Directional stimulation of subthalamic nucleus sweet spot predicts clinical efficacy: Proof of concept
Directional deep brain stimulation (dDBS) of the subthalamic nucleus for Parkinson's disease (PD) increases the therapeutic window. However, empirical programming of the neurostimulator becomes more complex given the increasing number of stimulation parameters. A better understanding of dDBS is...
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| Veröffentlicht in: | Brain stimulation 2019-09, Vol.12 (5), p.1127-1134 |
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| creator | Nguyen, T.A. Khoa Nowacki, Andreas Debove, Ines Petermann, Katrin Tinkhauser, Gerd Wiest, Roland Schüpbach, Michael Krack, Paul Pollo, Claudio |
| description | Directional deep brain stimulation (dDBS) of the subthalamic nucleus for Parkinson's disease (PD) increases the therapeutic window. However, empirical programming of the neurostimulator becomes more complex given the increasing number of stimulation parameters. A better understanding of dDBS is needed to improve therapy and help guide postoperative programming.
To determine whether clinical effects of dDBS can be predicted in individual patients based on lead location and volume of tissue activated (VTA) modelling.
We analysed a prospective series of 28 PD patients. Imaging analysis and systematic clinical testing performed 4–6 months postoperatively yielded location, clinical efficacy and corresponding therapeutic windows for 272 directional contacts. We calculated the corresponding VTAs to build a probabilistic stimulation map using voxel-wise statistical analysis.
We found a positive and statistically significant correlation between the overlap ratio of a patient's individual stimulation volume and the probabilistic map's sweet spot –defined as the 10% voxels with the highest clinical efficacy values (average Spearman's rho = 0.43, average p ≤ 0.036). Patients who had a larger therapeutic window with directional compared to omnidirectional stimulation had a larger distance between the electrode and the sweet spot centroid (average distances 2.3 vs. 1.5 mm, p = 0.0019).
Our analysis provides new insights into how the definition of a probabilistic sweet spot based on directional stimulation data and individual VTA modelling can be applied to predict clinically effective directional stimulation and help guide clinicians with the intricate postoperative DBS programming.
•The probabilistic sweet spot for directional stimulation projected onto the dorsolateral STN.•Overlap ratio of individual stimulation volume and sweet spot correlated with clinical efficacy.•Overlap ratio and distance to the sweet spot were indicators of efficient directional stimulation. |
| doi_str_mv | 10.1016/j.brs.2019.05.001 |
| format | Article |
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To determine whether clinical effects of dDBS can be predicted in individual patients based on lead location and volume of tissue activated (VTA) modelling.
We analysed a prospective series of 28 PD patients. Imaging analysis and systematic clinical testing performed 4–6 months postoperatively yielded location, clinical efficacy and corresponding therapeutic windows for 272 directional contacts. We calculated the corresponding VTAs to build a probabilistic stimulation map using voxel-wise statistical analysis.
We found a positive and statistically significant correlation between the overlap ratio of a patient's individual stimulation volume and the probabilistic map's sweet spot –defined as the 10% voxels with the highest clinical efficacy values (average Spearman's rho = 0.43, average p ≤ 0.036). Patients who had a larger therapeutic window with directional compared to omnidirectional stimulation had a larger distance between the electrode and the sweet spot centroid (average distances 2.3 vs. 1.5 mm, p = 0.0019).
Our analysis provides new insights into how the definition of a probabilistic sweet spot based on directional stimulation data and individual VTA modelling can be applied to predict clinically effective directional stimulation and help guide clinicians with the intricate postoperative DBS programming.
•The probabilistic sweet spot for directional stimulation projected onto the dorsolateral STN.•Overlap ratio of individual stimulation volume and sweet spot correlated with clinical efficacy.•Overlap ratio and distance to the sweet spot were indicators of efficient directional stimulation.</description><identifier>ISSN: 1935-861X</identifier><identifier>EISSN: 1876-4754</identifier><identifier>DOI: 10.1016/j.brs.2019.05.001</identifier><identifier>PMID: 31130498</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Aged ; Algorithms ; Brain Mapping - methods ; Deep brain stimulation ; Deep Brain Stimulation - methods ; Directional electrode ; Female ; Humans ; Male ; Middle Aged ; Parkinson Disease - therapy ; Parkinson's disease ; Predictive Value of Tests ; Probabilistic stimulation map ; Proof of Concept Study ; Prospective Studies ; Subthalamic Nucleus - physiology ; Treatment Outcome ; Volume of tissue activated</subject><ispartof>Brain stimulation, 2019-09, Vol.12 (5), p.1127-1134</ispartof><rights>2019 Elsevier Inc.</rights><rights>Copyright © 2019 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c419t-30f1b4a07e0548fb4752789795aedbab28a9fd9b1ce76697cf52afc303a15b9d3</citedby><cites>FETCH-LOGICAL-c419t-30f1b4a07e0548fb4752789795aedbab28a9fd9b1ce76697cf52afc303a15b9d3</cites><orcidid>0000-0001-7876-3225 ; 0000-0003-0577-5035</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.brs.2019.05.001$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3548,27923,27924,45994</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31130498$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Nguyen, T.A. Khoa</creatorcontrib><creatorcontrib>Nowacki, Andreas</creatorcontrib><creatorcontrib>Debove, Ines</creatorcontrib><creatorcontrib>Petermann, Katrin</creatorcontrib><creatorcontrib>Tinkhauser, Gerd</creatorcontrib><creatorcontrib>Wiest, Roland</creatorcontrib><creatorcontrib>Schüpbach, Michael</creatorcontrib><creatorcontrib>Krack, Paul</creatorcontrib><creatorcontrib>Pollo, Claudio</creatorcontrib><title>Directional stimulation of subthalamic nucleus sweet spot predicts clinical efficacy: Proof of concept</title><title>Brain stimulation</title><addtitle>Brain Stimul</addtitle><description>Directional deep brain stimulation (dDBS) of the subthalamic nucleus for Parkinson's disease (PD) increases the therapeutic window. However, empirical programming of the neurostimulator becomes more complex given the increasing number of stimulation parameters. A better understanding of dDBS is needed to improve therapy and help guide postoperative programming.
To determine whether clinical effects of dDBS can be predicted in individual patients based on lead location and volume of tissue activated (VTA) modelling.
We analysed a prospective series of 28 PD patients. Imaging analysis and systematic clinical testing performed 4–6 months postoperatively yielded location, clinical efficacy and corresponding therapeutic windows for 272 directional contacts. We calculated the corresponding VTAs to build a probabilistic stimulation map using voxel-wise statistical analysis.
We found a positive and statistically significant correlation between the overlap ratio of a patient's individual stimulation volume and the probabilistic map's sweet spot –defined as the 10% voxels with the highest clinical efficacy values (average Spearman's rho = 0.43, average p ≤ 0.036). Patients who had a larger therapeutic window with directional compared to omnidirectional stimulation had a larger distance between the electrode and the sweet spot centroid (average distances 2.3 vs. 1.5 mm, p = 0.0019).
Our analysis provides new insights into how the definition of a probabilistic sweet spot based on directional stimulation data and individual VTA modelling can be applied to predict clinically effective directional stimulation and help guide clinicians with the intricate postoperative DBS programming.
•The probabilistic sweet spot for directional stimulation projected onto the dorsolateral STN.•Overlap ratio of individual stimulation volume and sweet spot correlated with clinical efficacy.•Overlap ratio and distance to the sweet spot were indicators of efficient directional stimulation.</description><subject>Aged</subject><subject>Algorithms</subject><subject>Brain Mapping - methods</subject><subject>Deep brain stimulation</subject><subject>Deep Brain Stimulation - methods</subject><subject>Directional electrode</subject><subject>Female</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Parkinson Disease - therapy</subject><subject>Parkinson's disease</subject><subject>Predictive Value of Tests</subject><subject>Probabilistic stimulation map</subject><subject>Proof of Concept Study</subject><subject>Prospective Studies</subject><subject>Subthalamic Nucleus - physiology</subject><subject>Treatment Outcome</subject><subject>Volume of tissue activated</subject><issn>1935-861X</issn><issn>1876-4754</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kM1q3TAQhUVoaNK0D5BN0bIbOxrbsqx0VdKfBALJIoXuhCSPqC625UhyS96-ur1pl4GBmYFzDpyPkHNgNTDoL3a1ialuGMia8ZoxOCKnMIi-6gTvXpVbtrwaevhxQt6ktGOMSzmI1-SkBWhZJ4dT4j77iDb7sOiJpuznbdL7jwZH02byTz3p2Vu6bHbCLdH0GzHTtIZM14ijtzlRO_nF2-JH58q2T5f0PoYSUMaGxeKa35Jjp6eE7573Gfn-9cvD1XV1e_ft5urTbWU7kLlqmQPTaSaQ8W5wpvRoxCCF5BpHo00zaOlGacCi6HsprOONdrZlrQZu5NiekQ-H3DWGxw1TVrNPFqdJLxi2pJqmbaDpOgFFCgepjSGliE6t0c86Pilgao9X7VTBq_Z4FeOq4C2e98_xm5lx_O_4x7MIPh4EWEr-8hhVsh4LgvEvZjUG_0L8HyMdjQI</recordid><startdate>201909</startdate><enddate>201909</enddate><creator>Nguyen, T.A. Khoa</creator><creator>Nowacki, Andreas</creator><creator>Debove, Ines</creator><creator>Petermann, Katrin</creator><creator>Tinkhauser, Gerd</creator><creator>Wiest, Roland</creator><creator>Schüpbach, Michael</creator><creator>Krack, Paul</creator><creator>Pollo, Claudio</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-7876-3225</orcidid><orcidid>https://orcid.org/0000-0003-0577-5035</orcidid></search><sort><creationdate>201909</creationdate><title>Directional stimulation of subthalamic nucleus sweet spot predicts clinical efficacy: Proof of concept</title><author>Nguyen, T.A. Khoa ; Nowacki, Andreas ; Debove, Ines ; Petermann, Katrin ; Tinkhauser, Gerd ; Wiest, Roland ; Schüpbach, Michael ; Krack, Paul ; Pollo, Claudio</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c419t-30f1b4a07e0548fb4752789795aedbab28a9fd9b1ce76697cf52afc303a15b9d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Aged</topic><topic>Algorithms</topic><topic>Brain Mapping - methods</topic><topic>Deep brain stimulation</topic><topic>Deep Brain Stimulation - methods</topic><topic>Directional electrode</topic><topic>Female</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Parkinson Disease - therapy</topic><topic>Parkinson's disease</topic><topic>Predictive Value of Tests</topic><topic>Probabilistic stimulation map</topic><topic>Proof of Concept Study</topic><topic>Prospective Studies</topic><topic>Subthalamic Nucleus - physiology</topic><topic>Treatment Outcome</topic><topic>Volume of tissue activated</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Nguyen, T.A. Khoa</creatorcontrib><creatorcontrib>Nowacki, Andreas</creatorcontrib><creatorcontrib>Debove, Ines</creatorcontrib><creatorcontrib>Petermann, Katrin</creatorcontrib><creatorcontrib>Tinkhauser, Gerd</creatorcontrib><creatorcontrib>Wiest, Roland</creatorcontrib><creatorcontrib>Schüpbach, Michael</creatorcontrib><creatorcontrib>Krack, Paul</creatorcontrib><creatorcontrib>Pollo, Claudio</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Brain stimulation</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Nguyen, T.A. Khoa</au><au>Nowacki, Andreas</au><au>Debove, Ines</au><au>Petermann, Katrin</au><au>Tinkhauser, Gerd</au><au>Wiest, Roland</au><au>Schüpbach, Michael</au><au>Krack, Paul</au><au>Pollo, Claudio</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Directional stimulation of subthalamic nucleus sweet spot predicts clinical efficacy: Proof of concept</atitle><jtitle>Brain stimulation</jtitle><addtitle>Brain Stimul</addtitle><date>2019-09</date><risdate>2019</risdate><volume>12</volume><issue>5</issue><spage>1127</spage><epage>1134</epage><pages>1127-1134</pages><issn>1935-861X</issn><eissn>1876-4754</eissn><abstract>Directional deep brain stimulation (dDBS) of the subthalamic nucleus for Parkinson's disease (PD) increases the therapeutic window. However, empirical programming of the neurostimulator becomes more complex given the increasing number of stimulation parameters. A better understanding of dDBS is needed to improve therapy and help guide postoperative programming.
To determine whether clinical effects of dDBS can be predicted in individual patients based on lead location and volume of tissue activated (VTA) modelling.
We analysed a prospective series of 28 PD patients. Imaging analysis and systematic clinical testing performed 4–6 months postoperatively yielded location, clinical efficacy and corresponding therapeutic windows for 272 directional contacts. We calculated the corresponding VTAs to build a probabilistic stimulation map using voxel-wise statistical analysis.
We found a positive and statistically significant correlation between the overlap ratio of a patient's individual stimulation volume and the probabilistic map's sweet spot –defined as the 10% voxels with the highest clinical efficacy values (average Spearman's rho = 0.43, average p ≤ 0.036). Patients who had a larger therapeutic window with directional compared to omnidirectional stimulation had a larger distance between the electrode and the sweet spot centroid (average distances 2.3 vs. 1.5 mm, p = 0.0019).
Our analysis provides new insights into how the definition of a probabilistic sweet spot based on directional stimulation data and individual VTA modelling can be applied to predict clinically effective directional stimulation and help guide clinicians with the intricate postoperative DBS programming.
•The probabilistic sweet spot for directional stimulation projected onto the dorsolateral STN.•Overlap ratio of individual stimulation volume and sweet spot correlated with clinical efficacy.•Overlap ratio and distance to the sweet spot were indicators of efficient directional stimulation.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>31130498</pmid><doi>10.1016/j.brs.2019.05.001</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0001-7876-3225</orcidid><orcidid>https://orcid.org/0000-0003-0577-5035</orcidid></addata></record> |
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| source | MEDLINE; ScienceDirect Journals (5 years ago - present) |
| subjects | Aged Algorithms Brain Mapping - methods Deep brain stimulation Deep Brain Stimulation - methods Directional electrode Female Humans Male Middle Aged Parkinson Disease - therapy Parkinson's disease Predictive Value of Tests Probabilistic stimulation map Proof of Concept Study Prospective Studies Subthalamic Nucleus - physiology Treatment Outcome Volume of tissue activated |
| title | Directional stimulation of subthalamic nucleus sweet spot predicts clinical efficacy: Proof of concept |
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