Most effective stimulation site in subthalamic deep brain stimulation for Parkinson's disease

Herzog, Jan; Fietzek, Urban M.; Hamel, Wolfgang; Morsnowski, A.; Steigerwald, Frank; Schrader, B.; Weinert, D.; Pfister, G.; Müller, Dieter; Mehdorn, H. M.; Deuschl, Günther; Volkmann, Jens

doi:10.1002/mds.20056

Cited by 229 publications

(166 citation statements)

References 21 publications

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“…While our patient-specific model system suffers from a number of limitations, the comparisons with our clinical measurements are consistent with previous studies on location of therapeutically effective electrode contacts (Saint-Cyr et al, 2002;Voges and J, 2002;Herzog et al, 2004;Zonenshayn et al, 2004;Kitagawa et al, 2005;Nowinski et al, 2005;Plaha et al, 2006). The results of this study, though limited to a single patient, suggest that the therapeutic volume of tissue to activate is centered on ZI/H2 (Fig.…”

Section: Discussionsupporting

confidence: 89%

“…These studies have resulted in general guidelines on the selection of stimulation parameters, as well as clinical algorithms for programming the devices. Imaging studies have developed correlations between stimulation parameters and markers of brain activity (Hershey et al, 2003;Haslinger et al, 2005;Phillips et al, 2006;Trost et al, 2006), and identified the location of therapeutic DBS electrode contacts (Saint-Cyr et al, 2002;Voges and J, 2002;Herzog et al, 2004;Zonenshayn et al, 2004;Kitagawa et al, 2005;Nowinski et al, 2005;Plaha et al, 2006). Modeling studies have characterized the theoretical effects of DBS electric fields on the underlying neural tissue (McIntyre et al, 2004b;Miocinovic et al, 2006b).…”

Section: Discussionmentioning

confidence: 99%

“…However, there is substantial debate regarding the optimal anatomical location for the DBS electrodes in the STN region (Saint-Cyr et al, 2002;Voges and J, 2002;Herzog et al, 2004;Zonenshayn et al, 2004;Kitagawa et al, 2005;Nowinski et al, 2005;Plaha et al, 2006). And, while guidelines exist on stimulation parameter settings that are typically effective (Volkmann et al, 2006), it is infeasible to clinically evaluate each of the thousands of stimulation parameter combinations that are possible.…”

Section: Deep Brain Stimulation (Dbs) Is An Established Therapy For Tmentioning

confidence: 99%

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Patient-specific analysis of the volume of tissue activated during deep brain stimulation

et al. 2007

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Despite the clinical success of deep brain stimulation (DBS) for the treatment of movement disorders, many questions remain about its effects on the nervous system. We have developed a methodology to predict the volume of tissue activated (VTA) by DBS on a patient-specific basis. Our goals are to identify the intersection between the VTA and surrounding anatomical structures and to compare activation of these structures with clinical outcomes. The model system consists of three fundamental components: 1) a 3D anatomical model of the subcortical nuclei and DBS electrode position in the brain, each derived from magnetic resonance imaging (MRI); 2) a finite element model of the DBS electrode and electric field transmitted to the brain, with tissue conductivity properties derived from diffusion tensor MRI; 3) VTA prediction derived from the response of myelinated axons to the applied electric field, which is a function of the stimulation parameters (contact, impedance, voltage, pulse width, frequency). We used this model system to analyze the effects of subthalamic nucleus (STN) DBS in a patient with Parkinson's disease. Quantitative measurements of bradykinesia, rigidity, and corticospinal tract (CST) motor thresholds were evaluated over a range of stimulation parameter settings. Our model predictions showed good agreement with CST thresholds. Additionally, stimulation through electrode contacts that improved bradykinesia and rigidity generated VTAs that overlapped the zona incerta / fields of Forel (ZI/H2). Application of DBS technology to various neurological disorders has preceded scientific characterization of the volume of tissue directly affected by the stimulation. Synergistic integration of clinical analysis, neuroimaging, neuroanatomy, and neurostimulation modeling provides the opportunity to address wide ranging questions on the factors linked with the therapeutic benefits and side effects of DBS.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Deep Brain Stimulation (Dbs) Is An Established Therapy For Tmentioning

confidence: 99%

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Patient-specific analysis of the volume of tissue activated during deep brain stimulation

et al. 2007

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“…Despite the improvements in motor function, several clinical trails have yielded information about negative limbic effects of STN DBS, including depression, apathy, and decreased cognitive function [7,8] . Recent studies, however, have reported that the most effective contact of a quadripolar DBS lead (contact 3 in DBS of the STN) lies dorsal/dorsomedial to the STN, in the region of the zona incerta (ZI) [9][10][11] . The ZI, an embryological derivate of the ventral thalamus, is a small horizontally elongated area of grey matter cells in the subthalamic region of the mesencephalon.…”

Section: Deep Brain Stimulation (Dbs)mentioning

confidence: 99%

Imaging for deep brain stimulation: The zona incerta at 7 Tesla

Kerl

Gerigk²,

Brockmann³

et al. 2013

WJR

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AIM:To evaluate different promising magnetic resonance imaging (MRI) methods at 7.0 Tesla (T) for the pre-stereotactic visualization of the zona incerta (ZI). METHODS:Two neuroradiologists qualitatively and quantitatively examined T2-turbo spin-echo (T2-TSE), T1-weighted gradient-echo, as well as FLASH2D-T2Star and susceptibility-weighted imaging (SWI) for the visualization of the ZI at 7.0 T MRI. Delineation and image quality for the ZI were independently examined using a 6-scale grading system. Inter-rater reliability using Cohen's kappa coefficient (κ ) were assessed. Contrast-tonoise ratios (CNR), and signal-to-noise ratios (SNR) for the ZI were calculated for all sequences. Differences in delineation, SNR, and CNR between the sequences were statistically assessed using a paired t -test. For the anatomic validation the coronal FLASH2D-T2Star images were co-registered with a stereotactic atlas (Schaltenbrand-Wahren). RESULTS:The rostral part of the ZI (rZI) could easily be identified and was best and reliably visualized in the coronal FLASH2D-T2Star images. The caudal part was not definable in any of the sequences. No major artifacts in the rZI were observed in any of the scans. FLASH2D-T2Star and SWI imaging offered significant higher CNR values for the rZI compared to T2-TSE images (P > 0.05). The co-registration of the coronal FLASH2D-T2Star images with the stereotactic atlas schema (Schaltenbrand-Wahren) confirmed the correct localization of the ZI in all cases.CONCLUSION: FLASH2D-T2Star imaging (particularly coronal view) provides the reliable and currently optimal visualization of the rZI at 7.0 T. These results can facilitate a better and more precise targeting of the caudal part of the ZI than ever before.

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“…Herzog et al [30] demonstrated that the effective DBS contacts located in the dorsolateral STN border produced the best clinical results. Neurosurgeons at our institution also regard the dorsolateral portion of the STN as the most favorable stimulation site in STN DBS.…”

Section: Targeting Techniquesmentioning

confidence: 99%

Surgical targeting accuracy analysis of six methods for subthalamic nucleus deep brain stimulation

Guo¹,

Parrent²,

Peters³

2007

Computer Aided Surgery

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A commonly adopted surgical target in deep brain stimulation (DBS) procedures, the subthalamic nucleus (STN) is located deep within the brain and is surrounded by delicate deep-brain structures. Symptoms of Parkinson's disease can be reduced by precisely implanting a multi-electrode stimulator at a specific location within the STN and delivering the appropriate signal to the target. A number of techniques have recently been proposed to facilitate STN DBS surgical targeting and thereby improve the surgical outcome. This paper presents a retrospective study evaluating the target localization accuracy and precision of six approaches in 55 STN DBS procedures. The targeting procedures were performed using a neurosurgical visualization and navigation system, which integrates normalized and standardized anatomical and functional information into the planning environment. In this study, we employed as the ''gold standard'' the actual surgical target locations determined by an experienced neurosurgeon using both pre-operative image-guided surgical target/trajectory planning and intra-operative electrophysiological exploration and confirmation. The surgical target locations determined using each of the six targeting methods were compared with the ''gold standards''. The average displacement between the actual surgical targets and those planned with targeting approaches was 3.0 AE 1.3 mm, 3.0 AE 1.3 mm, 3.0 AE 1.0 mm, 2.6 AE 1.1 mm, 2.5 AE 0.9 mm, and 1.7 AE 0.7 mm for approaches based on T 2 -weighted MRI, a brain atlas, T 1 and T 2 maps, an electrophysiological database, a collection of final surgical targets from previous patients, and the combination of these functional and anatomical data, respectively. The technique incorporating both anatomical and functional data provides the most reliable and accurate target position for STN DBS.

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Most effective stimulation site in subthalamic deep brain stimulation for Parkinson's disease

Cited by 229 publications

References 21 publications

Patient-specific analysis of the volume of tissue activated during deep brain stimulation

Patient-specific analysis of the volume of tissue activated during deep brain stimulation

Imaging for deep brain stimulation: The zona incerta at 7 Tesla

Surgical targeting accuracy analysis of six methods for subthalamic nucleus deep brain stimulation

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