. These results show that our method of accelerometric evaluation can potentially improve DBS targeting.

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Section: Introductionmentioning

confidence: 99%

Intraoperative acceleration measurements to quantify improvement in tremor during deep brain stimulation surgery

Shah

Coste

Lemaire

et al. 2016

Med Biol Eng Comput

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Subthalamic nucleus input-output dynamics are correlated with Parkinson’s burden and treatment efficacy

Liu,

Guang,

Glowinsky

et al. 2024

npj Parkinsons Dis.

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The subthalamic nucleus (STN) is pivotal in basal ganglia function in health and disease. Micro-electrode recordings of >25,000 recording sites from 146 Parkinson’s patients undergoing deep brain stimulation (DBS) allowed differentiation between subthalamic input, represented by local field potential (LFP), and output, reflected in spike discharge rate (SPK). As with many natural systems, STN neuronal activity exhibits power-law dynamics characterized by the exponent α. We, therefore, dissected STN data into aperiodic and periodic components using the Fitting Oscillations & One Over F (FOOOF) tool. STN LFP showed significantly higher aperiodic exponents than SPK. Additionally, SPK beta oscillations demonstrated a downward frequency shift compared to LFP. Finally, the STN aperiodic and spiking parameters explained a significant fraction of the variance of the burden and treatment efficacy of Parkinson’s disease. The unique STN input-output dynamics may clarify its role in Parkinson’s physiology and can be utilized in closed-loop DBS therapy.

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Use of quantitative tremor evaluation to enhance target selection during deep brain stimulation surgery for essential tremor

Shah

Coste

Lemaire

et al. 2015

Current Directions in Biomedical Engineering

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Deep brain stimulation (DBS), an e ective surgical treatment for Essential Tremor (ET), requires test stimulations in the thalamus to nd the optimum site for permanent electrode implantation. During these test stimulations, the changes in tremor are only visually evaluated. This, along with other parameters, increases the subjectivity when comparing the e cacy of di erent thalamic nuclei. We developed a method to quantitatively evaluate tremor during the test stimulations of DBS surgery and applied to 6 ET patients undergoing this treatment. From the quantitative data collected, we identi ed e ective stimulation amplitudes for every test stimulation position and compared it with the ones identi ed visually during the surgery. We also classi ed the data based on the thalamic nuclei in which the center of the stimulating contact was present during test stimulations. Results indicate that, to achieve the same reduction in tremor, on average, the stimulation amplitude identi ed by our method was 0.6 mA lower than those identi ed by visual evaluation. The comparison of the di erent thalamic nuclei showed that stimulations in the Ventro-oral and the Intermediolateral nuclei of the thalamus result in higher reduction in tremor for similar stimulation amplitudes as the frequently targeted Ventrointermediate nucleus. We conclude that our quantitative tremor evaluation method is more sensitive than the widely used visual evaluation. Using such quantitative methods will aid in identifying the optimum target structure for patients undergoing DBS.

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Intra-operative Identification of the Subthalamic Nucleus Motor Zone Using Goniometers

Cited by 3 publications

References 17 publications

Intraoperative acceleration measurements to quantify improvement in tremor during deep brain stimulation surgery

Intraoperative acceleration measurements to quantify improvement in tremor during deep brain stimulation surgery

Subthalamic nucleus input-output dynamics are correlated with Parkinson’s burden and treatment efficacy

Use of quantitative tremor evaluation to enhance target selection during deep brain stimulation surgery for essential tremor

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