Analysis of adverse effects of stimulation during DBS surgery by patient-specific FEM simulations

Area of Science:

• Neurosurgery
• Computational Neuroscience
• Medical Imaging

Background:

• Deep brain stimulation (DBS) is a standard treatment for movement disorders, but its precise mechanism remains unclear.
• Intraoperative stimulation during DBS surgery helps evaluate therapeutic and adverse effects, guiding lead placement.
• Previous identification of anatomical structures linked to adverse effects relied solely on implanted lead data.

Purpose of the Study:

• To develop and validate a methodology for identifying anatomical structures responsible for adverse effects during intraoperative DBS testing.
• To utilize patient-specific electric field simulations and visualization on individual anatomy for this identification process.

Main Methods:

• Developed a novel methodology integrating patient-specific electric field simulations with intraoperative stimulation data.
• Visualized simulated electric fields directly onto patient-specific anatomical models.
• Applied the methodology to four patients experiencing adverse effects like dysarthria, paresthesia, or pyramidal symptoms during DBS surgery.

Main Results:

• Successfully identified potential anatomical structures correlated with induced adverse effects in the studied patients.
• Several identified structures align with those previously reported in existing literature.
• Demonstrated the feasibility of the simulation-based approach for mapping adverse effect generators.

Conclusions:

• The proposed methodology offers a novel way to map adverse effects to specific anatomical targets during DBS surgery.
• This approach, combined with visualization of therapeutic effects, could enhance neurosurgeon decision-making for optimal lead placement.
• Further application in a larger patient cohort is necessary to establish statistical significance and clinical utility.