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Localization of Deep Brain Stimulation Contacts Using Corticospinal/Corticobulbar Tracts Stimulation.

Julien F Bally1,2, Maria-Isabel Vargas3, Judit Horvath1

  • 1Department of Neurology, University Hospitals of Geneva (HUG), Geneva, Switzerland.

Frontiers in Neurology
|June 17, 2017
PubMed
Summary

Optimizing deep brain stimulation (DBS) for Parkinson's disease involves electrode placement. This study found that using current, not voltage, and electromyography (EMG) improved predicting safe electrode distance to motor pathways.

Keywords:
DBSMRIPDcorticospinal/corticobulbar tractcurrent spreadelectromyography

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Area of Science:

  • Neurosurgery
  • Neurology
  • Biomedical Engineering

Background:

  • Accurate electrode placement is crucial for effective deep brain stimulation (DBS) in Parkinson's disease (PD).
  • Intraoperative testing involves assessing stimulation thresholds to identify motor responses from corticospinal/corticobulbar tracts (CSBT).

Purpose of the Study:

  • To analyze correlations between DBS electrode distance to CSBT and contraction thresholds.
  • To develop an intraoperative tool for ensuring safe electrode placement relative to CSBT.

Main Methods:

  • Assessed contraction thresholds using clinical and electromyography (EMG) methods in 12 PD patients undergoing subthalamic nucleus DBS.
  • Evaluated three stimulation parameter sets: 130 Hz high-frequency stimulation (HFS) and 2 Hz low-frequency stimulation (LFS) with 60 or 210 µs pulse widths.
  • Measured anatomical electrode-CSBT distance using fused CT-MRI.

Main Results:

  • The strongest correlation between electrode distance and visually detected contraction thresholds was with HFS using estimated currents (r²=0.63).
  • Electromyography (EMG) detection improved correlation, especially for LFS, by enabling more frequent identification of facial muscle contractions.
  • Correlation using currents, rather than voltages, reduced variance caused by electrode impedance.

Conclusions:

  • Estimating stimulation current, not voltage, enhances the correlation between electrode distance and contraction thresholds, mitigating electrode impedance variability.
  • Low-frequency stimulation (LFS) did not improve precision, but electromyography (EMG) did enhance the evaluation.
  • This method offers a predictive tool to ensure minimum safe distances between electrode contacts and CSBT during DBS surgery.