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

Shah, Ashesh; Coste, Jérôme; Lemaire, Jean‐Jacques; Taub, Ethan; Schüpbach, W. M. Michael; Pollo, Claudio; Schkommodau, Erik; Guzman, Raphael; Hemm-Ode, Simone

doi:10.1007/s11517-016-1559-9

Cited by 16 publications

(39 citation statements)

References 54 publications

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“…But those systems were not designed to be used in different clinical centers or during stimulation tests performed through an exploration electrode. In a previous study, we have demonstrated the use of our system in 15 DBS surgeries in two different clinical centers, the possibility to visualize and revisit recorded data during surgery and the possible influences of quantitative evaluations on the choice of the final implant position of the lead for chronic stimulation (Shah et al, 2016b). …”

Section: Discussionmentioning

confidence: 99%

“…In order to quantify the clinical improvement for each stimulation amplitude, a previously developed analysis method in Matlab (R2014b) was used (Shah et al, 2016b). As a first step, movements other than tremor were removed offline by using the smoothness priors method (Tarvainen et al, 2002) and thereafter a second order Butterworth low pass-filter was applied at 10 Hz in order to suppress noise.…”

Section: Methodsmentioning

confidence: 99%

“…We have previously presented a method to support the physician’s evaluation during surgery by quantifying intraoperatively obtained therapeutic effects on tremor (Shah et al, 2016b) and rigidity (Shah et al, 2016a) with the help of wrist acceleration measurements. These results suggest that mathematical parameters extracted from the acceleration signal are more sensitive to detect changes in tremor during intraoperative stimulation tests than the subjective neurologist’s evaluation.…”

Section: Introductionmentioning

confidence: 99%

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Patient-Specific Electric Field Simulations and Acceleration Measurements for Objective Analysis of Intraoperative Stimulation Tests in the Thalamus

Hemm

Pison

Alonso

et al. 2016

Front. Hum. Neurosci.

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Despite an increasing use of deep brain stimulation (DBS) the fundamental mechanisms of action remain largely unknown. Simulation of electric entities has previously been proposed for chronic DBS combined with subjective symptom evaluations, but not for intraoperative stimulation tests. The present paper introduces a method for an objective exploitation of intraoperative stimulation test data to identify the optimal implant position of the chronic DBS lead by relating the electric field (EF) simulations to the patient-specific anatomy and the clinical effects quantified by accelerometry. To illustrate the feasibility of this approach, it was applied to five patients with essential tremor bilaterally implanted in the ventral intermediate nucleus (VIM). The VIM and its neighborhood structures were preoperatively outlined in 3D on white matter attenuated inversion recovery MR images. Quantitative intraoperative clinical assessments were performed using accelerometry. EF simulations (n = 272) for intraoperative stimulation test data performed along two trajectories per side were set-up using the finite element method for 143 stimulation test positions. The resulting EF isosurface of 0.2 V/mm was superimposed to the outlined anatomical structures. The percentage of volume of each structure’s overlap was calculated and related to the corresponding clinical improvement. The proposed concept has been successfully applied to the five patients. For higher clinical improvements, not only the VIM but as well other neighboring structures were covered by the EF isosurfaces. The percentage of the volumes of the VIM, of the nucleus intermediate lateral of the thalamus and the prelemniscal radiations within the prerubral field of Forel increased for clinical improvements higher than 50% compared to improvements lower than 50%. The presented new concept allows a detailed and objective analysis of a high amount of intraoperative data to identify the optimal stimulation target. First results indicate agreement with published data hypothesizing that the stimulation of other structures than the VIM might be responsible for good clinical effects in essential tremor. (Clinical trial reference number: Ref: 2011-A00774-37/AU905)

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Patient-Specific Electric Field Simulations and Acceleration Measurements for Objective Analysis of Intraoperative Stimulation Tests in the Thalamus

Hemm

Pison

Alonso

et al. 2016

Front. Hum. Neurosci.

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“…We have previously published a method [42] using accelerometers to quantitatively evaluate improvement in tremor during intraoperative stimulation tests. By classifying the data collected from DBS for ET patients based on the position of the electrode with respect to the nuclei, it was possible to show that the ventro-oral (VO) nucleus of the thalamus can be as efficient in reducing tremor as the VIM [41].…”

Section: Introductionmentioning

confidence: 99%

Stimulation maps: visualization of results of quantitative intraoperative testing for deep brain stimulation surgery

Shah

Vogel

Alonso

et al. 2020

Med Biol Eng Comput

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Deep brain stimulation (DBS) is an established therapy for movement disorders such as essential tremor (ET). Positioning of the DBS lead in the patient's brain is crucial for effective treatment. Extensive evaluations of improvement and adverse effects of stimulation at different positions for various current amplitudes are performed intraoperatively. However, to choose the optimal position of the lead, the information has to be "mentally" visualized and analyzed. This paper introduces a new technique called "stimulation maps," which summarizes and visualizes the high amount of relevant data with the aim to assist in identifying the optimal DBS lead position. It combines three methods: outlines of the relevant anatomical structures, quantitative symptom evaluation, and patient-specific electric field simulations. Through this combination, each voxel in the stimulation region is assigned one value of symptom improvement, resulting in the division of stimulation region into areas with different improvement levels. This technique was applied retrospectively to five ET patients in the University Hospital in Clermont-Ferrand, France. Apart from identifying the optimal implant position, the resultant nine maps show that the highest improvement region is frequently in the posterior subthalamic area. The results demonstrate the utility of the stimulation maps in identifying the optimal implant position.

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“…The sensor was always attached at the same position on the wrist of the patient, and at each position a baseline recording was acquired before initiation of each stimulation sequence. In order to quantify the clinical improvement for each stimulation amplitude, a previously developed analysis method in Matlab (R2014b) was used (Shah et al, 2016b). As a first step, movements other than tremor were removed offline by using the smoothness priors method (Tarvainen et al, 2002) and thereafter a second order Butterworth low pass-filter was applied at 10 Hz in order to suppress noise.…”

Section: Acceleration Measurementsmentioning

confidence: 99%

Models and Simulations of the Electric Field in Deep Brain Stimulation: Comparison of Lead Designs, Operating Modes and Tissue Conductivity

Alonso¹

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Deep brain stimulation (DBS) is an established surgical therapy for movement disorders such as Parkinson's disease (PD) and essential tremor (ET). A thin electrode is implanted in a predefined area of the brain with the use of stereotactic neurosurgery. In the last few years new DBS electrodes and systems have been developed with possibilities for using more parameters for control of the stimulation volume. In this thesis, simulations using the finite element method (FEM) have been developed and used for investigation of the electric field (EF) extension around different types of DBS lead designs (symmetric, steering) and stimulation modes (voltage, current). The electrode surrounding was represented either with a homogeneous model or a patient-specific model based on individual preoperative magnetic resonance imaging (MRI). The EF was visualized and compared for different lead designs and operating modes. In Paper I, the EF was quantitatively investigated around two lead designs (3389 and 6148) simulated to operate in voltage and current mode under acute and chronic time points following implantation.Simulations showed a major impact on the EF extension between postoperative time points which may explain the clinical decisions to change the stimulation amplitude weeks after implantation. In Paper II, the simulations were expanded to include two leads having steering function (6180, Surestim1) and patient-specific FEM simulations in the zona incerta. It was found that both the heterogeneity of the tissue and the operating mode, influence the EF distribution and that equivalent contact configurations of the leads result in similar EF. The steering mode presented larger volumes in current mode when using equivalent amplitudes. Simulations comparing DBS and intraoperative stimulation test using a microelectrode recording (MER) system (Paper III), showed that several parallel MER leads and the presence of the non-active DBS contacts influence the EF distribution and that the DBS EF volume can cover, but also extend to, other anatomical areas. Paper IV introduces a method for an objective exploitation of intraoperative stimulation test data in order to identify the optimal implant position in the thalamus of the chronic DBS lead. Patient-specific EF simulations were related to the anatomy with the help of brain atlases and the clinical effects which were quantified by accelerometers. The first results indicate that the good clinical effect in ET is due to several structures around the ventral intermediate nucleus of the thalamus.

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

Cited by 16 publications

References 54 publications

Patient-Specific Electric Field Simulations and Acceleration Measurements for Objective Analysis of Intraoperative Stimulation Tests in the Thalamus

Patient-Specific Electric Field Simulations and Acceleration Measurements for Objective Analysis of Intraoperative Stimulation Tests in the Thalamus

Stimulation maps: visualization of results of quantitative intraoperative testing for deep brain stimulation surgery

Models and Simulations of the Electric Field in Deep Brain Stimulation: Comparison of Lead Designs, Operating Modes and Tissue Conductivity

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