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How Sample Size Impacts Probabilistic Stimulation Maps in Deep Brain Stimulation.

Teresa Nordin1, Patric Blomstedt2, Simone Hemm1,3

  • 1Department of Biomedical Engineering, Linköping University, 58185 Linköping, Sweden.

Brain Sciences
|May 27, 2023
PubMed
Summary
This summary is machine-generated.

Small sample sizes in deep brain stimulation (DBS) p-map analysis lead to unstable results. Researchers need over 120 simulations for reliable probabilistic stimulation maps in essential tremor studies.

Keywords:
deep brain stimulation (DBS)electric field simulationfinite element method (FEM)probabilistic stimulation maps (PSM)

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Area of Science:

  • Neurosurgery
  • Neurology
  • Medical Imaging

Background:

  • Probabilistic stimulation maps (p-maps) using voxel-wise statistics are increasingly used to visualize deep brain stimulation (DBS) effects.
  • These p-maps require correction for Type-1 errors due to multiple testing, and their reliability can be affected by sample size.

Purpose of the Study:

  • To evaluate the impact of sample size on the computation and stability of probabilistic stimulation maps (p-maps) for DBS effects.
  • To determine the minimum number of simulations required for reliable p-map generation in essential tremor patients.

Main Methods:

  • A dataset of 61 essential tremor patients treated with DBS was utilized.
  • Random sampling with replacement (5 to 61 patients) was performed, with each sample size iterated 20 times (total 1140 maps).
  • Overall p-values, significance volumes, and Dice coefficients (DC) were evaluated for each sample size.

Main Results:

  • Sample sizes below 30 patients (120 simulations) showed increased variation in overall significance and median significance volumes.
  • Trends stabilized above 120 simulations, though some cluster location variations persisted.
  • A highest median Dice Coefficient of 0.73 was observed for n=57, indicating good overlap in estimated effect volumes.

Conclusions:

  • Probabilistic stimulation maps (p-maps) generated with small sample sizes should be interpreted with caution.
  • Single-center studies likely require over 120 simulations for stable and reliable deep brain stimulation (DBS) p-map results.
  • Variations in cluster location, particularly between high- and low-improvement regions, are noted with smaller sample sizes.