Lead-OR: A multimodal platform for deep brain stimulation surgery

Abstract

Background: Deep Brain Stimulation (DBS) electrode implant trajectories are stereotactically defined using preoperative neuroimaging. To validate the correct trajectory, microelectrode recordings (MER) or local field potential recordings (LFP) can be used to extend neuroanatomical information (defined by magnetic resonance imaging) with neurophysiological activity patterns recorded from micro- and macroelectrodes probing the surgical target site. Currently, these two sources of information (imaging vs. electrophysiology) are analyzed separately, while means to fuse both data streams have not been introduced.Methods: Here we present a tool that integrates resources from stereotactic planning, neuroimaging, MER and high-resolution atlas data to create a real-time visualization of the implant trajectory. We validate the tool based on a retrospective cohort of DBS patients (𝑁 = 52) offline and present single use cases of the real-time platform. Results: We establish an open-source software tool for multimodal data visualization and analysis during DBS surgery. We show a general correspondence between features derived from neuroimaging and electrophysiological recordings and present examples that demonstrate the functionality of the tool.Conclusions: This novel software platform for multimodal data visualization and analysis bears translational potential to improve accuracy of DBS surgery. The toolbox is made openly available and is extendable to integrate with additional software packages.Funding: Deutsche Forschungsgesellschaft (410169619, 424778381), Deutsches Zentrum für Luftund Raumfahrt (DynaSti), National Institutes of Health (2R01 MH113929), Foundation for OCD Research (FFOR).

Optimal Stimulation Sites and Networks for Deep Brain Stimulation of the Fornix in Alzheimer’s Disease

“…In this regard, we were not able to find apparent differences in i) electrode placement or ii) fiber-score activations between patients younger than versus older than 65, which suggests other factors might have influenced the clinical outcome in the younger group (Figure S10). As previously reported, possible explanations for the decline in early onset subjects include a more aggressive presentation of the condition, greater brain atrophy and comparably more reduced glucose metabolism in this subgroup of patients 29,60,66,67 .…”

“…Each processing step was meticulously monitored and corrected, if necessary. In addition, we applied a first-of-its kind manual refinement of normalization warp fields 67 , which was crucial to yield accurate registrations due to large variabilities in patient anatomy. A demonstration of this laborintensive manual refinement process is visualized in video S1, which shows that upon manual refinements, a good registration accuracy between patient and template fornices was achieved.…”

A ubiquitous spectrolaminar motif of local field potential power across the primate cortex

“…Moreover, probe placement could become fully-automated and unsupervised by allowing the output of FLIP to perform closed-loop control of a standard computerized microdrive with the help of structural MRI data. In medicine, these methods may improve surgical implantation of probes in patients with epilepsy (for pre-surgical screening 56 ), Parkinson’s (for deep brain stimulation 57 ), and paralysis (for brain-machine interface systems 58 ), among others. Lastly, some neurological and psychiatric disorders are associated with abnormal beta oscillatory patterns in Parkinson’s 59 and abnormal gamma oscillatory activity schizophrenia 60,61 and Alzheimer’s disease 62 .…”

Multifunctional fibers enable modulation of cortical and deep brain activity during cognitive behavior in macaques

“…The current gold-standard probe implantation procedure relies on acquisition of magnetic resonance imaging (MRI) images throughout the surgery, which only provide coarse snapshots of the implantation process (67). Many microscale subcortical structures have characteristic electrophysiological signatures that can act as biomarkers for implantation trajectories (69)(70)(71)(72). MRI-compatible multifunctional fibers with embedded electrodes (36) would improve MRI-guided neurosurgical procedures by offering real-time readout of probe location.…”